Connecting medical professionalism and large bureaucracies in the changing hospital governance

Abstract

Background It is commonly agreed that organizations are changing due to reinforced managerial structures, increasingly demanding clients, and governments’ attempts to better regulate professional services and Erms. However, according to recent evidence the paths of change result from complex interconnections between organizational and professional spheres at the workplace level. Nonetheless, there is still not much evidence about the extent to which professionals’ projects actually impact on the structural configuration of organizations, particularly in terms of the design and functioning of the bureaucratic model. Methods The presentation reports to a qualitative research conducted in a general public hospital during the process it adopted a corporatized model. Direct observations were systematically made over a year and half, followed by in-depth, semistructured interviews with all managers on the hospital’s board of directors and doctors from a pre-selected ward. Results We found a kind of hybridization, not yet found in the debate, between the divisionalised form and professional bureaucracy named here as the divisionalised professional bureaucracy. These structures created at the ward level are fully controlled by doctors in close connection with managers. Implications are found in health professions-related fields: on the one hand, professionalism seems to be reinforced through the control of both managerial and self-regulated clinical tools; on the other, these structures provide evidence of organizations’ adaptation to professionals’ projects and interests even under managerial interference. Conclusion This paper is included in the Workshop because it brings new emergent connections between large bureaucracies and professionalism into view.