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Lecture 1- Complex relationship between managers and professionals
Management
creating balance
Netherlands → Rise of health insurances needs to be managed
clip bbc documentary
Who run the hospital question→ consultants
What does this tell us → That there are different views on who had the lead, but most of
them say that the consultants have the lead.
The clip is pro management.
organizational change designed by top managers often fails to reach the level of everyday
work
highly institutional field, with professional control over…
- Professional knowledge, education, membership
- work itself (powerful claims for professional autonomy)
So why do some change initiative seem impossible, while others ‘work’ easily
key: understanding the social behavior of actors within organizations
Why do some actors have more power than others?
in this course
article hybrid professional-managers Mc Givern
Blending together ideas of management and professionalism within a single person
- hybrid roles
professionals move into a management position a lot of physicians are in the management
of the organization (example Aumc ⅘ of the board are physicians)
Not just a matter of taking on an extra role
challenges to identity as professional
Autonomy vs control competing internalized rules
incidental hybrid → (have to) temporary role; protecting professionalism, somebody has to
do the dishes, take up the role but do it reluctantly.
Willing hybrid (want to) Reconciling management/professionalism also challenging
professionalism
,Diversity of actors, perspectives, interests
Vast diversity within the care sector
Diversity as strength & accomplishment
actors base behavior on different ‘internalized rules’ that ‘need not be shared, explicit, or
even logical when viewed by another agent.’ (pisek & greenhalgh)
Internalized rules are often taken for granted and show
Instigation of multidisciplinary teams (Liberati)
- organizational innovation to better deal with complexity
Functional organization → multidisciplinary teams
- functional restructuring didn't always turned out as they hoped it would be, the
perspectives didn't always go smooth together with the professionals who were
involved → unintended consequences
Key takeaways
- Management always embedded in organizational context of highly institutional care
[practices
- Legitimacy and power of management/managers cannot be taken for granted
- Key when pursuing any transformations of established care practices understanding
underlying meanings & social dynamics of practices you try to influence
Seminar 1
Tentamen vragen
Hoofdlijnen artikelen
Bij tentamenvraag wel een voorbeeld vragen maar dat kunnen dan meerdere opties zijn
,Hoorcollege 2
What are organizations
Organization happens when people work together to accomplish some desired end state or
goal. It can happen through intentionally designed activity, spontaneous improvisations, or
some combination of the two, but it always depends upon coordinated action. The
coordination of human interests and activities can range from the simple to the massively
complex, and its goals from the mundane to th exotic
Different ways of structuring and organizing
Taylor’s scientific management (in short)
- standardization of work process
- Formalization in rules and procedures
- division of tasks: horizontal & vertical
- Pay for performance
Weber’s (ideal-typical) bureaucracy
- Standardization , formalization
- Division of tasks
- Pay for performance
- No nepotism
- Meroticoracy
Views on bureaucracies
- Fast, efficient
- Transparent
- Impartial
- Protective
- Dehumanizing
- inefficiënt, slow
- Inflexible
Mintzberg
Contingency theory: One size does not fill all
, Modes of coordination
Coordination: The process of organizing people or groups so that they work together
properly and well
Adhocracy
Machinal bureaucracy
Professional bureaucracy
Entrepreneurial/ simple
Divisional
Insitutional theory
- Adjustment to environment
- Rational myths
- Isomorphism
Logics and organizations in (home) health care
Institutional complexity → The coexistence of multiple (often competinging) institutional
logics
Institutional logics → Are the socially constructed, historical patterns of cultural symbols and
material practices, including assumptions, values, and beliefs, by which individuals and
organizations provide meaning to their activity and organize time and space
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