Samenvatting
Summary HPI4008 Strategic Management, leadership and organizational change in healthcare week 2
- Instelling
- Maastricht University (UM)
The lectures, tutorial groups, literature and other relevant information during week 2.
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Voorbeeld 2 van de 9 pagina's
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Voorbeeld van de inhoud
Strategic Management, Leadership and Organizational change (HPI 4008)Tutorial group 2 14-02-2020
Week 2: Professionalism and professional organizations
Professionalism
Professionalism: the occupational control of work (which is logically and empirically distinct from
consumer control and managerial control). What for a specific profession determines what should be
performed. The profession controls the work that is done, not the organization. Being part of a
profession influences your behaviour. It is about legitimacy; becoming officially recognized; it does
not have to be ‘real’ but it also about the practice, what others think.
A group is influenced by institutions (rules how people act), the professionals work in an organization
behaviour organizations/how professional acts. Type of professional organization: bureaucracy.
Institutions constants and variables influences professionals
Profession: has following four characteristics; one with 3 characteristics is a ‘stronger’ profession than
one that has 2 characteristics.
Constants: define professionalism; a process of becoming a professional.
a. An officially recognized body of knowledge and skill: they do something that requires skills.
E.g.: surgeons.
b. An occupationally division of labour (not professional schooling): strict protocols,
relationships with different divisions. Defined boundaries between themselves and other
occupations; what a professional should and should not do and you have to work together
(relations)
c. An occupationally controlled labour market based on training credentials: licenses. You
can’t hire anybody to be a doctor, you have to have a ‘labour market shelter’: requirements
of a profession to enter the labour market.
d. Professional schooling: external education, defines a profession from another job.
Variables: the interacting contingencies of the process of professionalism. Onvoorziene factoren die
invloed hebben op professionalism. The way organizations evolve.
a. State variations: the way they govern, the way they react. Someone from another country may
not be allowed to be a doctor in NL differences between states.
There are four types of state distinguished along two dimensions:
Hierarchical mode: rational-legal bureaucracy staffed by qualified career civil servants
Coordinative mode: simple, flat (i.e. non-hierarchical) structure staffed by transient
amateurs
Reactive state: allows most affairs to be organized and administered by the individuals
and organized groups of civil society, and merely facilitates their decisions. Vision of
groups.
Activist state: imposes its own vision of what is desirable on civil society, discouraging,
if not suppressing, all civil groups that cannot be trusted to subscribe to its vision.
Reactive/coordinate: self-organized professional associations.
Reactive/hierarchical: establishing and maintaining the institutions of professionalism.
Activist/hierarchical: the participating association being a creature of state policy that
can express no other position than that approved by the state.
Activist/coordinative: seeks to avoid the use of centralized planning and organized
bureaucratic administration but remains dedicated to realizing its vision by mobilizing
civil society.
b. Ideologies and values: standardization of skills, culture in an organization. Professional
boundaries and they can change over time.
c. Variation in knowledge and skills: it differs among professionals.
Professionalism create a ‘closed’ social system, self-controlling, developed based on:
- Autonomy (need for, focus on): it is needed to act as professional
- Quality (driven)
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, - Convergent thinking (stay within the box): professionals focus on staying within context of
procedures, otherwise they violate the normative pressure.
professionalism institutionalizes professionals.
Professional organizations
Non-professional organization: no education needed. E.g.: Philips, a manager
determines what should be done. Where the power is, in which level.
Managerial = non-professional.
Professional: power at professional level. E.g. hospital.
Mintzberg: 5 components of an organizations: how they interact defines the
organization. Professional bureaucracy is an example.
1. Top management/strategic apex: where decisions are made; consists of
the top general managers of the organization, and their personal staff.
2. Operation core: includes all those employees who themselves produce
the basic products and services of the organization, or directly support
their production. In professional organization: where the professionals are. The authority of
professionals is an important characteristic of a professional bureaucracy. Power is at the
operating core since the work is too complex to be supervised by managers and services of
professionals are in great demand A lot of tasks are delegated to the operating core of the
business, which works positively on the motivation of the workers..
3. Middle management: makes sure operation core works smoothly on behalf of top
management. Professional administrators: professionals within middle management (people of
the strategic apex and operating core).
4. Technical structure: logistics, HR, finance, planning-control, R&D. Consists of those analysts,
out of the formal "line" structure, who apply analytic techniques to the design and
maintenance of the structure and to the adaptation of the organization to its environment. This
part becomes more and more important, because of the growth of innovations and medical
incentives (Lega). From two-headed decentralized hospital to one-headed centralized
hospitals. They way hospitals are organized to facilitated growth of techno structure. External
pressures, they go against how professionals deal if they have all the power.
5. Support staff: secretary, support services providing indirect support to the rest of the
organization.
Due to context different institutional and legal framework, hospitals have developed differently and
can broadly be defined by two models
1. Decentralized two-headed hospital (more American and Anglo-Saxon): physicians as consultants
paid of a fee-for-services basis, management of hospital resources in the hands of nurses and
administrators, sharing of such resources among specialty units and de-centralized responsibility
departments, financially oriented culture quite spread in the organization.
a. Physician-centered
b. No optimal utilization of resources
c. Efficient allocation of resources
2. Centralized single-headed hospital (More European): salaried physicians, unified management of
all resources by the physician, centralized responsibility, resources acquiring and allocation from
the top management and the heads of the specialities.
a. Waste of resources (because heads want more than needed)
b. No efficient allocation of resources
Pigeonholing process
A professional bureaucracy; characterized by the search for standardization of procedures and
products through the so called pigeonholing process: the organization seeks to match predetermined
contingency to a standardized program, and so organize itself around the skills and knowledge of its
professionals who are in charge of categorizing or ‘diagnosing’ the patient’s need and apply, or
execute, the matching program or procedure. Put processes/patients into boxes. A problem of
professional organizations. Steps:
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