Abstract
Hospitals are increasing in size and complexity and hospital manage-ment is being professionalized. This paper aims to investigate how doctors engage in hospital management. Are doctors losing their influence? Based on a review of existing literature and data from a longitudinal study, we show that Norwegian doctors have seemingly lost some of their previous dominance in hospital manage-ment, as other professions have entered traditional areas of medical influence. However, we argue that doctors appear to regain an influential position in formal decision making by entering positions with higher potential for influence. We suggest an analytical approach that illustrates the changing engagement of doctors in management. Our paper contributes to the current and requested research on the relationship between medicine and management in European states.
Highlights
Hospitals are increasing in size and complexity and hospital management is being professionalized
There has been an increased emphasis on doctors as mediators between the different logics of management and medicine (Kragh Jespersen, 2005; Llewellyn, 2001), along with calls for doctors to take on management positions within the hospital sector (Edmonstone, 2009; Schwartz & Pogge, 2000)
As New Public Management related reforms are popularly believed to impede professional autonomy (Mastekaasa, 2011), this opens up the possibility of studying the impact of these reforms on the relationship between medicine and management
Summary
The organization of healthcare systems in most Western countries has traditionally been governed by the medical profession (Berg, 2008). Berg (1991, 2008) has used the terms “medicracy” and “iatrocracy” interchangeably to describe these traditional forms of medical governance. This was in part due to the influence of doctor Karl Evang, who held the position of Medical General Manager from 1934 to 1972 Before this period, medicine held a rather weak status in Norwegian health care in terms of professional dominance and power. In 1997, the committee recommended that the practice of dual management in clinical departments be replaced by unitary management While both management competence and competence within a health profession was emphasized for the new management role, the committee did not specify a profession, leaving the position open for individuals with different health related backgrounds. Doctors would have to compete for management positions against applicants with other health backgrounds They did not accept these changes lightly, and in 2004, three years after the reform, around half of the departments in Norwegian hospitals had experienced conflicts of various degrees (Gjerberg & Sørensen, 2006). Both doctors and nurses have had to give way to individuals with other backgrounds, such as information managers (9% in 1999 and 87% in 2009) and financial directors (89% in 1999 and 100% in 2009)
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