New roles for the middle manager in the hospital

Abstract

ABSTRACT The middle manager in hospitals in the Netherlands is responsible for the provision of high-quality care that fits the allocated budget. Recently, he also had to implement austerity measures because the cost of healthcare has grown faster than the economy. This paper deals with the competences, knowledge and skills the middle manager should have in order to be able to deal with budget limitations. We conducted semi- structured interviews with 30 middle managers, 10 health professionals and one business controller, spread out over different hospital types and locations throughout the Netherlands and organized two focus group meetings. We identify two new roles for the middle manager in what we call the ‘modern’ professional bureaucracy: the roles of ‘sense maker’ and ‘connector’. Hospital organizations have become flatter with more emphasis on horizontal flows and they have a growing technostructure. The number and variety of external signals for any department has increased. The middle manager has to explain the implications of external signals and is the connector between professionals and employees inside and outside the hospital.