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HPI4008 Full literature summary of case in week 2: Professionalism and professional organisations
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Full literature summary of case in week 2: Professionalism and professional organisations
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Week 2: Professionalism and professional organizationsLearning goals:
1. What is:
a. Professionalism
i. What are the core characteristics of a profession?
ii. ii. What implications does this have for healthcare organizations?
b. Professional organizations
i. What are the core features of these organizations?
ii. Which managerial problems occur in these organizations?
iii. Which (environmental) demands and expectations do professional
organizations have to balance?
For all concepts, ask yourself; what does this really mean (beyond a definition), why
is it important, and how does it relate to the other concepts?
2. How does institutional theory help us understand professionals and professional
organizations?
a. What are institutions, which types exist, and how do they influence behavior?
b. How do professional organizations gain legitimacy?
c. What are institutional logics, how do they conflict with each other, and what does
that teach us about managing healthcare organizations?
3. What are the implications of professional organizations for leadership?
a. What are the main sources of power in professional organization and how are
these related to leadership?
b. What is the leadership constellation and why does it matter?
c. How can non-professional leaders (i.e. managers) lead autonomous
professionals?
Book Chapters
The professional bureaucracy (chapter 10 in: Structure in Fives: Designing Effective
Organizations)
The Basic Structure
The work of the operating core
The Professional Bureaucracy relies for coordination on the standardization of skills and its
associated design parameter, training and indoctrination. It hires duly trained and
indoctrinated specialists— professionals—for the operating core, and then gives them
considerable control over their own work. Control over his own work means that the
professional works relatively independently of his colleagues, but closely with the clients he
serves.
Most of the necessary coordination between the operating professionals is then handled by
the standardization of skills and knowledge—in effect, by what they have learned to expect
from their colleagues.
,Training and indoctrination are a complicated affair in the Professional Bureaucracy. The
initial training typically takes place over a period of years in a university or special
institution. Here the skills and knowledge of the profession are formally programmed into the
would-be professional. But in many cases, that is only the first step, even if the most
important one. There typically follows a long period of on-the-job training, such as internship
in medicine and articling in accounting. Here the formal knowledge is applied and the
practice of the skills perfected, under the close supervision of members of the profession. On-
the-job training also completes the process of indoctrination, which began during the formal
teaching. Once this process is completed, the professional association typically examines the
trainee to determine whether he has the requisite knowledge, skills, and norms to enter the
profession. That is not to say, however, that the person is “examined for the last time in his
life, and is pronounced completely full," such that “after this, no new ideas can be imparted to
him," as humorist and academic Stephen Leacock once commented about the Ph.D., the
hurdle to entering the profession of university teaching. The entrance examination only tests
the basic requirements at one point in time; the process of training continues. As new
knowledge is generated and new skills develop, the professional upgrades his expertise. He
reads the journals, attends the conferences, and perhaps also returns periodically for formal
retraining.
The bureaucratic nature of the structure
The structure of these organizations is essentially bureaucratic, its coordination—like that of
the Machine Bureaucracy—achieved by design, by standards that predetermine what is to be
done. Whereas the Machine Bureaucracy generates its own standards— its technostructure
designing the work standards for its operators and its line managers enforcing them—the
standards of the Professional Bureaucracy originate largely outside its own structure, in the
self-governing associations its operators join with their colleagues from other Professional
Bureaucracies. So whereas the Machine Bureaucracy relies on authority of a hierarchical
nature—the power of office—the Professional Bureaucracy emphasizes authority of a
professional nature—the power of expertise.
The pigeonholing process
To understand how the Professional Bureaucracy functions in its operating core, it is helpful
to think of it as a repertoire of standard programs— in effect, the set of skills the
professionals stand ready to use—that are applied to predetermined situations, called
contingencies, also standardized. The process is sometimes known as pigeonholing. In this
regard, the professional has two basic tasks: (1) to categorize the client's need in terms of a
contingency, which indicates which standard program to use, a task known as diagnosis; and
(2) to apply, or execute, that program. Pigeonholing simplifies matters enormously. "People
are categorized and placed into pigeonholes because it would take enormous resources to
treat every case as unique and requiring thorough analysis.
It is this pigeonholing process that enables the Professional Bureaucracy to decouple its
various operating tasks and assign them to individual, relatively autonomous professionals.
Each can, instead of giving a great deal of attention to coordinating his work with his peers,
focus on perfecting his skills.
In the pigeonholing process, we see fundamental differences among the Machine
Bureaucracy, the Professional Bureaucracy, and the Adhocracy. The Machine Bureaucracy is
a single-purpose structure; presented with a stimulus, it executes its one standard sequence of
programs, just as we kick when tapped on the knee. No diagnosis is involved. In the
, Professional Bureaucracy, diagnosis is a fundamental task, but it is circumscribed. The
organization seeks to match a predetermined contingency to a standard program. Fully open-
ended diagnosis—that which seeks a creative solution to a unique problem—requires a third
configuration, which we call Adhocracy. No standard contingencies or programs exist in that
configuration.
Because clients are categorized, or categorize themselves, in terms of the functional
specialists who serve them, the structure of the Professional Bureaucracy becomes at the
same time both a functional and a market-based one.
Focus on the operating core
The operating core is the key part of the Professional Bureaucracy. The only other part that is
fully elaborated is the support staff, but that is focused very much on serving the operating
core. Given the high cost of the professionals, it makes sense to back them up with as much
support as possible, to aid them and have others do whatever routine work can be formalized.
Thus, Figure 10-1 shows the Professional Bureaucracy, in terms of our logo, as a flat
structure with a thin middle line, a tiny technostructure, and a fully elaborated support staff.
All these characteristics are reflected in the organigram of McGill University, shown in
Figure 10-2.
Decentralization in the professional bureaucracy
The Professional Bureaucracy is a highly decentralized structure, in both the vertical and
horizontal dimensions. The professional's power derives from the fact that not only is his
work too complex to be supervised by managers or standardized by analysts, but also his
services are typically in great demand. This gives the professional mobility, which enables
him to insist on considerable autonomy in his work. When the professional does not get the
autonomy he feels he requires, he is tempted to pick up his kit bag of skills and move on.
Why professionals bother to join organizations in the first place:
- For one thing, professionals can share resources, including support services, in a
common organization.
- Organizing also brings the professionals together to learn from each other, and to
train new recruits.
- Another reason professionals band together to form organizations is that the clients
often need the services of more than one at the same time.
- Finally, the bringing together of different types of professionals allows clients to be
transferred between them when the initial diagnosis proves incorrect or the needs of
the client change during execution.
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