PUSHED ORGANIZATIONAL PULLS Changing responsibilities,

This article presents empirical data on organi-zational reform in Dutch health care, and explores managerial work and behaviour. Two main questions will be answered. First, what organizational reforms are taking place, and how widespread are these reforms? Second, what do reformsmean for the real-lifeworkings of health care organizations, most specifically formanagerial behaviour?As far as reforms are concerned, it will be concluded that organiza-tional changes are widespread, especially strategic apex reform and mergers. To a lesser extent, organizational structures are adapted and new relations between management and professionals are developed. Organizational and managerial contexts count albeit in unexpected ways. The professional context counts: management uses organizational re-form to provide counterweight vis-à-vis and control of professionals. In addition, manag-erial background counts, but in a limited way: executives with limited managerial careers opt for organizational reform. Finally, organiza-tional size counts, exerting a strong influence on organizational reform. As far as behavioural consequences are concerned, it will be con-cluded that organizational reform goes hand-in-hand with behavioural confusion. An ‘orga-nizational pull ’ appears to be strong. Executives are forced to be ‘down to earth ’ managers, while they express ‘exotic ’ desires to be strategists and entrepreneurs. Paradoxically, most organizational reforms strengthen this pull. Key words Health care, managerial behaviour, managers