Management Between Autonomy and Transparency in the Enterprise Hospital

Better management and new organizational forms have been the preferred solutions in the efforts to slow down the rising expenditures in Norwegian hospitals. This has been explicitly expressed in a new law on health personnel and health enteprises, in which Norwegian hospitals have been required to implement the principle of unitary management. The introduction of unitary management and the belief in a new accountable and empowered manager seems to represent a break with traditional forms of management, like parallel professional hierarchies and representative structures. The authors have studied how a group of clinical managers, all members of the topmanagement team in a middle sized Norwegian hospital, has adjusted to the new demands for unitary management and the restructuring of hospitals. A key question is how clinic managers themselves perceive and adjust to the new roles and tasks they have been assigned. Managers try to enact their own importance by implementing performance management. However, this enactment leaves the managers more visible, transparent and vulnerable. The professional hierarchies in Norwegian healthcare have been based on professional imperatives of action and a logic of appropriateness. Another question discussed in the paper is whether these imperatives and logics are now replaced by a new logic of consequentiality, or whether they may continue to exist in a state of competition or in combination with the new managerial logic of consequentiality