Strukturer og reformer. En kvalitativ analyse av reformen «enhetlig ledelse» sett i lys av sykehusets arbeidsorganisering

In 2002 there was a large structural reform in Norwegian healthcare, and also a reform aiming at establishing a new management structure, the so-called unitary management reform (“enhetlig ledelse”). One purpose of the latter reform was to establish a more unambiguous and standardized management structure at all levels in Norwegian hospitals. Another purpose was to decentralize responsibility and establish a management role that was independent of professional qualifications. It was argued that such a management role was necessary in order to bridge the gap between an administrative–economic and a medical rationality in the hospital organization. However, it was also argued that these rationalities were deeply embedded in employees’ mindsets. A change in attitudes was thus also required, not just a change in the formal structure. It is the department level that is the focus of this study. How was the reform presented and interpreted at this level, and what happened when it was implemented? Interviews with nurses and doctors on the level of the clinical department show that it was difficult to establish decentralized responsibility. The study concludes that the reform was implemented in a way that did not interfere with the traditional organization of medical work. A possible explanation is that the standards and the categories presented in reform documents are not compatible with the established infrastructure at work