No one wants to get stuck with the losing card - Management conditions in conjunction with hospital mergers

Purpose – The rate of turnover of hospital managers has been high in Sweden. Hospitals are regarded to be difficult to manage, which is connected with different discourses and action logics such as politics, medicine, care and management creating complex conditions for hospital management. The purpose of this paper is to analyse hospital managers' management conditions in conjunction with hospital mergers. Design/methodology/approach – Two case studies concerning hospital mergers illustrate these management conditions by means of analysing how different actions are communicated by politicians, county council directors, and hospital managers. The author's own experiences as a hospital manager have been made use of, as have document studies. In the analysis, conducted with the support of several theoretical perspectives, certain themes emerge which touch upon these management conditions. Findings – In connection with hospital mergers, leading hospital actors carry out communicative games controlled by different action logics. No one wants to get stuck with the losing card. The article demonstrates the difficulties of implementing radical organizational changes in hospitals. A challenge for hospital managers lies in creating a shared dialogue and a consensus with the professions, the politicians and the media. The crucial position of power held by the politicians and the professions in critical situations has to be dealt with. Otherwise the hospital manager has to resign. Originality/value – The paper aims to clarify under which management conditions the hospital manager acts