Interdisciplinary promises and hierarchical ambiguities in a danish hospital context

Abstract

The public health sector in welfare states is increasingly subject to organisational changes, particularly in hospitals, as organisations comprise coalitions of various (healthcare) professionals. In this context, due to interprofessional competition, knowledge claims play an important role in achieving jurisdictional control. In this paper, we investigate the manifestations of and health professionals’ reactions to competing institutional discourses. Through qualitative interviews with hospital management, middle managers, and staff employees at three hospitals in Denmark, we demonstrate how managerial attempts to control tenacious professional bureaucracies are exercised through both bureaucratic forms of control and cultural-ideological modes of control with an introduction of new discourses of interprofessional teamwork. The findings suggest that hospitals seek not only to contain ambiguity through bureaucratic features of control, but also to cultivate it when seeking to strengthen cooperation between professions. Thereby, ambiguity itself becomes a mechanism for management.