h p://www.sciedup ess.com/jha Jou nal o Hospi al Adminis a ion 2016, Vol. 5, No. 1
ORIGINAL ARTICLE
Hospi al managemen eams – e lec ions on
o ganiza ional and medical specializa ion cul u es
Elina Vii anen∗1, Lau i Kokkinen2, Hannu Puolijoki3
1School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland
2Finnish Ins i u e o Occupa ional Heal h, Tampe e, Finland
3E elä-Pohjanmaa Hospi al Dis ich , Seinäjoki, Finland
Recei ed: Sep embe 15, 2015 Accep ed: No embe 19, 2015 Online Published: Decembe 1, 2015
DOI: 10.5430/jha. 5n1p90 URL: h p://dx.doi.o g/10.5430/jha. 5n1p90
ABSTRACT
Al hough hospi al managemen is s udied in se e al b anches o science, sca ci y o s udies in es iga ing managemen eam wo k
in hospi als exis . The pu pose o his pape was o s udy manage s’ unde s anding conce ning he ole o managemen eam wo k
in specialized heal h ca e, as well as managemen eam wo k me hods wi hin he di e en ac i i y a eas in a hospi al and in he
ope a ional uni s wi hin hei domain. A o al o 54 in e iews o ac i i y a ea manage s and ope a ional uni manage s in one
Finnish hospi al dis ic in 2007-2008 was analyzed using da a-d i en con en analysis. Wo k o all managemen eams ocused
on inancial and ope a i e issues. Howe e , di e en managemen eams used di e en wo king me hods, which implica es he
exis ence o medical specializa ion-speci ic wo k subcul u es wi hin a sha ed o ganiza ional cul u e. The psychia ic ac i i y
a ea appea ed he mos ac i e and he mos u u e-o ien ed, whe eas he ac i i y a ea o ope a i e specializa ions seemed he
mos de ensi e, and he ac i i y a ea o conse a i e specializa ions was businesslike and un ocused as ega ds he u u e. These
di e ences we e po ayed in he eams’ inne dynamics and in e ac ion p ac ices. Ac i i y a ea wo k me hods did no di ec ly
ans e o hose o he uni -le el managemen eams. We conclude ha managemen eams may no be op imally used as a o um
o s a egic issues o inno a ion h oughou hospi al o ganiza ions and mo e esea ch is needed in o de o be e unde s and he
connec ions be ween managemen eam wo k, o ganiza ional cul u e and medical specializa ion cul u e.
Key Wo ds: Managemen eams, Specialized heal h ca e, Specialis ields, Hospi al ac i i y a eas, Ope a ional uni s
1. INTRODUCTION
In e na ional managemen li e a u e deems la ge hospi als
complex, di icul - o-manage o ganiza ions,
[1–3]
which can-
no be o ganized wi hou conside a ion o he wide heal h
ca e con ex .[4]
In addi ion o i s o mal ju idical and adminis a i e o gani-
za ion, a hospi al is also un by a no ma i e o ganiza ional
s uc u e, in which he ins i u ionalized ules and me hods
o ope a ion o he hospi al come in o play.
[5]
Typically,
hospi als ha e a mul i- ie hie a chy o managemen le els,
as well as highly specialized wo k uni s buil a ound s ong
p o essional expe s.
[6]
Va ying o ien a ions be ween di -
e en p o essions may cause communica ion p oblems and
ic ion.[7–9]
Medical specializa ions g ea ly de e mine he s uc u e o
la ge hospi al o ganiza ions. Specializa ions unc ion as he
basis o he ope a ional o ganiza ion and he di e en ac i -
i y a eas. Ope a ional uni s a e usually g ouped by hese med-
ical specializa ions. Hospi al manage s discuss specializa-
ions wi hou making he dis inc ion be ween o ganiza ional
s uc u es and medical e ms. Fo examples “gas oen e ol-
ogy” may e e o ei he a medical specializa ion o s uc u al
∗Co espondence:
Elina Vii anen; Email: [email p o ec ed]; Add ess: School o Heal h Sciences, Uni e si y o Tampe e, Tampe e, Finland.
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uni wi hin he hospi al o ganiza ion.[10]
Hospi als a e also pa h-dependen on hei his o y. They a e
in a cons an s a e o dynamic e olu ion and hei his o y
pa ially de ines hei cu en ope a ion and ope a ional cul-
u e.
[11]
Cul u ally, hospi als can be b oken down in o se e al
subcul u es.
[12]
O ganiza ional cul u e ela es o he assump-
ions, alues, a i udes and belie s ha a e sha ed among
signi ican g oups wi hin an o ganiza ion.
[13,14]
Cul u e con-
ce ns he common, accep ed ways o doing hings wi hin an
o ganiza ion, as well as he sha ed, indi idual ways o each
o i s membe s o making sense o he o ganiza ion. O gani-
za ional cul u e a ies ac oss he hospi al o ganiza ion and
some o his a ia ion is a ibu able o he a ie y o o gani-
za ional cha ac e is ics and measu es o pe o mance.
[15]
In a
hospi al, subcul u es may be ound in, o example, specialis
ields and managemen eam ope a ions.[10]
One B i ish s udy ocused on he NHS’s 189 acu e hospi al
us s and he nea ly 900 manage s unning hem. Desc ibing
senio managemen eam cul u e, mo e han hal o he us s
we e iden i ied as dominan clan cul u e ypes, whe eas 29
pe cen we e dominan a ional, 11 pe cen we e de elop-
men al, and only 6 pe cen we e hie a chical in hei cul-
u e.
[15]
A hospi al may be conside ed a complex, dynamic
and adap i e sys em, in which no one is ully able o con ol
he sys em o o e ell he ou comes o decisions.
[16,17]
Hospi-
als ep esen cul u ally and s uc u ally di ided ope a ional
ields, and a e e y challenging o manage as a whole. To
be e manage such an en i y, one may ake ad an age o
a enas ha b ing oge he people om di e en sub-g oups.
In a hospi al, hese include managemen eams on di e en
hie a chical le els.
Concep ual amewo k
In his s udy, a managemen eam deno ed a g oup o peo-
ple om a gi en o ganiza ion, and was composed o man-
age s, expe s, human esou ce (HR) and o he in e es g oup
ep esen a i es, b ough oge he by a manage o egula
planned mee ings, o discuss ma e s conce ning he hos-
pi al’s ope a ions. A managemen eam’s main ole is o
suppo he manage in his/he wo k, o which he/she is
pe sonally esponsible. Managemen eams a e con inuous
in hei ope a ions and a e no o med o ca y ou only a
single p ojec .
Recen esea ch on op managemen eams (TMT) has
demons a ed ha hey can ha e a p o ound impac on he
s a egic di ec ion and pe o mance o hei o ganiza ions.
The majo i y o TMT esea ch has b ough he impo ance
o managemen eam composi ion o ligh , and has employed
a ious e sions o demog aphy heo y.
[18]
Demog aphy he-
o y sugges s ha he composi ion o TMTs, wi h ega ds
o a ious demog aphic cha ac e is ics (e.g. age, enu e,
unc ional and educa ional backg ound), may explain he
collec i e beha io o managemen eams.
[19–21]
Recen s ud-
ies on TMTs ha e also demons a ed ha he managemen
eam cul u e s ongly in luences he beha io s, a i udes and
alues o he indi iduals o an o ganiza ion
[22]
and impac s
he o ganiza ion’s pe o mance.[23]
A i s bes , managemen eam wo k helps b oaden he pa ici-
pan s’ pe spec i e on he o ganiza ion’s ope a ions and helps
hem unde s and he signi icance o decisions ela ing o hei
own ield as ega ds he o ganiza ion’s main ask and he
inancial success o he business.
[24–26]
A unc ional manage-
men eam ac i ely pa icipa es in ca ying ou and moni o -
ing he o ganiza ion’s s a egy.
[27,28]
A well- unc ioning man-
agemen eam is also a s ong decision-making body
[29–31]
and inc eases he o ganiza ion’s inno a i eness.[32–34]
In a hospi al, managemen eam membe ship is mainly based
on he pe son’s hie a chical o p o essional posi ion wi hin
he o ganiza ion, and no , o ins ance, on pe sonal quali ies,
o an analysis o he alen o knowhow he managemen
eam lacks, o he ideal combina ion o demog aphic ac o s.
Managemen eams a e composed wi h e e ence o ep esen-
a ion.
[35]
They a y g ea ly in how hey ope a e. The mos
dis inc i e a e he p o essional and execu i e managemen
eams and hei ways o ealizing he o ganiza ion’s s a egy
di e conside ably om hose o o he s.[27,36]
The aim o his s udy is o add o he unde s anding o he
ole ha managemen eam wo k plays in hospi al manage-
men . The s udy ocuses on ac i i y a eas and ope a ional
uni managemen eams’ asks as a pa o unning a hospi-
al, as well as on managemen eam p ac ices. Ou esea ch
ques ions a e he ollowing: 1) How do managemen eam
membe s pe cei e he ope a ion o hei managemen eam?
2) How do managemen eam p ac ices in di e en ac i i y
a eas and ope a ional uni s di e om each o he ?
2. METHOD
2.1 Da a collec ion
The Specialized Medical Ca e Ac (1062/1989) equi es ha
Finnish municipali ies p o ide specialized heal h ca e o
hei esiden s. Fo his pu pose, each municipali y is asso-
cia ed wi h one o 20 hospi al dis ic s, which each ha e a
cen al hospi al. Hospi al dis ic s collec a clien ee, bu he
majo i y o he se ices a e paid o by he municipali ies,
ha is, hey a e ax- unded. The highes decision-making
powe in hospi al dis ic s lays wi h a poli ical o gan.
The p esen s udy is based on semi-open in e iews o man-
age s who a e membe s o managemen eams. The in e -
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iews we e abou managemen eam ope a ions. The da a
we e collec ed om he ac i i y a eas (conse a i e, ope a-
i e, psychia ic) o one hospi al dis ic and he ope a ional
uni s subo dina e o hem, and conce ned he subjec o
hei managemen eams. The conse a i e ac i i y a ea
included he ope a ional uni s o in e nal medicine, neu ol-
ogy, lung diseases, physia y and ehabili a ion, cance , skin
diseases and ge ia ics, and co e ed al oge he 390 employ-
ees. The ope a i e ac i i y a ea included he ope a ional uni s
o su ge y, o hopedics, gynecology, anes hesia, in ensi e
ca e, pedia ics, oph halmology, o o hinola yngology and
o al diseases, co e ing al oge he 660 employees. The hi d
ac i i y a ea, psychia ics, included he ope a ional uni s o
adul and elde ly psychia y, child and adolescen psychia-
y and collabo a i e psychia ic ou pa ien clinics, co e ing
al oge he 370 employees.
In e iew pa icipa ion was olun a y. The in e iews we e
hemed, and hey add essed, o example, managemen eam
s uc u e, wo k me hods, in e ac ion, ime managemen , he
ole o he chai pe son, and managemen eam decision-
making. A he end o he in e iews, he in e iewees ook
ime o hink abou how hey could imp o e hei manage-
men eam.
The da a included 54 manage in e iews, which we e con-
duc ed indi idually. The in e iews a ge ed a managemen
eam chai pe son and eam membe s in i e ac i i y a eas and
in i e ope a ional uni s. They we e conduc ed du ing he
all o 2007 and he sp ing o 2008, and las ed app oxima ely
45-60 minu es. All in e iews we e eco ded and ansc ibed
as 15-25 yped pages.
The in e iewees we e 23 head physicians, 6 head nu ses, 7
us ees, 9 nu se manage s, and 9 pe sonnel membe s. O
hose in e iewed, 21 we e men and 33 we e women. The
in e iews and he analysis we e conduc ed by he same wo
esea che s h oughou he s udy. Because managemen eam
membe ship was connec ed o he pe son’s o mal posi ion
in he o ganiza ion, he ep esen a i eness o managemen
eams u ned ou o be qui e la ge. The size o managemen
eams a ied om 8 o 15 pa icipan s.
2.2 Da a analysis
Fo he i s esea ch ques ion, we u ilized all 54 in e iews,
and o he second esea ch ques ion, we used he in e iews
o he managemen eam membe s om he conse a i e,
ope a i e and psychia ic ac i i y a eas and he managemen
eam membe in e iews o he ou ope a ional uni s subo -
dina e o he a o emen ioned ac i i y a eas. These in e iews
amoun ed o 44. App oxima ely hal o he membe s in each
managemen eam we e in e iewed, aking in o conside a-
ion he ep esen a i eness o he g oups.
We applied da a-d i en con en analysis o he esea ch ques-
ions.
[37]
Fi s , he da a was ead h ough se e al imes o
ob ain a gene al iew. The i s s age conce ned looking o
subjec -ma e ela ing o managemen eam ope a ions. The
analysis uni was a sen ence o a comple e hough . The
o iginal quo es we e chosen wo d o wo d, a e which hey
we e pa aph ased, g ouped and labeled wi h wo ds desc ip-
i e o con en . Du ing he g ouping phase, we looked o
simila i ies and di e ences. Exp essions wi h simila con-
en we e g ouped in o sub-ca ego ies, and u he , h ough
abs ac ion, in o umb ella ca ego ies and uni ing ca ego ies.
The ca ego ies we e named acco ding o hei con en .
[37,38]
3. RESULTS
The managemen eams deal wi h a la ge a ie y o di e en
subjec s. Some o hese we e on he agenda each ime, some
ollowed an annual schedule, and some we e si ua ional. The
majo i y o he subjec s a hand we e in o ma i e, ou ine
and ecu en in na u e. The a mosphe e a he mee ings
was, acco ding o he in e iewees, mainly posi i e and dia-
logic. New managemen eam membe s we e no b ie ed on
managemen eam wo k be o ehand. The e we e no known
common goals o he managemen eam’s wo k, no did
eam membe s come oge he o assess he success o hei
wo k. The manage s in e iewed we e membe s o one o
mo e managemen eams and some o hem we e chai pe -
sons in hei own specialis ield’s managemen eam.
3.1 Managemen eam asks
The da a showed ha hospi al managemen eams had se -
e al di e en asks. A summa y o hese asks is p esen ed in
Table 1.
Table 1. Managemen eam asks
• Sha ing in o ma ion
• Inc easing in e ac ion
• Fo ming a common consensus
• Di ision o asks and du ies ela ing o ope a i e managemen
• Assis ing and coo dina ing u u e-planning
• Making Decisions
• Inc easing commi men o o ganiza ion
• O e ing de elopmen oppo uni ies o manage s
As in o ma ion channels, he managemen eams wo ked
bo h e ically and ho izon ally. The chai pe son was able
o use he managemen eam o dis ibu e in o ma ion and
he membe s we e able o ecei e i . The managemen eam
mee ing ac ed as a o um o aising issues. In addi ion,
managemen eam membe s ecei ed in o ma ion om o he
sub-uni s in hei own ope a ional uni .
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Managemen eam mee ings had a ying le els o success
as in e ac ion o ums. The chai -pe son’s ole was seen as
highly impo an in achie ing success ul in e ac ion. Mem-
be s epo ed ha managemen eams we e “ he image o
hei chai pe son”. All membe s had he oppo uni y o speak
bu no e e yone el he need o do so. Manage s (mos ly
doc o s) spoke, and depu ies (mos ly nu ses) emained quie ,
al hough hey we e amilia wi h he subjec s a hand. HR
ep esen a i es did no speak unless spoken o. Pa icipan in-
e es was mainly ocused on he subjec ha hey hemsel es
ep esen ed. In ac i i y a ea managemen eam mee ings in
pa icula , membe s we e mainly only in e es ed in ma e s
conce ning hei own specialis a ea o specialis a eas close
o hei own.
Managemen eam mee ings we e used o o ming a com-
mon consensus and ag eemen on how o de s om highe up,
di ec ions, o some ask o he wise deemed impo an , would
be ca ied ou in p ac ice.
Managemen eam mee ings laid ounda ions and discussed
coo dina ion o u u e plans, alked abou pa ien queues
o he need o s and-ins and assigned indi idual planning
assignmen s o membe s o he managemen eams. S a e-
gic planning had li le p ominence in managemen eams’
ou ine ope a ions.
Pe sonnel issues came up in managemen eam in e iews
as small snippe s o discussion conce ning employee well-
being a wo k, appoin men s, applica ions o u he aining,
wo k o ce su iciency, and ec ui men . No sha ed o planned
HR managemen iews we e b ough up in managemen eam
in e iews.
The in e iews depic ed he managemen eam’s ole as a
decision-making body as somewha ambiguous in e ms o
ac ual decisions being made in he mee ings and whose de-
cisions hese we e. In e iewees mainly spoke o decisions
made by he managemen eam, bu o mos o hem - hough
no o e e yone - i was clea ha he ope a ional uni man-
age was esponsible o he decisions. The decision-making
p ocess was e y much po ayed as a sea ch o consensus.
Open dispu es we e a e. Chai pe sons in pa icula empha-
sized he p esen uni y and good a mosphe e o hei own
managemen eams. Consensus was sough h ough con e -
sa ions in which e e y oice coun ed and comp omises we e
made. Mee ings in which no consensus was eached we e
a e. Once a decision was join ly made, e e yone commi -
ed o i , especially in op- ie managemen eams, in spi e
o possible di e ing pe sonal opinions. Managemen eam
wo k was seen o possess a quali y o commi ing a pe son
o join decisions.
3.2 Managemen eam’s signi icance o manage ial
wo k
Table 2 p esen s he mos signi ican ma e s ha he man-
age s b ough up in he in e iews when discussing he man-
agemen eams’ signi icance o hei own wo k.
Table 2. Managemen eams’ signi icance o manage ial wo k
Ac i i y a ea managemen eams Ope a ional uni managemen eams
• Fo ming a gene al iew o e ac i i y a eas • Fo ming a gene al iew o e ope a ional uni s
• Recei ing in o ma ion • Recei ing in o ma ion
• Commi ing o he ac i i y a ea subcul u e • Achie ing join ag eemen
• Inc easing he unde s anding o o he special ields • Inc easing he in e ac ion be ween manage s
• Inc easing he unde s anding o o he s' wo k • Commi ing a manage o he leade ship ole
• Suppo ing pe sonnel managemen • Cla i ying ones own manage ial ole
Membe s o ac i i y a ea managemen eams who we e man-
age s s essed he impo ance o in o ma ion low, as well as
ha ing a bigge pic u e o he ac i i y a ea and he specialis
a eas ope a ing wi hin hem. In ope a ional uni managemen
eam in e iews, he manage s emphasized ea u es ha sup-
po ed hei own manage ial wo k and i s imp o emen . Join
ac i i ies and pee suppo we e also deemed impo an .
3.3 Ac i i y a ea managemen eam p ac ices
The manage s in he managemen eams o all h ee ac i i y
a eas we e o he opinion ha ep esen a ion was key o in-
o ma ion sha ing. All eams ecei ed he same in o ma ion
a he same ime. All h ee managemen eams conside ed
hei chai pe son o be communica i e and esponsi e o he
managemen eam.
The e we e ce ain dis inc ions in he way managemen eams
ope a ed. These we e mainly isible in he manage s’ de-
sc ip ions o g oup a mosphe e, in e ac ion wi hin he g oup,
he manage ’s a i ude owa d managemen eam membe s,
inclina ion owa ds de elopmen , and join ac i i ies. Ta-
ble 3 con ains desc ip ions o he di e en wo k cul u es
dis inc i e o di e en ac i i y a eas’ managemen eams.
The psychia ic ac i i y a ea clea ly s ood ou om he o he
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wo by i ue o i s own s ong emi s a egy, cla i y o
decision-making, inclina ion o change and openness, and
i s dialogic wo king me hod. The managemen eam s o e
o de elopmen and inno a ion wi h an eye on he u u e.
The e was less ocus on esul s o inancing han in he con-
se a i e and ope a i e ac i i y a eas. In bo h o hese wo
ac i i y a eas, he s a egy seemed unclea . The e we e di e -
ences be ween he wo managemen eams’ wo king me hods.
In he ope a i e ac i i y a ea, he emphasis was on he pa ic-
ipan s s anding up o hei own subspecialis a eas, headed
by la ge specialis ields such as su ge y and o hopedics.
The conse a i e ac i i y a ea’s in e nal wo king me hods
we e cha ac e ized by s icking o ac s, he impo ance o
in o ma ion sha ing, he managemen eam’s aci u ni y, and
es ablished wo king me hods.
3.4 Ope a ional uni managemen eam p ac ices
Table 4 p esen s he wo k cul u es o he ou ope a ional
uni s’ managemen eams. Two o he uni s belonged o he
ope a i e ac i i y a ea, one o he conse a i e and one o he
psychia ic.
The same p ac ices appea ed o be la gely in use in he ope a-
ional uni s, as in he ac i i y a ea managemen eams abo e
hem. Obse ing inances and p o i abili y was emphasized.
In all he ope a ional uni s, as well as in he ac i i y a eas
abo e hem, he p inciple o he managemen eam’s unc-
ion appea ed unclea . The e was also some con usion abou
decision-making in all bu wo ope a ional uni s. Ma e s
conce ning he whole hospi al dis ic we e no discussed in
uni -le el managemen eam mee ings and we e mainly only
epo ed.
Each ope a ional uni managemen eam had i s own in e nal
in e ac ion p ac ices which gene ally did no ollow hose o
he ac i i y a ea managemen eams. The managemen eams
ha sha ed he la ges amoun o managemen eam p ac ices
we e he su ge y ac i i y a ea and uni -le el managemen
eams, which emphasized a simila specialis e i o ial ide-
ology o ha o he ope a i e ac i i y a ea managemen eam.
The lung diseases uni , which is a pa o he conse a i e
ac i i y a ea, appea ed he mos ac i e and open o change.
The child psychia y uni had a d i e o change in i s com-
munica i e p ac ices and was inno a i e and dialogic, and
was in his way simila o he psychia ic ac i i y a ea, bu
disjoin ed and chao ic in i s o he p ac ices.
Table 3. Ac i i y a ea managemen eam wo k cul u es
Conse a i e ac i i y a ea
• The managemen eam is o mal and uncommunica i e. The chai -pe son p epa es he mee ings and o he pa icipan s do no b ing issues o he
agenda.
• Finding consensus is always he main goal.
• The mee ings ocus on medical issues and he nu ses' p esence is a nuisance. The doc o s do no speak o hei own p oblems and no pee -suppo is
expec ed o he managemen eam.
• Fa - eaching issues a e no discussed.
• Discussions abou pe sonnel a e a e.
• Chai -pe son is conside ed businesslike, p ecise, conside a e and mode a e, wi h a ouch o an expe ienced clinician.
Ope a i e ac i i y a ea
• The a mosphe e is open and con iden ial in he managemen eam mee ings.
• The eam ecognizes i s own po en ial and is open o change.
• The ocus is on he head doc o s and nu sing- ela ed ma e s a e le o o he o ums.
• Head doc o s de end hei own special ields and a e unin e es ed in o he s. The eam is no used o pee -suppo .
• The mee ings a e domina ed by a he o ic o inance and e ec i eness.
• Decision-making is unclea , consensus is sough .
• Chai -pe son is deemed as someone who sha es esponsibili ies and se s he one o he mee ings.
Pshycia ic ac i i y a ea
• The a mosphe e is elaxed, egali a ian and da ing in he managemen eam mee ings.
• Di e en opinions a e well ole a ed and he eam is open o new ideas, con iden ial and suppo i e.
• The managemen eam aises discussion on he ac i i y a ea's ocus and u u e-plans.
• In he discussions, inance is no dominan . Pe sonnel's abili ies a e deemed as impo an discussion- opics.
• Di e en p o essions de end hei posi ions, bu head nu ses ake ca e o he g ass- oo s le el and ha e no ime o a end managemen eam mee ings.
• Chai -pe son is deemed as adap i e and as someone who se s he one o he mee ings.
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Table 4. Ope a ional uni managemen eam wo k cul u es
Ope a ional uni o Lung diseases (in Conse a i e ac i i y a ea)
• The a mosphe e is con iden ial and open in he managemen eam mee ings.
• Chai -pe son keeps e e yone in o med abou ma e s conce ning he en i e o ganiza ion. O he pa icipan s also aise issues o he agenda.
• Focus is on inancial ma e s, and on HR ma e s, such as pe sonnel well-being, ec ui men and educa ion.
• Common consensus is sough and decisions a e made.
• Chai -pe son has emula ed managemen eam p ac ises om he ac i i y a ea-le el managemen eam he pa icipa es in.
Chai -pe son is deemed as inspi ing and able o c ea e a good a mosphe e.
Ope a ional uni o Su ge y (in Ope a i e ac i i y a ea)
• The managemen eam is businesslike, ou ined and open o de elopmen .
• Te i o ial hinking is s ongly p esen , bu he eam seeks o sha ed unde s anding.
• Wi hin di e en special ields he pa icipan s seek pee -suppo om ou side o hei own p o ession.
• Discussion concen a es on pa ien -ques and pe sonnel well-being and ec ui men .
• Common consensus is sough ou , decision-making is unclea .
• Chai -pe son is deemed as dynamic and a ional.
Ope a ional uni o Pedia ics (in Ope a i e ac i i y a ea)
• The managemen eam is undiscou si e and has i s own mee ing p ac ice wi h no agenda.
• Team-wo k is deemed equal, wi h no clea doc o -nu se jux aposi ion p esen .
• Dispu es be ween special ields, which esul s in in ense discussions.
• Mee ing- opics include pe sonnel cos s, ec ui men and well-being, bu a ely inance.
• Pa icipan s do no eel hey ecei e pee -suppo .
• Chai -pe son is deemed ai o all.
Ope a ional uni o Child and adolescen pshychia y (in Psychia ic ac i i y a ea)
• The managemen eam is deemed a sa e place whe e e e yone can b ing up hei opinions.
• People wi h s ong pe sonali ies con ol he mee ings. Nu sing pe sonnel is less ocal han doc o s.
• Se e e ensions be ween di e en special ields exis .
• Mee ings ocus on pe sonnel coping and appoin men s. Finance is also a dominan opic.
• Decisions a e a ely made and hings a e o en le un inished.
• Chai -pe son is deemed meande ing and inexpe ienced in leading he magagemen eam mee ings.
4. DISCUSSION
The aim o he s udy was o obse e managemen eam wo k
in specialized heal h ca e, and o de e mine he di e ences in
he ways di e en managemen eams wo k. Table 5 p esen s
he summa y o ou indings.
The managemen eams we s udied we e qui e la ge. La ge
g oups may no be ideal o in o ma ion p ocessing o inno-
a ion, bu hey do inc ease he likelihood o he managemen
g oup’s he e ogenei y. On he o he hand, he e ogenei y may
dec ease he g oup’s p oduc i i y i he g oup is unable o
each a sa is ac o y le el o consensus.
[39]
The mos c ucial
pa is he in e ac ion be ween eam membe s and he shape
ha his akes.
[40,41]
Hospi als ypically ha e a consensus-
seeking wo k cul u e, which also became e iden du ing his
s udy. In addi ion o a posi i e ou look, i may also lead o
he selec ion o neu al opics o he managemen eam’s
pe usal which do no lead o open, p og essi e discussion.
The esul s indica e ha no new ideas o de elopmen
p ojec s we e ha ched in he managemen eams. This may
be a esul o hei a o e-men ioned la ge size. The lack
o b ains o ming dec eases in o ma ion p ocessing and in-
o ma ion use and inally a ec s he hospi al’s openness o
de elopmen .
[19,42]
Acco ding o p e ious li e a u e, he bes -
unc ioning managemen eams ha e membe s wi h di e en
le els o expe ience, skills and pe sonal ou looks, and hei
powe is une enly dis ibu ed. Managemen eams such as
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his a e be e equipped o p omo e s a egic change in hos-
pi als and o imp o e ce ain igu es depic ing pa ien -ca e
e iciency.[27,43]
I has also been s a ed ha mul i- alen ed managemen eams
a e openly mo i a ed o lea n new hings (such as inancial ad-
minis a ion da a sys ems and da a adminis a ion) ela ed o
he de elopmen o a hospi al’s s a egic de elopmen .
[44,45]
Acco ding o c i e ia based on expe ience and p o ession, all
he managemen eams in his s udy had equal oppo uni y o
ac i ely pa icipa e in de eloping he hospi al’s ope a ion.
Table 5. Summa y o indings
• Membe s o ac i i y a ea managemen eams s essed he impo ance o in o ma ion low, as well as ha ing a bigge pic u e o he ac i i y a eas
ope a ing wi hin hem. In ope a ional uni managemen eams he membe s emphasized ea u es ha suppo ed hei own manage ial wo k and i s
imp o emen .
• The e we e ce ain dis inc ions in he way ac i i y a ea managemen eams ope a ed. The psychia ic ac i i y a ea clea ly s ood ou om he o he
wo by i ue o i s own s ong emi s a egy, cla i y o decision-making, inclina ion o change and openness, and i s dialogic wo king me hod. In
conse a i e and ope a i e ac i i y a eas he s a egy seemed unclea . In he ope a i e ac i i y a ea, he emphasis was on he pa icipan s s anding up
o hei own subspecialis a eas, headed by la ge specialis ields such as su ge y and o hopedics. The conse a i e ac i i y a ea’s in e nal wo king
me hods we e cha ac e ized by s icking o ac s, he impo ance o in o ma ion sha ing, he managemen eam’s aci u ni y, and es ablished wo king
me hods.
• The same p ac ices appea ed o be la gely in use in he ope a ional uni s, as in he ac i i y a ea managemen eams abo e hem. Howe e , each
ope a ional uni managemen eam had i s own in e nal in e ac ion p ac ices which gene ally did no ollow hose o he ac i i y a ea managemen
eams.
The da a showed se e al asks assigned o he managemen
eams. They o med an excellen channel o he ickling
up o down o in o ma ion. Regula mee ings b ough me h-
ods o manage ial wo k. Managemen eam membe ship
inc eased commi men o he decisions al eady made and
o he “subcul u e” o managemen . Middle-manage s in
pa icula saw he managemen eams o hei espec i e op-
e a ional uni s as he mos impo an manage ial ool a hei
disposal. The managemen eam di ec ly abo e a manage ’s
own ope a ional uni was no deemed impo an . The e is a
con adic ion he e, in ha he manage s la gely deal wi h
ma e s in hei own le el’s managemen eam mee ings,
which hey we e in o med o and asked wi h in uppe -le el
managemen eam mee ings. In addi ion, he esul s indi-
ca e ha chai pe sons modeled hei own ac ions on hose o
hei p edecesso s and he chai pe sons in uppe -le el man-
agemen eams. P ac ices such as his ha e been p e iously
s a ed o s em om he adi ion o p o essional manage-
men .[10]
The esul s show ha managemen eams se ed he ope -
a i e managemen and coo dina ion o e e yday unc ions
o a hospi al, which consis ed o mul iple hie a chal le -
els and se e al highly specialized uni s. Ce ain signi ican
managemen a eas, such as s a egic emi managemen , HR
managemen and o e all u u e-o ien a ion, we e a ely ad-
d essed in managemen eam mee ings. The s udy aises he
ques ion o whe e exac ly hese managemen a eas ma e ial-
ize in hospi als, and whe he hey ma e ialize enough a all.
The hospi al dis ic ’s sha ed s a egy emained seconda y in
all managemen eams and he s a egy conce ning he eam’s
own ield appea ed unclea in he ope a i e and conse a i e
ac i i y a ea.
Al hough managemen eam wo k is a common p ac ice in
public hospi als, he eams’ asks and goals appea ed la gely
unclea . This may be pa ly due o he ac ha new eam
membe s a e no gi en any o ien a ion owa ds he esponsi-
bili ies and liabili ies hey ha e as eam-membe s. Simila ly,
he hospi al’s s a egy, along wi h i s ou lined issues and
goals, quickly anished on he way down in managemen
eams along he hospi al hie a chy. Uni -le el managemen
eam asks appea ed o consis o o ganizing daily manage-
men and sol ing e e yday issues.
E en i he signi icance o managemen eam wo k o man-
aging a hospi al emained weak, as he esul s indica e, we
mus acknowledge he impo ance ha he eams had o
single soli a y manage s’ wo k and o imp o ing hei own
leade ship. Managemen eam wo k se ed o b oaden ho i-
zons and o help see one’s own wo k as pa o a la ge
whole. Managemen eams unc ioned as a enas o ou lining
a common ision wi hin a uni and o ou lining he asks
and esponsibili ies o ope a i e managemen .
Managemen eams had di e en ways o ope a ing acco d-
ing o emi . The mos clea ly pe cei able we e he di e -
ences in in e nal g oup dynamic and in e ac ion p ac ices.
Some o he managemen eams’ p ac ices may ha e di e ed
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due o he eam membe s’ backg ounds in specialized heal h
ca e, specialis ields, and hei subcul u es.[15]
In a s udy by Vi anen, di e en specialized heal h ca e man-
age s no ed ha people wi h p o essional backg ounds in
a ce ain medical specializa ion and who wo ked in he o -
ganiza ional uni adjacen o ha specializa ion had ce ain
common ai s unique o hei specializa ion backg ound, and
ha hey migh di e g ea ly om people wi h o he medical
specializa ion backg ounds. The di e ence was appa en
in beha io and i was clea ly pe cei able among doc o s;
less so among nu ses. Conce ning su geons, he image was
one o s aigh o wa d, some imes exube an , people wi h
an app ecia ion o hemsel es and o p ac ical su gical ex-
pe ience. O in e ns, he image was one o slow-mo ing,
ho oughly analy ical people who made decisions and ac ed
in a calm and elaxed manne , all he while e aining hei
own opinions. A an equal dis ance om bo h hese g oups
we e he psychia is s, who we e conside ed o be “di e en ”
and impossible o de ine using he same c i e ia.[10]
These di e ences we e also appa en in managemen eam in-
e ac ion and in e nal dynamics. The ope a i e managemen
ac i i y a ea’s managemen eam had di e en subspecializa-
ion manage s who jealously gua ded hei own e i o y, and
manage s who had a dis inc p e e ence o p ocedu es,
[8,9]
whe eas he conse a i e ac i i y a ea managemen eam
membe s could be desc ibed as composed, businesslike, and
con empla i e. Membe s o psychia ic managemen eams
o en b ough o he eam’s discussion an open and mul i al-
ued discou se conce ning nea ly e e y hing ha happened
wi hin he eam’s emi . The mee ings we e meande ing in
na u e, bu o en he open in e ac ion and e e yone being
hea d p oduced a good a mosphe e; one in which inno a ion
was also possible.[31]
In he ligh o his s udy, i would appea ha he su gical
specialis s and hei ep esen a i es had a s onge endency
o ans e hei own wo k me hods o managemen eam
wo k han he o he specialis s and hei ep esen a i es. The
su gical uni was go e ned by he same e i o ial men ali y
and he igh o one’s own ield ound in non-su gical uni s,
and in he ac i i y a ea abo e i . In u u e s udies, i would
be pe inen o pay mo e a en ion o he ans e o wo k
me hods om uppe o lowe managemen le els, because
he wo k cul u e a managemen eam adop s has been ound
o a ec heal h ca e o ganiza ion e ec i eness in hospi als,
as well as in p ima y heal h ca e.[15,46,47]
Li e a u e on hospi al managemen eam ope a ion om a
medical specializa ion pe spec i e is sca ce, so i is di icul
o say how s ong he subcul u es ound ac ually a e and
whe he o no hey ha e cha ac e is ics which, in he long
un, could ei he hinde o p omo e managemen eam wo k.
In his s udy, we only looked a ou di e en ope a ional
uni s and o make a conclusi e judgmen , da a om addi-
ional uni s om di e en ac i i y a eas would ha e been
necessa y.
The esea ch was ca ied ou in one hospi al and he esul s
a e no di ec ly applicable mo e gene ally. This would e-
qui e addi ional da a o compa ison om o he hospi als
and he wo k o hei managemen eams. Also, as ce ain
aspec s o o ganiza ional cul u e and p o essional cul u e
may by highly embedded in ce ain na ional con ex ,
[48]
he
s udy needs o be eplica ed ou side i s No dic con ex . How-
e e , as ecen leade ship esea ch has demons a ed, s udies
conduc ed in se e al Wes e n coun ies ha e been highly con-
sis en wi h esea ch ou comes om China and o he Asian
coun ies,
[48–50]
indica ing he impo ance o o ganiza ional
and p o essional cul u es on he global scale. Also, as such,
he one-on-one in e iews o 54 manage s om di e en
specialis ields o e a b oad iew o managemen eams’
oles in hospi als, and he pa allel analysis ca ied ou by wo
esea che s imp o es he eliabili y o he s udy.
F om a hospi al managemen pe spec i e, we should pay
mo e a en ion o managemen eam ope a ion, hei asks,
and he way in which a hospi al’s op managemen di ec s
i s managemen eams. As managemen eam wo k me hods
mani es di e en ea u es o specialized heal h ca e, he
managemen eams do no necessa ily ope a e in he same
way. Manage s a di e en o ganiza ional le els ha e di e -
en pe sonal and o ganiza ional goals and needs.[17]
Managing di e si y in managemen eam wo k is a challenge
o he hospi al managemen . Quinn e al.
[51]
s a e ha man-
age s mus simul aneously ackle mul iple di e en oles and
e en ho izons, which hey need o unde s and and accep .
Managemen eam chai pe sons would be ha d p essed o
u ilize he di e en wo k cul u es ound in di e en g oups
while e lec ing on imp o ing hei own managemen eams’
wo k.
Managemen eam wo k could be imp o ed by cla i ying
ope a ional goals and in o ming e e yone in he o ganiza ion
abou hem, as well as by e ining managemen eam dy-
namics by consciously dissol ing ou inized wo k me hods,
a oiding unnecessa ily ou ine handling o ma e s, enhanc-
ing mee ing echniques, and by adding u u e o ien a ion o
he eams’ wo k. Managemen eam leade ship and decision-
making could also be imp o ed by applying di e en models
o eam wo k.[52]
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