This master thesis is prepared in context of the structural changes that have been implemented in the health care system of the Region of the Capitol in Denmark in the last three years. After implementation of the "Hospitalsplan 2007" from 2007 to 2010, the region has re-organized their hospitals in four subdivisions, each consisting of one major and one or two minor hospitals. Departments has been established covering two locations, organized with small specialized functions as an outpost at the minor hospitals. The subject of this thesis has therefore been to study "How Dilemmas of management evolves and how do the Manager handles these, managing a Department at two locations" and furthermore, "How do the Manager handle his Role of Management in the pressure between the Manager of the Hospital and the local Manager of the Outpost ?". The field study has been performed during the early autumn of 2010 through ten semi-structured interviews divided on six with heads of departments with outpost at minor hospitals, two with hospitals managers and two with local managers at outposts at minor hospitals in The Region of the Capitol in Denmark. In addition, relevant policy documents from the Region of the Capitol from 2007 to 2010 has been identified and reviewed to elucidate the platform of which the managers of departments can perform their leadership. The theoretical foundation for the analysis was selected to be the organizational theories of Henry Mintzberg from 1983, defining the basic five structures of organizations and the psychodynamic organizational theory about the person and his role in system of the organization and the individual, as described by James Krantz and Marc Maltz in 1997, the Role as taken and given. The analysis of the interview concerning the first subject of the study with the organizational view did make it possible to identify four dilemmas of managing the outpost (1) lack of contracts, resulting in opposed orders from the hospital managers at the different locations, making it difficult to use the pigeonholing process in the division of labor (2) the professionals at the outpost after all, are not interested in being managed by a remote head of department, which not are given authority, (3) due to the fact that the patients distributed to the outpost with a high degree of horizontal job specialization, can occur to be too complex to be handled treated there and (4) the organization and the flow of patient categories is ever changing, inducing press and pulls from the other parts of the organization. The analysis of the second subject of the study, showed that these dilemmas are handled by the managers in different ways. (1) The manager is waiting, when there are serious expectations, but change his role of leadership in response to the need. (2) The managers role is dependent on the level of authority he is allocated and on his internal authority and the role ideal of the person. (3) The manager has resistance to make unpleasant decisions and may withdrawal himself from an active role of leadership. But in case of severe problems, he will enact in his role, and solve the problems. In conclusion, we find that the thesis have the following implications of the use of outpost for the health care system in Denmark: (1) The manager must be a person, acting both as a general manager and as a professional manager, (2) There must be allocated a local manager on the outpost with responsibility to become the formal manager with contact to the local hospital manager, (3) It is mandatory to compose detailed contracts, describing the co-operation between the actors of the outpost, and (4) The superior level of management of hospitals should be aggregated to one for each of the four planning areas in the Region of the Capitol.
|Uddannelser||Master of Health Management, (Masteruddannelse) Afsluttende afhandling|