The Structure of the Healthcare System

Abstract

The theme of this master thesis is structure within public healthcare with a focus on hospitals and their respective departments. The focus is narrated through the nurses’ perspective using qualitative interviews with a methodological approach on seeking diversity in the narratives. The problem definition is as follows: How can structural barriers to effective collaboration be identified in hospital departments, and how can organizational initiatives promote efficiency for nurses? The thesis theoretical starting point is the organizational theory of Henry Mintzberg´s book “Structure in 5’s: A Synthethis of the Research on Organizaiton Design” which focuses on a general framework for organizational structure with a core focus on how to design and establish effective organizations. Mintzbergs theory is the overall frame and theoretical approach of the thesis. Mintzberg’s research explores the effectiveness and prevalence of different organizational types in different contexts and I utilize Mintzberg’s typology as a conceptual framework to analyze the coordination mechanisms and the organizational forms that emerge from this. I use Dave Ulrich and Norm Smallwoods theoretical framework on capabilities as this theory represents a strategic outlook on structure rather than an organizational outlook on structures. The methodological approach is based on interviews from five informants from five different hospital departments and hospitals. My methodological approach is to seek as much diversity in the narratives as possible in order to identify the greater issues of structure within hospitals. I applied an abductive method to identify the problems as my knowledge on the subject continuously became greater. I found that there are several structural barriers that compromises the nurse’s ability to cooperate in an efficient manner. There is a need for greater autonomy amongst the nurses as well as a need for a more organized structure that promotes the ability for the nurses to coordinate their activities alongside and with each other.