Managing Professional Work: Three Models of Control for Health Organizations

This chapter describes the primary rationale, the support structures that have fostered its development, the key structural features and the advantages and disadvantages of each arrangement. From a sociological point of view, there are three primary arrangements for structuring the work of professional participants within organizations. The chapter discusses each of these structural types as a vehicle for describing and assessing the relation between physicians and administrators, and to a lesser extent, trustees in US hospitals. It also describes the rationale, the support structures that have fostered its development, the organizational features, the advantages—and for whom they are such—and the problems or issues associated with its operation. Heteronomous professional organizations appear to be conventional bureaucratic structures with horizontal division of labor— usually along functional lines—and vertical hierarchies to direct and coordinate the flow of work. However, there are also important differences between bureaucratic and heteronomous forms.