Converging patterns in hospital organization: beyond the professional bureaucracy

This study builds a framework to investigate the current trends emerging in hospital organizational design and its main consequences on human resources management. The analysis derives from an extensive literature review, which shows over the last 30 years a significant lack of works on organization design for hospitals, and from a number of experiences in hospital settings, which provide useful insights on changes taking place in hospitals. We intend to contribute to the filling of the gap in literature created by the lack of interest scholars have shown on hospital organization. The framework we discuss depicts the major converging trends of reorganization that can be observed in hospital contexts of industrialized countries. What we found is that large multi-specialty hospitals--by large we mean hospitals over about 300 beds--located in different countries, though starting from different internal and external organizational and environmental features are mostly converging towards a common design scheme. We labelled that scheme the care-focused hospital and we analysed in-depth its features in the attempt to facilitate cross-national comparison, otherwise difficult due to the fact that organizational concepts are value loaded and tend to be culture-bound. Challenges and managerial implications of this more and more widely diffused organizational paradigm are debated in the last part of the study.