The challenged conscience: Moral predicaments of hospital frontline administrators in China's medical disputes

Although medical disputes have become a pervasive challenge in global healthcare systems, the role of hospital organizations in this process has received limited scholarly attention. In the Chinese context, existing research on medical disputes often treats hospitals as the background or monolithic actors, neglecting internal organizational dynamics. This article addresses this gap by examining hospital frontline administrators (HFAs), a pivotal group in resolving medical disputes. Drawing on the theory of street-level bureaucracy and ethnographic fieldwork, the study demonstrates how structural and working conditions, including conflicting institutional goals, resource constraints, and information asymmetry, generate acute moral predicaments for HFAs. These predicaments manifest as severe role conflicts, institutional suppression of empathy, and the normalization of habitual misrepresentation. The article further highlights that HFAs actively develop coping strategies to navigate these challenges, exercising different forms of agency within institutional constraints. By centering on HFAs, this study reexamines the complex role of hospitals in China's medical dispute resolution and provides broader sociological insights into the intersection of healthcare governance, moral ambiguity, and frontline administration.