Professional practice. A framework for transition to a new culture

The reorganization of healthcare systems has largely focused on the redesign of clinical management structures with little emphasis on the systems that are essential to support professional practice and quality of care. This article describes the unique process of designing a framework that clearly articulates the essential elements of professional practice. The framework was crucial in clarifying account-abilities and role relationships between the clinical management and professional practice structures in the design and implementation of a major reorganization at Toronto East General Hospital, a 400-bed community teaching hospital in Toronto, Canada.