Bureaucracy friend or foe? - organizing for social capital in hospitals

INTRODUCTION: A strong criticism of bureaucracy in hospitals has emerged during the last years. It is related to standard procedures, quality control systems, patient safety and performance management. The critique claims that professional judgement is getting jeopardized, limited resources are wasted, patient waiting time is extended and employee well-being reduced. But what is really the alternative? There may be too many standard procedures, but just removing them is obviously not possible. Our claim is that bureaucracy can positively influence organizational social capital if bureaucracy is used in enabling and participatory ways and thereby improve professional treatment and care, patient safety and performance. This theoretical paper presents key points about how organizational design can promote organizational social capital. We focus on locally formalized structures as they influence how people interact and managers have the ability to change it. This knowledge is important to hospitals as social capital is associated with, for instance, organizational performance and employee wellbeing.
THEORY: Organizational social capital is the collective resource that enables employees to work together to solve organizational tasks.Trust, collaboration skills and fairness are three central aspects. Organizational design concerns how the organization solves its tasks, and it is operationalized along the eight dimensions in the findings section.
FINDINGS: (1) Enabling and participatory management and hierarchy structures. (2) Collective incentive structures. (3) Develop role structures with a focus on coordination and transparency. (4) Team organization grouped by product (e.g., care pathways) and/or shared multidisciplinary tasks (the day’s surgery). (5) Collective competences, focusing on team skills. (6) Institutionalized meetings such as short standing kaizen meetings or timeout meetings during the day. (7) Artifacts which facilitates multidisciplinary collaboration such as whiteboards, kaizen boards, monitors and bedside records. (8) Integrated and interactive ICT such as intranet or electronic patient record systems used for instance during kaizen meetings.
CONCLUSION: Bureaucracy stands out as a foe of professionalism and employee well-being but it needs not be the case. On the contrary, in order to build and use the re-sources in organizational social capital a certain level of standardized structures and processes is necessary. The decisive point is that the bureaucracy is enabling and participatory.