SPECIALTY HOSPITALS AND COMMUNITY HOSPITALS

Specialty Hospitals and Community Hospitals

Specialty Hospitals and Community Hospitals

Professional health care today is generally provided through formal organizations. A patient's visit to a doctor in her or his office may involve booking an appointment, retrieving, updating and refiling personal medical records, issuing bills or prescriptions that have to be processed by other organizations and other administrative activities; all expected to be conducted according to established organizational procedures. Modern health care professionals deliver care that is embedded in complex networks of other workers: for example, receptionists, clerical workers, cleaners, technicians, accountants and especially managers who are formally responsible for co-ordinating all these activities. Moreover, individual health care institutions and locales for care may themselves be linked in networks and wider organizational structures, for example, a state health system such as the NHS or a multinational commercial company running a chain of hospitals. Studies of patients' interactions with professionals, inter-professional relations, the introduction of new medical technologies, inequalities in access to care, the role of the state in health care and professional regulation are all, at least in part, studies of organizational processes and structures. So, in one sense, the sociological study of formal health care is the study of health care organization. However, the concept of organization itself has not been especially prominent within medical sociology for much of the past three decades (Davies, 2003), in marked contrast to the situation in the 1960s (Armstrong, 1998).

In the 1960s, the hospital as a social organization was a major topic of enquiry within medical sociology, as demonstrated in an important collection edited by Freidson (1963). This interest was not surprising. At the time, the hospital was almost universally regarded as being the central location for health care, with primary and community care relatively neglected in policy and in sociological analysis. Moreover, hospitals appeared to be particularly interesting organizations from a sociological perspective. A key concept in organizational sociology at the time was bureaucracy, as developed from the work of the leading early twentieth-century sociologist, Max Weber. Weber argued that, in industrialized societies, bureaucracy had become the dominant mode of formal organization, because it embodied the type of authority accorded greatest legitimacy in such societies. Weber termed this type of authority 'rational-legal authority', that is, socially accepted power based on rules and regulations enacted by law or equivalent formal processes. According to Weber, a model bureaucracy (what he termed an 'ideal type') had a number of key features, for example, a hierarchy of positions, with specified functions, organized into a single control and disciplinary system. The occupants of positions were recruited and promoted on merit, worked full-time and were paid by salary.

The formal structure of hospitals, in most parts of the Western world in the 1960s, diverged from this bureaucratic model in significant ways. Although there were hierarchies of positions, notably for nursing and administrative staff, there was not a single authority line: recruitment, promotion and disciplinary structures generally being organized by professional groups within the hospital, or even ...