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2013 | t. 14, z. 10, cz. 1 Współczesne problemy zarządzania w ochronie zdrowia z perspektywy systemu i organizacji | 215--227
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Perspective of Control in the Light of Professional and Managerial Role within Health Care Organisations

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The medical profession has always a high degree of autonomy. However, the rapid growth of health care costs that has started in the second half of the last century, has forced governments to tighten the control over medical practice and introduce managers into medical organizations, and also to induce competitive forces in health care systems. However, there is no conclusive evidence that the juxtaposition of bureaucratic and market control mechanisms with the autonomy of the medical profession has led to cost reduction. These actions strengthened, however, the conflict between the role of a manager focused on cost control and the role of a doctor directed towards quality control. One of the key area where the control mechanisms have low efficacy, is treatment of patients with multi chronic conditions, as in this case, the coordination of the therapeutic process must include the alignment of actions of various specialties. At the organization level bureaucratic mechanisms of coordination dominated, at the specialty/ward level clan mechanisms within the therapeutic team are functioning. However, in the spaces between autonomous teams of specialists neither bureaucratic mechanism nor clan mechanism of control is effective. From the literature review appears, that the medical profession response to tighter control is a combination of defensive mechanisms. Therefore, it seems that the chance of improving health care effectiveness is not the strengthening of control, but the cultural changes within medical profession resulting affirmation of cost control behaviour. (original abstract)
  • Wojewódzki Szpital Rehabilitacyjny dla Dzieci w Ameryce
  • Abbott A. (1988), The system of professions, London: The university of Chicago Press.
  • Abernethy M. A. (1996), Physicians and resource management: the role of accounting and non-accounting controls, "Financial Accountability & Management", z. 12(2).
  • Abernethy M. A., Chua W. F. (1996), A field study of control system "redesign": the impact of institutional processes on strategic choice, "Contemporary Accounting Research", z. 13(2).
  • Abernethy M. A., Horne M., Lillis A. M. Malina M. A., Selto, F. H. (2005), A multi-method approach to building causal performance maps from expert knowledge. "Management Accounting Research", z. 16(2).
  • Abernethy M. A., Lillis, A. M. (2001), Interdependencies in organization design: a test in hospitals, "Journal of Management Accounting Research", z. 13(1).
  • Abernethy M. A., Stoelwinder J. U. (1991), Budget use, task uncertainty, system goal orientation and subunit performance: a test of the "fit" hypothesis in not-for-profit hospitals, "Accounting, Organizations and Society", z. 16(2).
  • Abernethy M. A., Stoelwinder, J. U. (1995), The role of professional control in the management of complex organizations. Accounting, "Organizations and Society", z. 20(1).
  • Abernethy M. A., Vagnoni E. (2004), Power, organization design and managerial behaviour, "Accounting, Organizations and Society", z. 29(3-4).
  • Abernethy M., Chua W.F., Grafton J., Mahama H. (2007), Accounting and Control in Health Care: Behavioural, Organisational, Sociological and Critical Perspectives [w:] Chapman S., Hopwood A.G., Michael D., Shields R. (red.), Handbook of Management Accounting Research Edited by Christopher, Elsevier Ltd.
  • Abernethy M.A., Brownell P. (1997), Management control systems in research and development organizations: the role of accounting, behavior and personnel controls, "Accounting, Organizations and Society", z. 22.
  • Adamiecki K. (1985), O nauce organizacji, PWE, Warszawa.
  • Aidemark L.G. (2001), The meaning of balanced scorecards in the health care organisation, "Financial Accountability & Management", z. 17(1).
  • Anderson G. (2011), The latest disease burden challenge: People with multiple chronic conditions, [w:] OECD, Health Reform: Meeting the Challenge of Ageing and Multiple Morbidities, chapter 1. Paris: OECD Publishing,.
  • Correia T. (2013), The interplay between managerialism and medical professionalism in hospital organizations from the doctors' perspective: a comparison of two distinctive medical units, "Health Sociolgy Review", z. 22(3).
  • Covaleski M. A., Dirsmith M. W. (1983), Budgeting as a means for control and loose coupling, "Accounting, Organizations and Society", z. 8(4).
  • Covaleski M. A., Dirsmith M. W., Michelman J. E. (1993), An institutional theory perspective on the DRG framework, case-mix accounting systems and health-care organizations, "Accounting, Organizations and Society", z. 18(1).
  • Davies H.T.O., Harrison S. (2003), Trends in doctor-manager relationships, "BMJ", 326(7390).
  • DeAngelis C. D. (2005), Rainbow to dark clouds, "JAMA".
  • Dixon-Wood M., Yeung K., Bosk C.L. (2011), Why is UK medicine no longer a self-regulating profession? The role of scandals involving "bad apple" doctors, "Social Science & Medicine", z. 73.
  • Eldenburg L. (1994), The use of information in total cost management, "The Accounting Review", z. 69(1).
  • Etzioni A. (1965), Oganizational control structure, [w:] J.G. March, (red.), Handbook of organizations, Rand McNally, Chicago, III.
  • Freidson E. (1970), Professional Dominance: The Social Struciure of Medical Care, Atherton: New York.
  • Freidson E. (1975), Doctoring Together: A Study of Professional Social Control, University of Chicago Press: Chicago.
  • Freidson E. (2001), Professionalism: The Third Logic, Chicago, IL: University of Chicago Press.
  • Hatch M.J. (2002), Teoria organizacji, PWN, Warszawa.
  • Johnson T. J. (1977), The Professions in the Class Structure, [w:] Scasc, R. (red.), Industrial Society, Class, Cleavage and Control,(London: Allen & Unwin.
  • Jones C. S. (2002), The attitudes of British National Health Service managers and clinicians towards the introduction of benchmarking, "Financial Accountability & Management", z. 18(2).
  • Kim K. K. (1988), Organizational coordination and performance in hospital accounting information systems: an empirical investigation, "The Accounting Review", z. 63(3).
  • Koontz H., O'Donnell C. (1969), Zasady zarządzania. Analiza funkcji kierowniczych, PWN, Warszawa.
  • Kuhlmann E. (2006), Traces of Doubt and Sources of Trust: Health Professions in an Uncertain Society, "Current Sociology", z. 54, DOI: 10.1177/0011392106065092.
  • Kuhlmann E. (2008), Governing beyond markets and managerialism: professions as mediators, [w:] Kuhlmann, E., Saks, M. (red.) Rethinking professions. International direction in healthcare, Bristol: Policy Press.
  • Kuhlmann E., Burau V. (2008), The 'Healthcare State' In Transition: National and international contexts of changing professional governance, "European Societies", R. 10, z. 4, nr 633, (DOI: 10.1080/14616690701871886).
  • Kuhlmann E., Burau V., Correia T., Lewandowski R., Lionis C., Noordegraaf M., Repullo J. (2012) Hospital Control Assessment Framework (H-CAF)© . [online], dostęp: 15 maja 2013.
  • Kuhlmann E., Burau V., Correia T., Lewandowski R., Lionis C., Noordegraaf M., Repullo J. (2013), "A manager in doctors' mind": A comparison of new modes of control in European hospitals, "BMC Health Services Research"13:246.
  • Kuhlmann E., Burau V., Larsen C., Lewandowski R., Lionis C., Repullo J. (2011), Medicine and management in European healthcare systems: How do they matter in the control of clinical practice?, "International Journal of Clinical Practice", z. 65(7).
  • Lambert, H., Gordon, E. J., Bogdan-Lovis, E. A. (2006), Introduction: Gift horse or Trojan horse? Social science perspectives on evidencebased health care, "Social Science and Medicine", z. 62.
  • Lamothe L., Dufour Y. (2007), Systems of interdependency and core orchestrating themes at health care unit level, "Public Management Review", z. 9(1).
  • Lewandowski A. R. (2011c), Zaufanie w ochronie zdrowia, "Współczesne zarządzanie", z. 1.
  • Lewandowski R. (2008), Wykorzystanie Zrównoważonej Karty Wyników w organizacjach ochrony zdrowia - studium przypadku, "Współczesne Zarządzanie", z. 4.
  • Lewandowski R. (2009), Zastosowanie Zrównoważonej Karty Wyników i Modelu Doskonałości EFQM w publicznych organizacjach ochrony zdrowia, "Przegląd Organizacji", z. 4.
  • Lewandowski R. (2011b), Wpływ poziomu zaufania na korzyści uzyskiwane przez wybrany polski szpital, "Ekonomika i Organizacja Przedsiębiorstwa", nr 1(732).
  • Lewandowski R.A. (2011a), Trust in Health Care: Susceptibility to Change [w:] Organizational Relations as a Key Area of Positive Organizational Potential, (red.) Chodorek M., Wydawnictwo Naukowe Uniwersytetu Mikołaja Kopernika, Toruń.
  • Martinussen P., Magnussen J. (2011), Resisting market inspired reform in health care: The role of professional subcultures in medicine, "Social Science & Medicine", z. (73)
  • Mia L., Goyal M. (1991), Span of control, task interdependence and usefulness of MAS information in not-for-profit government organizations, "Financial Accountability & Management", z. 7(4).
  • Modell S., Lee A. (2001), Decentralization and reliance on the accountability principles in the public sector, "Financial Accountability & Management", z. 17(3).
  • Moran M., (1999), Governing the Health Care State, United Kingdom, [online],, dostęp: 40 kwietnia 2013.
  • Moryś J. (2012), List otwarty-raport Rektora Gdańskiego Uniwersytetu Medycznego do Przewodniczącego Rady Pomorskiego Oddziału Narodowego Funduszu Zdrowia, "Rynek Zdrowia" [online],, dostęp: 4 maja 2013.
  • Nogalski B., Apanowicz J., Rutka R., Czermiński A., Czerska M. (2002), Zarządzanie organizacjami, TNOiK. Toruń.
  • Noordegraaf M. (2011), Risky business: How professionals and professional fields (must) deal with organizational issues, "Organization Studies", z. 32(10).
  • Nyland K. & Pettersen I. J. (2004), The control gap: the role of budgets, accounting information and (non-) decisions in hospital settings, "Financial Accountability & Management", z. 20(1).
  • Orlikowski W. J. (1991), Integrated Information Environment or Matrix of Control? The Contradictory Implications of Information Technology, [online] http://dspace., dostęp: 28 kwietnia 2013.
  • Ouchi W.G. (1979), A conceptual framework for the design of organizational control mechanisms, "Management Science", z. 25.
  • Ouchi W.G. (1980), Markets, Bureaucracies, and Clans, "Administrative Science Quarterly", z. 25.
  • Plochg T. (2013), Reconfiguring health professionalism towards addressing multimorbidity, Eurohealth2013, z. 19(2).
  • Purdy D. E. (1993), Accounting, controls, change and the perceptions of managers: a longitudinal study of ward units in a teaching hospital, "Financial Accountability & Management", z. 9(1).
  • Relman A. S. (2008), Medical professionalism in a commercialized health care market, "Cleveland Clinic Journal Of Medicine", z. 75, Supplement 6.
  • Relman A.S. (2001), Separating continuing medical education from pharmaceutical marketing, JAMA", z. 285.
  • Saks, M. (1999), Professions, markets and public responsibility, [w:] M. Dent, M. O'Neill and C. Bagley (red.), Professions, Public Management and the European Welfare State, Stafford: Staffordshire University Press.
  • Salter B. (2007), Governing UK medical performance: A struggle for policy dominance, "Health Policy", z. 82.
  • Saltman R.B., Durán A., Dubois H.F.W. (Eds.) (2011). Governing public hospitals. Copenhagen: WHO, [online], file/0017/154160/e95981.pdf, dostęp: 25 kwietnia 2013.
  • Samuel S., Dirsmith M. W., McElroy B. (2005), Monetized medicine: from the physical to the fiscal, "Accounting, Organizations and Society", z. 30(3).
  • Tannenbaum A. (1968), Control in Organisations, McGraw-Hill, New York.
  • Turner, B. S. (1995), Medical Power and Social Knowledge (2nd edition), London: Sage.
  • Von Knorring M., von de Rijk A., Alexanderson K. (2010), Managers' perceptions of the manager role in relation to physicians: A qualitative interview study of the top managers in Swedish healthcare, "BMC Health Services Research", 10:271, http://
  • Waring J., Currie G., (2009), Managing expert knowledge: Organizational changes and managerial futures for the UK medical profession, "Organization Studies", z. 30(7).
  • Weber M. (1947), The Theory of Social and Economic Organization. Translated By A. M. Henderson And Talcott Parsons, New York Oxford University Press (http://, dostęp: 2 maja 2013.
  • Zieleniewski J. (1972), Organizacja zespołów ludzkich, PWN, Warszawa.
  • Zucker L. G. (1991), Markets for Bureaucratic Authority and Control: Information Quality in Professions and Services, Research in the Sociology of Organizations", z. 8.
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