ABSTRACT
This chapter sets out a framework based on a theoretical model that enables people to understand why these issues arise and how to better deal with them A number of the key characteristics of a professional bureaucracy apply to doctors within healthcare organisations. A professional bureaucracy is characterised by the power of expertise. Doctors share a large amount of specialised knowledge with one another4 that has been inaccessible to others within healthcare organisations and to patients. The professionals' power is legitimised through professional validation by a community of their peers. In turn, this means that organisational configurations and structures with strong management or strategic control, where the work processes and outputs are standardised, are difficult to apply. Clinicians' acceptance of personal responsibility for patients and their sociolegal authority, are important additional factors. Management within the National Health Service (NHS) was originally expected to support the work of professionals by organising and providing resources.
