Hospitals as Bureaucracies
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Hospitals as Bureaucracies book
There are several important features of the bureaucratic approach to organizations in general, and hospitals in particular, contained in the assumption that organizations may be viewed as “microsocieties.” From such a point of view, hospitals are assumed to be self-contained and to have definitive boundaries which clearly demarcate them from other social institutions. The microsociety approach to organizations is imbedded in the assumption that organizations are rational plans for the achievement of specific ends. Satisfactory criteria of efficiency constitute a further important element. These prime conditions are related in the following way: The presumption of definitive organizational boundaries is a prerequisite of organizational efficiency to the extent that the presence of impermeable boundaries enhances the rational pursuit of specific organizational ends. A third distinguishing feature of the microsociety approach lies in the fact that the classical Weberian conception of organizations does not contain the analytic tools required to incorporate either organizational operatives or organizational clientele. This is so because Weber’s analysis of bureaucracy was geared principally to a concern with administration—organization for work—rather than to the actual performance of work. Hence a parody of such a study of hospitals would yield a description of a hospital unrelated to the larger social order in which it resides, which operates with reference to uniformly applied criteria of efficiency and rationality, which contains no doctors or 50nurses except as they are involved in the administration of work rules, and finally, a hospital which has no patients.