1. Managing a complex hospital organisation through diverse management teams European Health Management Association (EHMA) Annual Conference June 26th Athens, Greece Lauri Kokkinen University of Tampere

2. Content of the presentation The Context Research Question Material and Methods The Results Discussion

3. The Context Finnish health care works according to the basic principles of of Nordic Welfare Model Municipalities have a great responsibility in arranging health care services Here we have studied one central hospital owned by several municipalities The hospital takes care of about 200 000 inhabitants specialised medical care

4. The Context In theoretical perspective the hospital organization studied here follows closely to Max Webers theory of ideal bureaucracy - Contrary to theory functions are thought organized as functional profit areas and units Because of that decision making is more decentralized than in ideal bureaucracy - The work of management teams in organizations different levels is highlighted

5. The Context In the written strategy of the studied hospital a lot of attention is paid in enforcing the co-operation between different activity areas and units - Strategic concentration is in processes inside the hospital organization Despite this the structure of the organization has not been changed towards for example matrix or boundaryless organization

6. Research Question Here we look at the work of management teams that are originally formed highlighting the traditional boundaries between hierarchical levels and line organizations The research question is: How are management teams used to meet the strategic goal of horizontal co-operation?

7. Material and Methods We studied 8 of the hospitals management teams in three different levels Top management team Activity area level management teams Unit level management teams

8. Material and Methods We videotaped 3 meetings from each management team We interviewed members of them We are using material based content analysis and observation based content analysis to analyze the materials

9. The Results A lot of time and human resources were spent for taking part in the management teams 8-20 persons per team 1-3 hours per meeting 1 or 2 times a month

10. The Results Construction of the management teams was diverse: On the upper level the management teams were larger there were more men in them they were led by men In the unit level there were more nursing managers in the management teams they were led by women

11. The Results Generally there was no willingness to develop the routiined ways of working in the management teams Many individuals saw their membership in a management team only as an obligation - management was not valued by health care professionals

12. The Results All the action areas and units acted like their own special field was the most important one in the organization Synergy inside management teams was mostly neutral - sometimes positive or negative The goal for the work of management teams below top management team was rather sharing of information than collective performance of the teams

13. The Results Different action areas and units saw themselves as competitors Meetings of the management teams included conflicts concerning allocation of resources Protecting interests of the own special field seemed more important than addressing the overall goals of the organization

14. The Results Management teams were not seen as forums of horizontal co-operation Things concerning horizontal co-operation were said to be discussed in non-official forums

15. Discussion Specialization always creates subunit conflicts - The management teams are a place to protect the interests of different action areas and units There will always have to be some degree of partial optimization inside the hospital organization to keep it functioning

16. Discussion Could management teams be a tool to help managers to understand the effects of the decisions made in their areas and units to the organization as a whole - Yes Could management teams as central coordination devices help break down the horizontal barriers - No?

17. Discussion To cut through horizontal barriers: Employees could be rotated into and out different action areas and units - Would turn specialists into generalists Organizational structure should be changed following the strategy!

18. Discussion There are plenty of studies concerning construction and characteristics of management teams - But not about the real life of management teams work Here I tried to answer for one question only using our interviews and video material The results will be published more broadly elsewhere

19. Our research group also includes: Professor Elina Viitanen, University of Tampere Researcher Juha Virtanen, University of Turku

20. Thank you! lauri.kokkinen@uta.fi