Rivers P A, Woodard B, Munchus G
Department of Health Services Administration, University of Alabama, Birmingham, USA.
Health Serv Manage Res. 1997 May;10(2):91-106. doi: 10.1177/095148489701000110.
The purpose of this paper is to provide a critical review of organizational power and conflict regarding the hospital-physician relationship. The issue of power being symbolic and/or substantive is discussed. The classification (Mintzberg Model) of organizations as simple structures, machine bureaucracies, professional bureaucracies, divisionalized forms and adhocracies are reviewed. Also, the issue of whether the perceived autonomy that professional employees enjoy increases the likelihood that an executive level manager in a professional bureaucracy (hospital entity) will devote substantial attention to influencing symbolic outcomes as opposed to substantive outcomes in a machine bureaucracy is discussed. In conclusion, conflicts between hospitals and physicians can be resolved in two ways: (1) by avoiding controversial decisions that might threaten the powers and prerogatives of professional groups; and (2) by agreeing to decisions that hold something for everyone involved in the hospital-physician power relationship.
本文旨在对医院与医生关系中的组织权力和冲突进行批判性审视。文中讨论了权力具有象征性和/或实质性的问题。回顾了组织的分类（明茨伯格模型），即简单结构、机械式官僚机构、专业官僚机构、事业部制形式和临时机构。此外，还讨论了专业员工所享有的感知到的自主权是否会增加专业官僚机构（医院实体）中的高管级经理相较于机械式官僚机构更倾向于投入大量精力影响象征性结果而非实质性结果的可能性。总之，医院与医生之间的冲突可以通过两种方式解决：（1）避免做出可能威胁专业团体权力和特权的有争议的决策；（2）就对医院-医生权力关系中所有相关方都有利的决策达成一致。
