[Unified management in Norwegian hospitals--still controversial?].

BACKGROUND

The Norwegian parliament's decision to establish unified management on all hospitals units was accompanied by strong public debate. The arguments focused especially on the decision that other than doctors could fill the top managerial position at the department level. We have studied the selection of managers, the prevalence and content of disagreements and conflicts, and how the departments handled the conflicts.

MATERIAL AND METHODS

We have used three data sets: a survey of the top managements at all hospitals, interviews with 28 managers, and a survey of a sample of managers at the department level.

RESULTS AND INTERPRETATIONS

In 2004, about 67% of the managers were doctors, 28% were nurses and 5% had other professional backgrounds. Managers educated as nurses were most prevalent in psychiatric wards and in emergency medicine. About half of the hospitals and departments had experienced conflicts when implementing the reform. Confusion about medical responsibility and resistance towards the manager not being a doctor seemed to be most common. With some exception, the conflicts have calmed down, probably because of some clarification from the Ministry of Health about the managers' medical responsibility; also, departments with managers who not are doctors have established a division of labour that satisfy the doctors in the department.