Reasoning bureaucracy in professional organisations: Enabling conditions for professional and bureaucratic values to merge in hospitals

Abstract

Bureaucratic values are routinely believed to clash with professional values in professional organisations, and bureaucratisation is equated with being a top-down phenomenon. In contrast, this article contributes to theory on bureaucracy by analysing hospital departments where frontline professionals have actively implemented bureaucratic elements, thereby limiting their individual professional autonomy. For this type of frontline bureaucracy to take place, we identify two enabling conditions for bureaucratic and professional values to merge: healthcare professionals perceive the bureaucratic element as appropriate (make clinical sense, serve a specific end and involve key stakeholders) and effective (improve care coordination and support work relations). Our analysis shows that frontline professionals implement the bureaucratic elements to build a scaffold for collaboration. This type of bottom-up, micro-level bureaucracy aligns and breaks with a top-down, macro-level understanding of bureaucracy. Our study has theoretical implications for the understanding of hybrid bureaucracy in professional organisations and holds practical insights for how frontline professionals can simultaneously harness bureaucratic and professional values.