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The conflict between professional and bureaucratic models of behaviour has long been recognised. Evidence provided in the professional/bureaucratic literature indicates that this conflict will impact on the effectiveness of management control systems when dominant professionals, such as physicians, are incorporated into bureaucratic organisations. This article elaborates Mintzberg′s (1979) professional bureaucracy model and empirically examines a number of propositions concerning the way in which activities are controlled and coordinated in hospitals. An analysis of 192 subunit managers in four large Australian teaching hospitals indicated significant differences in the use of control and co‐ordinating mechanisms by health care professionals who manage core operating subunits and managers of subunits which provide support services. These differences do not all follow the predictions of Mintzberg′s model.

Mergers are important and challenging elements in hospital reforms. The authors study the social aspects of management and the roles of middle managers in the aftermath of a hospital merger. Especially, the purpose of this paper is to investigate how professional staff and middle managers perceive their relationships with top managers several years after the merger.

A survey was conducted among the professional staff in two merging hospitals’ units six years after a merger. Based on the main findings from this survey, a follow-up interview study was done with a group of middle managers.

The management practices were diagnostic with few interactive or communicative activities. The respondents expressed that mistrust developed between the staff and the top management, and a lack of involvement and interaction lead to decoupled and parallel organizations. Social controls, based on shared norms, had not been developed to create mutual commitment and engagement.

Policy makers should be aware of the need in profound change processes not only to change the tangible elements, but to take care of changing the less tangible elements such as norms and values. Professionals in hospitals are in powerful positions, and changes in such organizations are dependent on trust-building, bottom-up initiatives and evolutionary pathways.

The paper addresses the need to understand the dynamics of the social aspect in managing hospitals as knowledge-intensive organizations when comprehensive restructuring processes are taking place over several years.

This paper presents a study which goes beyond the process of constructing performance measures in hospital Intensive Care Units (ICUs). The making of input-output measures in ICUs should be based on richer information than statistics normally found in the hospitals' patient administrative systems. A study of national sample of ICUs was conducted in Norwegian hospitals to analyse the relations between abstract and more concrete measures of unit performance. We found that there are not necessarily conflicts between abstract perceptional measures and more concrete efficiency measures in high-reliability organisations like ICUs. Reliable performance requires a well-developed collective mind to form an attentive, complex system tied together by trust. To improve health care management more attention should be directed towards the practical implications of the interrelationships between different elements of performance measures.