Summary
The multiple middle: managing in healthcare
Lieke Oldenhof
Aim: Conventionally middle management in healthcare is conceptualized as a fixed position in the organizational hierarchy: i.e. a space in between the work floor and higher management. The dissertation’s central aim is to open up the middle by showing its multiplicity, thereby gaining new insights in day-to-day work of middle management and important transitions in this work.
Method: Ethnographic methods were used to explore mundane routines and embedded perceptions of actors. Middle managers were shadowed during daily work. To deepen the empirical analysis, ethnographic observations were triangulated with semi-structured interviews and document analysis. Sensitizing concepts were used to focus on specific aspects of work, such as ‘values’, ‘justifications’, ‘boundaries’.
Findings/conclusion: The empirical analysis sheds light on the work that is conducted ‘in the middle’ of conflicting values, justifications, organizational boundaries and managerial/professional discourses. Different types of work are conducted in the multiple middle: i.e. valuation work, justification work, boundary work, articulation work and professionalization work. The dissertation also shows that increasingly managerial work is being distributed to professionals and clients, thereby moving towards more collective forms of management.