Emerging Identity- and Control-Based Arrangements Between Hospital Directors, Chief Physicians, Practitioners and Patients: The Case of the German Public Health Sector.

While the classic professional bureaucracy (Mintzberg 1983) was said to have relatively rigid boundaries, the contemporary field of hospitals is marked by increasing and tightening external network activities (Scott et al. 2000: 60). Due to rising economic pressure that German hospitals are facing, former stakeholders are no longer taken for granted. Specific patient groups (e.g. private patients or patients with more complex and therefore economically profitable diseases) and doctors in private practice who work close to the hospital are now becoming much more relevant. However, what kind of implications this has for the involved actors, in terms of the actual networking activities and identity constructions, remains unclear. In-depth-interviews with chief physicians and hospital directors were conducted to analyze what actual identity attributions and control arrangements (White 2008) are being deployed between hospital directors, chief physicians, practitioners and patients within the given network structure.

There are at least three results that shall be presented on occasion of the session:

1. Through joint control projects by hospital directors and chief physicians (e.g. legal acquisition of a private practice license for the respective chief physician) both manage to sustain their economical identity (as director) and professional autonomy (as physician).
2. Increasing networking activity between chief physicians and doctors in private practice may lead to “switching” of contexts which in turn leads to a change of identities. Some chief physicians perceiving themselves as network actors try to grasp the "logic” of the doctors in private practice in order to integrate it into their own actions.
3. Patients are commonly referred to as dependent and uninformed who therefore follow the advice of their doctors in private practice when it comes to select their hospital of choice. In some instances though patients are able to develop a kind of complaining power that influences the doctor’s decisions.