Formalizing Leadership Hierarchies, Dividing Professional Organizations
This paper examines how a formal reconfiguration of the management structure within Danish public hospitals has reshaped professional leadership hierarchies among medical doctors. Triggered by a 2021 union agreement, the reform mandated a new managerial position between senior consultants and clinical directors, thereby restructuring the professional landscape and altering career pathways. Using the concept of formal organization, this study explores how the new management hierarchy influences doctors’ professional identities and inter-hierarchical relationships, thereby challenging the traditional distinction between ‘knowledge elites’ and ‘administrative elites’ in healthcare (Freidson, 1985; Waring, 2014).
Based on qualitative group interviews with doctor-managers at three Danish hospitals, this paper reveals how formalized managerial positions have introduced new value conflicts, impacting doctors' perceptions of good leadership and professional status. Theoretically, the study combines literature on professional (re)stratification with pragmatic studies of valuation to elucidate how the reform redefines the boundaries of professional jurisdiction, highlighting the consequences of integrating formal organization elements in a domain where informality and professional autonomy have traditionally prevailed.
This case study underscores the enduring relevance of formal organization in structuring and mediating complex professional relations. This study contributes to understanding the societal and organizational implications of formalizing professional work, particularly in how such shifts affect inter-professional boundary negotiations and the enactment of formalized roles in healthcare settings.