Progressively larger hospitals, departments, and workplace collaboratives, along with the constant development in the healthcare system and increasing demands on its services, have challenged hospital management. In an effort to improve conditions for hospital managements, the 2021 collective agreement for physicians introduced a new position structure. This structure provides the possibility to establish new positions for managing physicians, allowing them to, among other things, be assigned formal managerial responsibility for research, education, quality, staff and organizational units. The previous position of managing physician have changed to the position of clinical director with overall managerial responsibilities for the department. These changes potentially shift the distribution of formal managerial authority, implying that the management of the medical treatment of patients at hospital departments in the future will be handled by a management team including both managing physicians from the department and the clinical director. A key feature of the reform is that, within the overall framework, hospitals and departments have considerable autonomy to organize themselves in the way they believe makes the most sense.
Generally, there is a need for studies examining what influences the distribution of formal managerial authority in highly specialized public organizations, and how this distribution affects both managers and employees in these types of organizations. The implementation of the new hierarchical structure introduced through the 2021 collective agreement provides a unique opportunity to examine this.
Accordingly, the aim of this project is:
· To map how formal managerial authority in hospital departments is distributed following the implementation of the new hierarchical structure in 2023 as well as how this distribution develops leading up to 2026
· To examine which factors influence the distribution of formal managerial authority.
· To investigate how the distribution of formal managerial authority affects managers’ ability to exercise leadership, their leadership identity, and how well the new management teams function.
· To examine how the distribution of formal managerial authority influences employees’ view on the managers and their decisions
The above is examined through a survey conducted in 2023 among clinical directors, managing physicians, and physicians without managerial responsibility, as well as a follow-up survey among clinical directors, managing physicians in 2026. The 2023 survey is informed by an interview study and by previous research.
The project is managed by Professor Christian Bøtcher Jacobsen (christianj@ps.au.dk) and Assistant Professor Mathias Rask Østergaard-Nielsen (mathiasoestergaard@ps.au.dk). The first part of the project, which took place in 2023–2025, was conducted in collaboration with VIVE and the University of Southern Denmark, while the second part of the project, which will take place in 2026–2027, is conducted in collaboration with the University of Southern Denmark.
