Ledelse på tværs i de danske sygehuse

Healthcare organizations are challenged by complexity in structure and knowledge, and
heterogeneity in deliveries and patient demands. Reductionist managerial approaches fall
short in resolving the quality issues of healthcare, but Scientific Management and New
Public Management (NPM) nevertheless has a strong hold on leadership thinking in hospitals. Increasing demand for adaptive and collaborative capacity emphazises the need to
rethink the way we organize and lead these organisations. We conducted semi-structured
interviews, examining the organizational and leadership thinking of 14 key decision makers, hospital directors and ward leaders, holding a key role in planning and implementing
new organisational structures in the Region of Southern Denmark. Informants stress the
organizational complexity, and the need for better coordination and collaboration across
boundaries. In contrast, they present leadership discourses that are grounded on hierarchical positions and individual agency. Hospitals are complex organisations characterised
by extensive bureaucracy, struggling with quality issues, attributable to rigid organisational boundaries and the dominant SM and NPM thinking. We show that an organisational change meant to address this problem is not accompanied by a similar change in
leadership constructs, and we offer ideas of complexity leadership, enhancing relational
coordination, adaptability and flexibility.