Hospital organisation and structure and its effect on inter-professional behaviour and the delivery of care

Some form of organisation within and between hospitals is necessary to provide effective and integrated care to patients, to ensure that medical, nursing and paramedical services develop efficiently and coherently, and to ensure that needs of the community are met. However research into the design of structures for the provision of hospital services has been remarkably limited considering the transformation of hospital work in recent decades. The absence of clearly articulated models of organisation and lack of consensus on the relevant data make needed comparative studies difficult to mount. Nevertheless systematic empirical and evaluative studies of matters like appropriate limits to authority, working of intraprofessional hierarchies, management of clinical autonomy, and the effects of interprofessional rivalry on patient-care seem both feasible and desirable. Many studies bearing directly on these topics take the form of inquiries mounted within government departments or by professional groups with an interest in the outcome.