Caring for the Carers: A Mintzbergian Kaleidoscope for a More Caring Bureaucracy in Hospitals

Contemporary hospitals face an enduring organisational paradox. Historically grounded in professional bureaucracies centred on clinical expertise and professional autonomy, they have increasingly incorporated New Public Management reforms that intensify administrative control, standardisation, and divisionalised financial logics. These dynamics produce what we term an infernal triad: the weakening of professional bureaucracy, the overextension of mechanistic coordination, and the dominance of divisionalised structures, with detrimental consequences for both patient care and staff well-being. While hybrid models—such as the caring bureaucracy—have been proposed as remedies, they remain weakly operationalised. This article advances a practice-based reconceptualisation of hospital coordination by introducing the concept of structural pluralism. Drawing on a single-case study of a Swiss hospital organised as a decentralised, community-oriented network, we theorise structural pluralism through a Mintzbergian kaleidoscope, showing how hospitals rely on the simultaneous coexistence of multiple, practice-specific bundles of coordination mechanisms rather than converging toward a dominant structural configuration. Our findings show that a caring bureaucracy emerges not as a stable form, but as a situated and adaptive organisational design grounded in the selective leveraging of complementarities and containment of tensions across coordination mechanisms for heterogeneous practice. We provide five detailed empirical examples of such coordination bundles.