Reengineering Organizational Form and Process: The Old Shapes the New
This chapter concentrates on the relationship between reengineering and organizing arrangements within the hospital. The first half of the chapter further develops the argument that the choices and actions of managerial and other agents are mediated by the same cognitive and relational structures that these choices and actions collectively attempt to modify. The second half relates this argument with the reengineering within the largest clinical directorate in the hospital — the medical directorate. The chapter presents a brief history and context of the medical directorate and discusses the changes and new establishments that occurred in each phase. The reported effects of reengineering on such aspects as gastroenterology, emergency medicine, cardiovascular services and the like are summarized to view the degree of the specific impacts made. The organization of clinical work within the medical directorate displayed important elements of stability.
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