Managing professional organizations: conditions and levers to support managerial roles in public health care

The research focus of this dissertation lies in the analysis of enabling conditions and levers for supporting managerial role use in professional organizations, based on the case of Italian healthcare sector. The overarching framework of all chapters is that of Mintzberg’s tripartite classification of managerial work, including informational, interpersonal and decisional roles (Mintzberg 1971); moreover, contextual specificities are accounted for at both macro level, by employing an institutional approach (Thornton and Ocasio 2008), and meso level, building on scholarship in management and organization sciences on professional bureaucracies (Mintzberg 1989). The introductory chapter presents the results of a literature review about the role of professionals appointed with managerial roles working in public organizations. These organizational actors are expected to be the intersection and junction between the professional and managerial domains, and to add value by spanning organizational and professional boundaries. At the same time, their role urges them to cope with conflicts emerging from such complex organizational contexts. Existing scholarship on the role of hybrid professionals is reviewed and a classification of the emerging approaches is eventually presented. Chapter 2 investigates whether and how managerial training contributes to support the hybrid professionals’ (Noordegraaf 2007) ‘two-way window’ (Llewellyn 2001) role. In fact, investing on managerial training programs aims to empower professionals with managerial skills and competencies, but assessing the impact of such programs is still a limited practice. The chapter explores whether participation in managerial training programs in healthcare can enhance the involvement of clinical directors in top management decision-making, and investigates the mediation effects of knowledge of performance information and its use. The results of the study suggest that managerial training can support hybrid professionals in engaging with managerialism and playing upward influence on top management decision-making. Chapter 3 explores the role of information sharing and communication processes in the relationship between top management competencies, as perceived by professionals, and organizational performance. Results show that managerial competencies play a significant role on overall performance, and that communication and information strategies are key competences to be acquired and practiced throughout formal and informal channels. Chapter 4 investigates the impact that a set of managerial levers and job design features may have on the job satisfaction and work motivation of public healthcare professionals. By employing a mixed-method approach in order to triangulate observational, experimental and qualitative data from two public healthcare organizations, the study improves upon nascent research into job satisfaction and work motivation by disentangling context-invariant from context-specific determinants. Eventually, it is shown how the use of multi- or mixed methods may provide partially conflicting results, thus calling for their adoption in the investigation of complex research questions and ‘wicked problems’ in public sector management.