Alternatives to a bureaucratic structure for the national health service. The point of view of a nurse.

Marta Lima Basto


Bureaucracy is characterised by rules, specific sphere of competence, hierarchy, specialized training, separation from means of production or administration and the recording in writing. The NHS is not a typical bureaucratic organization, but it has some of its characteristics. The alternative models (democratic, matrix-type structure) do not seem to respond to the need for change. It is suggested that the characteristics of an organization’s structure be treated as variables. Partial alternatives are discussed. The relationship between the goals, the users and the workers - workers and users’ participation in the planning and control of the NHS. Conflict as a motor for change. Controlling power - representatives of the community and of the workers. The person in the organization - involvement of all workers in management at different levels and the development of persons towards their full capacity. The case is made for the person-centered approach to management.

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