title: Professional responses to post bureaucratic hospital reforms and their impact on care provision.
abstract: BACKGROUND
  Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers.
  
  
  OBJECTIVE
  To explore experiences of post bureaucratic hospital reforms and their impact on care provision.
  
  
  METHODS
  Data builds on nine mini group interviews with midwives (n=three), nurses (n=three) and physiotherapists (n=three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy.
  
  
  RESULTS
  Two overarching themes were identified: 'Time, tasks and institutional duties' which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. 'Managerial control of work' which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures.
  
  
  CONCLUSIONS
  The institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others.
authors: Midwifery Program, Department of Nutrition and Midwifery, Faculty of Health and Technology, Metropolitan University College, Sigurdsgade 26, 2200 Copenhagen N., Denmark. Electronic address: hejo@phmetropol.dk.
authors: Helle
authors: H
authors: Johnsen
mesh_terms: D005260:Female; D017144:Focus Groups; D018166:Health Care Reform; D006761:Hospitals; D006801:Humans; D007400:Interprofessional Relations; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration*; D024802:Nurse's Role; D009774:Obstetrics; D018802:Patient-Centered Care; D011247:Pregnancy; D017009:Professional Autonomy; D036301:Qualitative Research
keywords: Bureaucracy; Managerialism; Professionalism; Protocol-based care; Woman centred care