The Social Structure of a General Hospital

Abstract

Hospitals are among the most complex organiza tions in modern society, characterized by extremely fine divi sion of labor and an exquisite repertory of technical skill. The major hospital embraces multiple goals, chiefly patient care, teaching, and research. It is at once a hotel, a treatment center, a laboratory, a university. Because the institution's work is so specialized, staffed by a variety of professional and technical personnel, there are very important problems of co-ordination and authority. Paramount in the social structure are relation ships between patients and hospital staff and among staff members. The patient, both client and product of the organ ization, enters a therapeutic situation in which his style is largely passive. He encounters the physician—like himself, a "guest" of the hospital—and the nurse, who is the full-time symbol of the organization's atmosphere. The physician is undergoing a shift from his older charismatic role toward a more nearly bureaucratic niche in the hospital. Staff relation ships are distinguished by unclear patterns of authority and intense competition for spheres of competence and prestige. The physician is implicated as the professional least amenable to hierarchical control and the leading figure in skill and status. Although the hospital illustrates vital, unresolved issues in the organization of work, it flourishes under the impetus of professional zeal and patients' needs.