Discovering informal aspects of German Hospitals

The informal aspect plays an important role as it offers a different way to overcome the rigidity of the formal structure. Although, according with the Organizational Theory, this requires a high grade of planning and control. In Germany, a process of economization has developed within hospitals and the change process in this complex organization, in accordance with some authors, corresponds with ongoing work organizational problems. We analyze the existence of non-regulated initiatives in labor organization aspects within North-east German Hospitals. Hence, problems, situations and/or challenges that tend to lead to informal actions, shall be analyzed. In this ongoing project, a methodological triangulation was chosen. In a first stage a quantitative study is accomplished, implemented by auto-administered questionnaires within hospitals. In a second stage, according to the results obtained in the first phase, a qualitative study is carried out. All this is accompanied by analyses of documents. Until now 6 hospitals were relieved (N=211, doctors: 76, nursing-staff: 135 response-rate: 37,5%) and 11 interviews were made.

The most important problems are: lack of time (71%) and personnel (69%), absence of appreciation/recognition (59,7%) abundance of rules (62,1%) and work (58,5%). However, overwork represents a problem more for nurses (68,7%) than doctors (40,8%) also the lack of personnel (nurses 82,5%, doctors 51,3%). Meanwhile the lack of appreciation/recognition is definitely a problem of the nurses (80%), more than of the doctors (25%). But both think that they cannot spend more time with patients than planned (79,8%). 72.9% recognized carrying out activities which belongs to another occupational group. Respondents feel working all the time on their own limits (66.2%). 83,3% express that hospital work is not attractive for the young people, and the 89.1% highlighted that the lack of personnel has not got the due attention by the Health Policy. According them, the workplace equipment (69.4%), communication between professionals from other group (62.7%) and quality of patient care (61%) are a challenge. Nevertheless, communication between professionals represents more a challenge for nurses (71.7%) than for doctors (47.3%).

Faced on this problems, in a first approach, we can find the following informal initiatives: emergency-replacements doctors in different departments Guards: more than allowed Delegation of certain praxis Precarious employee pools as a reserve Priority list (nurses) New division of labor Medical supplies exchange between departments Patients in the bedroom: more than the number that is allowed Creation of overload indicators.

We can conclude that many of these informal initiatives lead to solve the problem of lack of personnel, or to solve problems of communication between professionals some others lead to compensate lack of resources or working place. But the informal aspect not necessarily is composed by initiatives aiming to solve a problem, also it can be up-down – informal – order to fulfill the organizational goals or a situation of anomia, in which the participants are working “in the way that they can”, due to work organizational problems. Thus, it must be discussed deeper what formality and informality mean, and its effects on the organizational dynamic.