Management structures and beliefs in a professional organisation. an example from Swedish Public Dental Health Services.

Work as a dentist is stressful and demanding. In the Public Dental Health Service (PDHS) the heads of clinics' have a great influence on the work environment. In turn the heads have to adapt to the overarching policies on management in each County, which create the environment for the clinics. The aims of this paper were to describe the management structure of the PDHS as described by their Chief Dental Officers (CDOs), and to test hypotheses that the management systems had "a logical administrative structure". A postal questionnaire was mailed to all 21 CDOs,who all responded. Context analysis and bivariate correlations were used. The PDHS employed on average 60% of all dentists in a county. The numbers of clinics for general dentistry in Sweden was 698, and for specialist care 144. The heads of clinics were dentists in 92%. Four hypotheses were tested. 1. separate political board did not lead to closer governance of the PDHS. 2. There was more emphasis on measurable than on qualitative objectives and followup. 3. There was only partial correlation between a larger county and a more formalized management. 4. There was no correlation between size of county and beliefs on advantages of scale. There was a widespread belief in advantages with larger clinics both from administrative, and rather surprisingly, from clinical aspects. Two of the four hypotheses could not be corroborated which indicates that the management structures were more formed by county specific principles. The four hypotheses on administrative behaviour were only partially corroborated. The implications for delivery of care to sparsely populated areas need to be monitored in view of the beliefs in larger clinics. The limits for decisions by management and for professional discretion must be monitored closely considering their effects on work environment and on the quality of care the professionals are able to deliver.