Achieving Rational Management: Bed Managers and the Crisis in Emergency Admissions

This paper uses data from a qualitative study to examine the extent to which the perceived problems of dealing with the acute emergency hospital admission can be used to illuminate the interface between professional and managerial authority in hospitals. Clinicians, nurses and managers all described emergency admissions as constituting a ‘constant crisis’ in their hospital. There were practical senses in which this was a realistic depiction of the situation but, as rhetoric, this description had two major implications for the management-professional interface. First, it served to legitimate the authority of managers by creating a problem which needed constant management. Second, in providing the ultimate challenge to general management it provided a scenario in which the superiority of rational management techniques over more localised and apparently self-interested clinical decisions could be demonstrated.