Systems of interdependency and core orchestrating themes at health care unit level

<title>Abstract</title> Configuration is an appealing concept to help understanding the complex arrangements that guide organizations' actions and contribute to their coherence. Although health care organizations are often described as professional bureaucracy a deep understanding of their structure and systems is still lacking. In this article, we draw on empirical data gathered in a Canadian teaching hospital to expose the nature of interdependencies and themes that drive some of its configurations at health care unit level. Five clinical activities were investigated (ocular surgery, brachytherapy, vascular surgery, rheumatology and geriatrics) using direct systematic observation. Four sub-orchestrating themes emerged. Based on the findings it is argued that the operating core of health care organizations is not homogeneous but rather heterogeneous. Therefore it is our contention that hospitals and other public organizations where professionals control the activities at operating level might be better regarded as ‘diversified professional federation’ than as professional bureaucracy.