Background: Manager is in most parts of society a prestigious title and an attractive role (Yukl 1989), however not in psychiatry. Here it is difficult to find people willing to take up the official lead of a unit. In some part of Swedish hospital psychiatry and community care for persons with mental disorders, there is a high turnover of managers, although a lot of psychiatry staff remains in psychiatry their whole working life and not seldom in the same organization. Psychiatry in Sweden has been delineated as an area characterized by sever problems and systematic defaults in terms of availability of adequate care, support and service, lacking cooperation among authorities at different levels, need of scarce resources, expertise and suitable methods (SOU 2006: 100). However in opposite to other sectors the manager is not a key-actor for change, (cf. Holmberg & Åkerblom 2001), but a person with a quit anonymous role
Middle-managers are generally described as being in a vulnerable position and trapped between interested parties (Glouberman & Mintzberg 2001; Dellve & Wikström 2009). Managers should undertake formal direction, supervision and control via technologically and methodologically driven labor processes, customer feedback, and performance targets, at the same time as they themselves are subject for all kinds of control. The middle managers' freedom seem to be violated by control mechanisms of a disciplinary cognitive character as well as mechanisms that constituted normative control, such as budget issues and legislation.
There is a need for theoretical and empirical knowledge about service work in general (claimed by for example Bolton & Houlihan 2010) and in this particular kind of public sector human service organization (Hasenfelt 1983; Foucault 1961/1986) to further understand the complex relation of worker–customer- management and the middle-managers situation in terms of power, control and autonomy. The significance of these terms is high, because of their close relation to well-being and work.
Purpose: The middle management, i.e. the role and discretion of first and second-line managers in Swedish psychiatry is the focus of this study.What does it mean to be a manager in psychiatry? What freedom to act does managers in psychiatry experience and what factors are related to their scope of action? The aim was to develop knowledge about the constraints within which the middle manager is supposed to act and which freedom of action he/she perceive to have and is actually using. The study focuses on the tensions between control and autonomy for psychiatry managers and their strategies to handle everyday conflicts and contradictions.
Method: The study springs from a two year research project of conditions for middle-management in Swedish psychiatry and has a mix-method design. The triangulation combines interviews with unit managers in different organization of mental care with observations from workplaces and management training within two geographical areas in southern Sweden, i.e. Västra Götaland Region and Scanie Region. Furthermore it draws on studies of documents, articles in professional journals and media and a short survey to professionals at management positions within Swedish psychiatry.
Presumed result: The study is drawing on notion of power, such as access to information, resources, and lines of support (e.g. Kanter 1979; Bolton & Houlihan 2010) as well as traditional and recent labor process debates on control and autonomy (for a review see Thompson & van Broek 2010). Being a manager in a human service organization convey an administrative approach. By adopting such approach the middle managers relinquish to some extent their moral responsibility (Karlsson 2006). Discretions are defined by the legislation, by the organizational aspects and by other aspects of the work and the work content in psychiatry. In concrete actions the actors’ experience based knowledge and personal features might to some point govern how the given discretion will be perceived and used and thereby what actions will be taken. However the scope of action seems to be rather fixed.
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