In the Eye of The Storm: When a new Horizontal Management Position meets hospital reality

Introduction: In 2013 the ‘Region of North-Jutland’ in Denmark started a major reorganization of their hospitals. In order to improve the quality of care for their patients, the reorganization was focusing on the coordination of patient flows through the hospitals and also between the hospitals and the primary sector.The new organization of the hospitals can be regarded as a sort of matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on team-work, meetings and information exchange is combined with elements of co-location and horizontal management.In short there are three main innovations. The first innovation is a new clinical structure with a creative combination of interdependent medical specialties in order to facilitate the patient flows. In each clinical department there is a management “troika” consisting of a clinical director (primarily physicians), a deputy clinical manager responsible for human resources (nurses) and a new horizontal management position accountable for patient flows (nurses and a few physicians).The second innovation is the appointment of this latter and third member of the “troika”: a new horizontal management position. They are accountable for horizontal integration strategies and development of patient flows within their own clinics, across the boundaries of the different clinics and across the boundaries of the hospital and the primary sector.The third innovation is the strong focus on teamwork to support the patient flows of the hospital. Among others the “troika” is working as a management team, where the new horizontal management position plays an important role.The aim of the article is to describe and analyze the role of the new horizontal management position in the reorganization of the hospital (in the following and to facilitate the written communication this role will be named the new managers). The paper maps these new managers’ efforts to shape their role in the management processes and to gain legitimacy.Theory and methods: The reorganization process which is still going on is followed by a group of organizational researchers. They are conducting a qualitative case study of Aalborg University Hospital, based on a number of individual and focus group interviews with professionals and managers on different organizational levels. The interview