Alternatives to a bureaucratic structure for the national health service. The point of view of a nurse.

Bureaucracy is characrerised by rules, specific sphere of competence, hierarchy, specia iized rraining, separarion from means of production or administrarion and the recording in writing. The NHS is nor a rypicai bureaucratic organizarion, but ir has some of irs characteris tics. The alternative modeis (democraric, matrix-type structure) do nor seem to respond to the need for change. Ir is sugj~esred that rhe characreristics of an organizarlon’s strucrure be treated as variabies. Parrial alter-narives are discussed. The reiarionship berween the goals, rhe users and the workers — workers and users’ participarion in the planning and control of rhe NHS. Conflict as a motor for change. Controlling power — represenranves of rhe communiry and of the workers. The person in the organizarion — involvemenr of ali workers in manage menr ar different leveis and the deveiopment of persons towards rheir fuil capaciry. The case is made for the person-cenrered approach co management.