Managing expert knowledge : organizational challenges and managerial futures for the UK medical profession

The blurring of managerial and professional jurisdictions remains a significant area of organizational research. This process is often described as involving `re-stratification', the drawing of professional elites into bureaucratic roles; or `bureaucratization', the standardization of work operating procedures. We examine these processes further through considering how professional work is reordered through the application of knowledge management techniques, focusing in particular on the management of knowledge around clinical risk. We suggest attempts by hospital risk managers to manage medical knowledge towards organizational learning represent a significant challenge to clinical freedom, given the centrality of expert knowledge to professional autonomy. In considering this challenge, we are attentive to the idea that change occurs not through the top-down challenge of management, nor the bottom-up resistance of professionals, but through the dynamic mediation of these influences within a wider institutional context. Accordingly, we find that doctors respond to change through a number of situated responses that limit management control over knowledge and reinforce claims to medical autonomy. In extending professional jurisdiction for the management of knowledge, we show how professionals such as doctors can themselves become managerialized as they seek to stave off managerial encroachment. Rather than seeing professionals as being drawn into management roles or bureaucratic ways of working, we suggest that managerial techniques and jurisdictions are also strategically drawn into professional practice and identity