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1. Introduction
Power is not a very popular concept in health care because it refers to health care professionals' exercise of power over patients. However, health care organizations are, like any other organization, systems of power. Organizations are complex systems of individuals and coalitions, where everyone has their own interests, beliefs, values, preferences and angles. Owing to limited resources, there is competition, which results in conflicts. The actors whose roles are more critical for the organization gain more power. ([24] Pfeffer, 1981, p. x; [25] Shafritz and Ott, 1996, pp. 352-353).
In Finland, health care services are based on public provision. As a consequence, the structures of health care organizations represent traditional organization models, such as bureaucracy and professional organization. Hospitals, for instance, are mainly seen as professional bureaucracies where the structure is bureaucratic but decentralized. The main performers are doctors, and nurses are classified as support staff. ([21] Mintzberg, 1989, pp. 174-179.) New waves of result-based management have delegated tasks to the unit level and brought features of managerialism to health care. It has strengthened unit based thinking, but at the same time it can lead to fragmentation. As a consequence first-line management has emerged to the forefront.
The aim of this article is to examine Finnish health care organizations' power structures from the first-line management perspective. What liable power structures derive from the theoretical bases of bureaucratic, professional and result based organizations? What power type do health care organizations represent according to the empirical data, and what conclusions can be drawn from the results?
2. Power and its sources
2.1 The concept of power
The concept of power has elicited a wide range of discussion, mainly among sociologists. Power can be seen as a potential for action through domination ([11] Hobbes, 1999, pp. 92-93) or consensus ([1] Arendt, 1970; [23] Parsons, 1963; [3] Barnes, 1988; cited in [10] Haugaard, 2009). On the other hand, power can be seen to manifest only in action through concrete decision making.
The modern view of power is three-dimensional. Power can be seen as domination, freedom or hegemony. The third dimension, hegemony, means gaining power through shared information. It is leadership that facilitates the autonomy of the led. Successful hegemony entails dominance through consent. Hegemony is, on the...