The Urban Public Hospital as Street-Level Bureaucracy: The Employee Perspective

Abstract

Urban public hospitals have many of the defining characteristics of Lipsky's (1980) street-level bureaucracy, but relatively little is known about what problems these characteristics produce for hospital employees, professionals in particular. This paper develops evidence on the extent of those problems as reported in a survey of employees of an urban public hospital in the Midwest. The data suggest a divided verdict on Lipsky's predictions. Hospital professionals are dissatisfied with how the hospital constrains, and society disdains, their work, but they are largely satisfied that the intrinsic nature of their work is appropriate to their training. Those findings may mean that the plight of the professional in the urban public hospital is not as bleak as Lipsky implies. As such, that plight may also be amenable to improvement by actions these hospitals can afford.