Interpersonal relationships and decision-making about patient flow : what and who really matters?

The aim of this research is to give insights into how interpersonal relationships influence managerial decision-making about resource allocation in the health context. The organizational culture literature suggests that an organization's culture is unique (Louis, 1985; Schein, 1985; Van Maanen and Barley, 1985; Smircich, 1983) and shared (Schein, 1996; Kunda, 1992; Hofstede et al., 1990; Kroeber and Kluckhohn, 1952), but exactly what is unique and what is shared varies depending on the context. This paper investigates stakeholder saliency in a medium tertiary hospital. The majority of the staff have worked at the institution for more than seven years, live in the local area and interact with one another outside of the institution's boundaries. Initial observations revealed that what was shared in this hospital is the sense of 'community'. Most staff not only knew each other by name, but also new family details of their colleagues, including birthdays and other events. Interactions between various stakeholders, and relationships with persons who are classified as possessing 'deep smarts' are used to exemplify the shared and unique attributes of the organization's culture, as well as the different decision-making approaches by stakeholders within the hospital. Leonard and Swap (2005: 2) define deep smarts as 'the knowledge that provides a distinctive advantage, both for organizations and for managers as individuals'. In addition, organizational cultural literature has not yet been linked to stakeholder theory and the notion of 'deep smarts'. We begin to address this gap in the literature.