n health care·important to have when you really need them, but not someone (or something) around which you build either an offense or defense" (Shortell, Gillies, & Devers, 1995, p. 136).
Hospital administrators must recognize that within a downsizing environment, some clinicians will fear that they will lose opportunities for employment, and many will fear that professional standards and clinical protocols, which were once developed internally by practicing clinicians, are likely to be imposed by non-professionals or non-practicing clinicians who have become managers of professional knowledge (Hafferty & McKinlay, 1993, p. 41). New processes for reshaping work based on such studies may undermine the "action-orientation" aspect of professional work: "Professionals reason toward the goal of wise action, rather than describing what is ... constantly making judgments about the appropriate course of action in a given situation" (Hafferty & McKinlay, 1993, p. 61).
The changes in the health care environment result from a combination of
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