How do street‐level bureaucrats manage high workloads? Collegial mechanisms at the organisational level—experiences from public healthcare organisations

• Published date: 01 July 2022
• Author: Johan Berlin,Stefan Szücs,Staffan Höjer,Andreas Liljegren
• Date: 01 July 2022
• DOI: http://doi.org/10.1111/emre.12480

RESEARCH ARTICLE

How do street-level bureaucrats manage high workloads? Collegial

mechanisms at the organisational level—experiences from public

healthcare organisations

Johan Berlin

1

| Stefan Szücs

2

| Staffan Höjer

2

| Andreas Liljegren

2

1

Department of Social and Behavioural Studies,

University West, Trollhättan, SE, Sweden

2

Department of Social Work, University of

Gothenburg, Gothenburg, SE, Sweden

Correspondence

Johan Berlin Professor, University West,

Department of Social and Behavioural Studies,

SE 461 86 Trollhättan, Sweden.

Email: johan.berlin@hv.se

Abstract

The aim of this study is to understand and explain how street-level bureaucrats

manage high workloads in public healthcare organisations. Data was collected

through observations, interviews and documents. The results show that high

workloads are reduced through use of collegial mechanisms at the organisation

level. The study shows that workloads are reduced in a two-step process, the first

is a negotiation between professionals and the second in the meeting with patients.

The two-step process explains the limitation problems in more detail and makes

an important contribution by explaining how high workloads are reduced in

public health services.

KEYWORDS

collegial mechanisms, public healthcare, public management, street-level bureaucrats, workload

INTRODUCTION

Public organisations are experiencing ongoing problems

of insufficient resources (Brodkin, 2011; Hupe & Buffat,

2014; Tummers & Bekkers, 2014; Tummers, 2017). This

is a classic problem and has previously been described

as public organisations not having mechanisms which,

in other contexts, holds back demand (Roemer, 1961;

Arrow, 1963; Lipsky, 2010

1

). This means that public

organisations tend to constantly be demanding more

resources than can be provided (Chul et al., 2017). In his

classic study, Lipsky (2010) showed that when needs

are greater than the common willingness to pay, the

result can easily be public services becoming undersized.

The result is that street-level bureaucrats,

2

that is,

the front-line staff, are gradually being given more to

do and a higher workload. According to Altaf &

Awan (2011, p. 93), it is characterised by: “conditions

having long difficult working hours, pressure to work

overtime, lesser holidays or breaks, unreasonable work

overload, and improbable expectations of what can

be achieved in some given limited time and with

available resources.”Earlier studies make it evident also

that insufficiency is common in public organisations

(Tummers & Rocco, 2015), especially in the public

healthcare sector (Thomann, 2015). In dealing with this

situation, staff need to find their own strategies, as well

as collegial ones, in order to reduce their workload and

manage what has previously been called “A Public

Service Gap”(Hupe & Buffat, 2014).

Earlier studies have elucidated that front-line staff

have strategies that give them greater power over how

matters are interpreted, decided and handled

(Lipsky, 2010). Frontline staff can also make a valuable

contribution to knowledge in relation to administrative

practice, informal routines and how policy is

implemented in practice (Gofen, 2014; Liljegren

et al., 2021). Public healthcare is a socially important

function which is performed by professionals, with the

staff needing to make major priorities to avoid becoming

overloaded with work. It is therefore important to create

increased understanding and explain how street-level

bureaucrats within healthcare (e.g., chief physician,

specialist physician, nurse, psychologist, physiotherapist

and mental attendant) act at an organisational level

to manage and avoid high workloads. Studying

healthcare personnel is relevant as, in common with

groups such as social workers and police officers, they

DOI: 10.1111/emre.12480

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any

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© 2021 The Authors. European Management Review published by John Wiley & Sons Ltd on behalf of European Academy of Management (EURAM).

European Management Review. 2022;19:299–312. wileyonlinelibrary.com/journal/emre 299