This thesis focuses on the work in primary health care enterprises within two municipals which have organised their services after new organisational models attuned to New Public Management ideologies. The organisational model, i.e. the purchaser – provider model, had features in common with tayloristic principles, including the separation between planning and execution of work, and it brought about a loss of opportunities for the employee’s flexibility. For this reason, the employee's control over their own work was focus of the study.

Method

The data are based on a comparative intensive case study of four organizations, i.e. enterprises that performed nursing and care services. The respondents in the study were home assistants, care workers, auxiliary nurses and registered nurses; all of which performed the work, i.e. practical assistance and primary health care services. The data was collected using participant observation, individual interviews and focus group interviews.

Findings

Employees often did more work than was expected by organisational standards. This work is called “hidden services” and categorised as organisational misbehaviour, since it was neither expected nor desired by the organisation. Five types of work were performed in addition to their expected work: surplus work, additional work, forbidden work, inappropriate basic work and collective work.

The rationale for doing so diverged among occupations, since different occupations called upon dissimilar types of rules to legitimize their misbehaviour. Three types of rules legitimized the overriding of organisational rules, all based on distinctive work relations among employees, including employees’ work relations to clients.

First, there were situational rules based on informal work relations with clients – situational work relations. Although these rules were established across all occupations in the study, situated rules were most active in long-lasting work relations between employees and clients. Second, there were collective rules, developed in consequence of employees’ social position at the workplace, bringing employees together in work teams and thereby establishing collective work relations. Collective rules included rules that modified organizational rules on how to provide service to clients, and rules that legitimized the breaking of administrative rules. Finally, professional rules, as a result of professionals’ socialisation through formal education and work relations among professionals at the workplace, provided the last distinct type of rules to legitimize organisational misbehaviour.

Conclusion

The thesis concludes that there are distinct work relations in the social structure of organisations that explains employees' execution of hidden services. Formal, private, collective and professional work relations are part of the social structure in organisations. These work relations generates mechanisms, i.e. norms, that modifies and legitimises the work in primary health care services