Comparing National Patterns of Medical Specialization: A Contribution to the Theory of Professions

Policy-making is often characterized by connected processes of conflict management in organizationally separated, but functionally linked arenas. Such multi-level structures are prone to blockades of decision-making, because boundaries between arenas can reinforce conflicts and rules of interaction can reduce the range of alternative decisions. These problems are structureinduced, their solution requires changes in the organizational framework. Linked arenas are - as a rule - merely loosely-coupled. This is why the fabric of multi-level policy processes can be structured by strategic manipulation. Three strategies of interorganizational management via structural adaptation are discussed. All of them revise conditions of conflict generation and conflict solving and reduce the likelihood of blockades. However, the consequences are ambivalent. As the strategies change power relations in the policy field, they provoke reactions of negatively affected actors, who try to regain influence by establishing secondary informal linkages. As a result, multi-level structures develop multiple connections and network-like relations which interact in a dynamic process of permanent adaptation.