Autonomy and monitoring on hospital wards

This paper describes the systems of relationships and manner of operation of several hospital wards. Data from these settings suggest three concepts of understanding the behavior of the participants. One is elastic autonomy: the autonomy of an actor is not fixed, but expands and contracts according to others' assessments of his professional competence. The second is accountability: an actor is held to be accountable or responsible for his decisions and actions. Third is monitoring: the process by which actors keep track of each other's performance. Contingencies affecting autonomy are discussed, as are the relationships between these concepts and those of bureaucratic theory.