The Professional (1981)

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The preset study was performed to assess the effect on caries and gingivitis of plaque control measures such as oral hygiene instruction, toothcleaning practice and professional toothcleaning. 104 children, 13-14 years old, participated in the trial. Prior to the start of the preventive treatment all children were examined regarding oral hygiene, gingivitis and caries. The caries examintion was limited to the proximal surfaces of molars and premolars. Following this baseline examination the children were randomly divided into two treatment groups A, and B. Both groups of children were recalled for professional toothcleaning once every 2 weeks during an 18-month period. In each child the professional toothcleaning was restricted to either the right or the left jaws by random selection. In addition, the children of Group A at each recall appointment received careful oral hygiene instruction and practice in proper toothcleaning methods. In conjunction with the professional toothcleaning an abrasive paste was used including fluoride. The children were re-examined 18 months after the baseline examination. The result of the present investigation demonstrated that professional toothcleaning repeated every second and week is a prophylactic measure which in children substantially improves the oral hygiene status, and effectively reduces clinical signs of gingivitis and caries. It was also observed that while oral hygiene instruction and practice in proper toothcleaning techniques reduced plaque and gingivitis, no such effect could be detected regarding the development of caries.

If the client has chosen not to disclose the engineer's report topersons or entities the lawyers believe are entitled to suchdisclosure, the lawyers will have to decide whether they cancontinue to represent the client at all. The lawyers may considerthe nondisclosure to be morally repugnant, or they may concludethat the nondisclosure may expose the lawyers, themselves, to therisk of legal liability to third parties. If that is the case, theloyalties of the lawyers to their client may have been so dilutedby the lawyers' personal opinions or interests that they shouldconsider whether they ought to continue to represent the client.The lawyers are required to exercise their professional judgmentsolely for the benefit of their client, free of compromisinginfluences. Their personal interests and the risks to third personsshould not be permitted to dilute this loyalty. (ABA Code of Prof.Responsibility, EC 5-1.) Therefore, if they conclude that there isrisk to themselves or to third parties if their advice is notfollowed, the lawyers should withdraw after taking reasonable stepsto avoid foreseeable prejudice to the rights of the client. (SeeABA Code of Prof. Responsibility, DR 2-101(A)(2), 2-101(C)(l)(e),5-101(A); EC 5-2.)

In the context of Business and Professions Code section 6068, subdivision (e), \"secret\" is not limited to attorney-client communications. \"This ethical precept, unlike the evidentiary privilege, exists without regard to the nature or source of information or the fact that others share the knowledge.\" (ABA Code of Prof. Responsibility, EC 4-4.) Any \"information gained in the professional relationship that the client has requested be held inviolate or the disclosure of which would be embarrassing or would likely be detrimental to the client\" is a secret which must be preserved. (ABA Code of Professional Responsibility, DR 4-101(A).) Both \"confidences\" and \"secrets\" are privileged communications. (ABA Committee on Ethics and Prof. Responsibility, opns. Nos. 341 (1975) and 1458 (1980).)

Although the information which has been communicated to theattorneys is not a confidential attorney-client communication, itis the client's secret. In addition to the statutory duty tomaintain inviolate the secrets of their client, the attorneys hereare forbidden to disclose the information in question without theirclient's consent, unless disclosure is compelled by law. (ABA Codeof Prof. Responsibility, DR 4-101(B)(I).) Disclosing the report tothird parties would be the revelation of information gained in theprofessional relationship. The client has requested that theinformation not be disclosed and it is likely that the disclosureof the information would be detrimental to the client. Since we areaware of no statutory compulsion to disclose this information, thestatutory duty to maintain the information in confidence shouldprevail. This duty persists even if the attorneys are discharged.(ABA Code of Prof. Responsibility, EC 4-6.).

The attorneys here are in a difficult position. Morally, they maywant to warn third parties of potential risks. Personally, they maywant to protect themselves against future claims. Professionally,however, the standards of professional ethics and Business andProfessions Code section 6068, subdivision (e), both require thatthe attorneys' primary responsibility is to maintain their ownloyalty to their client and to protect the client's secret. Thisresponsibility may not ultimately give the attorneys a safe harborfrom liability to third parties, but their duty is to safeguard theclient's secret regardless of the risk to themselves.

If we look at the enormous amount of research on organizational structuring in light of this idea, a lot of the confusion falls away and a striking convergence is revealed. Specifically, five clear configurations emerge that are distinct in their structures, in the situations in which they are found, and even in the periods of history in which they first developed. They are the simple structure, machine bureaucracy, professional bureaucracy, divisionalized form, and adhocracy. In this article I describe these configurations and consider the messages they contain for managers.

Training and indoctrination refer to the use of formal instructional programs to establish and standardize in people the requisite skills, knowledge, and norms to do particular jobs. Training is a key design parameter in all work we call professional. Training and formalization are basically substitutes for achieving the standardization (in effect the bureaucratization) of behavior. In the one, the standards are internalized in formal training as skills or norms; in the other, they are imposed on the job as rules.

As can be seen in Exhibit 2, above the operating core we find a unique structure. Since the main standardization occurs as a result of training that takes place outside the professional bureaucracy, a technostructure is hardly needed. And because the professionals work independently, the size of operating units can be very large, and so few first-line managers are needed. (I work in a business school where 55 professors report directly to one dean.) Yet even those few managers, and those above them, do little direct supervision; much of their time is spent linking their units to the broader environment, notably to ensure adequate financing. Thus to become a top manager in a consulting firm is to become a salesperson.

Standardization is the great strength as well as the great weakness of professional bureaucracy. That is what enables the professionals to perfect their skills and so achieve great efficiency and effectiveness. But that same standardization raises problems of adaptability. This is not a structure to innovate but one to perfect what is already known. Thus, so long as the environment is stable, the professional bureaucracy does its job well. It identifies the needs of its clients and offers a set of standardized programs to serve them. In other words, pigeonholing is its great forte; change messes up the pigeonholes. New needs arise that fall between or across the slots, and the standard programs no longer apply. Another configuration is required.

Second, the divisions often require structures other than machine bureaucracy. The professionals in the multiversities, for example, often balk at the technocratic controls and the top-down decision making that tends to accompany external control of their campuses. In other words, the divisionalized form can be a misfit just as can any of the other configurations.

There are two basic types of adhocracy, operating and administrative. The operating adhocracy carries out innovative projects directly on behalf of its clients, usually under contract, as in a creative advertising agency, a think-tank consulting firm, a manufacturer of engineering prototypes. Professional bureaucracies work in some of these industries too, but with a different orientation. The operating adhocracy treats each client problem as a unique one to be solved in creative fashion; the professional bureaucracy pigeonholes it so that it can provide a standard skill.

For its part, the operating adhocracy is often associated with young organizations. For one thing, with no standard products or services, organizations that use it tend to be highly vulnerable, and many of them disappear at an early age. For another, age drives these organizations toward bureaucracy, as the employees themselves age and tend to seek an escape from the instability of the structure and its environment. The innovative consulting firm converges on a few of its most successful projects, packages them into standard skills, and settles down to life as a professional bureaucracy; the manufacturer of prototypes hits on a hot product and becomes a machine bureaucracy to mass-produce it.

What in fact are these configurations Are they (1) abstract ideals, (2) real-life structures, one of which an organization had better use if it is to survive, or (3) building blocks for more complex structures In some sense, the answer is a qualified yes in all three cases. These are certainly abstract ideals, simplifications of the complex world of structure. Yet the abstract ideal can come to life too. Every organization experiences the five pulls that underlie these configurations: the pull to centralize by the top management, the pull to fo