Abstract:

The relationship between expertise and organizational structures has long been marked by both interdependence and tension, a dynamic particularly evident in technology collaboration between hospitals at different hierarchical tiers. Existing studies on healthcare resource integration have predominantly focused on institutional barriers while overlooking the complex mechanisms underlying the operation of knowledge. This paper, based on an organizational-professional interaction framework, presents a case study of a county-level hospital integrating into a "medical consortium" system and receiving technical support from a higher-level hospital. The study conceptualizes the knowledge practice dilemma triggered by institutional integration as "knowledge misalignment", wherein the relationships between hospitals, physicians, and medical technologies are reconstructed during consolidation, leading to inefficient knowledge operations in circulation, application, and interaction. This misalignment result in unintended consequences such as upward migration and concentration of patients and functional overlap, thereby deviating from the policy objectives of the "tiered healthcare delivery system". Specifically, in terms of knowledge flow, physicians are constrained by organizational boundaries and career development incentives, leading to the short-term and inefficient nature of cross-institutional practice; in knowledge application, the mismatch between advanced technologies and primary healthcare settings increases medical risks; and in knowledge interaction, the unequal relationship between senior and junior doctors reinforces the dominance of specialized expertise, further marginalizing primary care. These mechanisms reveal the deep-seated challenges in healthcare resource integration. This study expands the sociological perspective on cross-level healthcare integration and critically reflects on the institutional tensions in China's pursuit of healthcare equity: professional knowledge systems are not merely passive objects controlled by administrative power, but rather closely intertwined with organizational conditions, constituting an integral element within the hierarchical structure of healthcare.

Key words: knowledge misalignment, medical consortium, organizational integration, knowledge transfer, tiered healthcare delivery system