SUMMARY
The aim of this article is to describe and analyse observed managerial communication. The research questions concerned: What characterizes managerial communication practices and the organizational consequences? We make use of structuration theory and view communication as a social interaction process in which temporary structures are negotiated. Ten first- and second-line managers were shadowed. The managers used a combination of structuration of caring, interdependency and accountability typical of health care organizations. The communication practices were related to how new norms of reputation management were institutionalized through structuration. The types of structuration were sometimes contradictory and productive communication was rare or non-existent. The managerial communication practices had consequences for the power and domination and for which issues were signified as part of the agenda. The conclusions can be generalizable to other professional organizations.