As it had to be, changing events, transforming events, that are born out and developed by political and social imperatives, have influenced the “hospital” institution to search for efficiency and excellence. This influence, as I will try to document in the case of a hospital, has arisen in a larger proportion from the dominant logic, from business or managerial actions, to the resorting of preferably instruments and techniques of economic science; whereas other social events, such as people, professionals, relationships that are built or created in the core of healthcare delivery, and which  are more accessible to the methods  of social and human science, have not occupied the place, which in my opinion, I consider most relevant. If we do not take into account the people and the professionals as individuals with responsibilities, it makes no sense to implement the concept of management by areas of competences.