PROFESSIONS,INSTITUTIONAL DYNAMICS,AND NEW PUBLIC MANAGEMENT IN THE DANISH HOSPITAL FIELD

ABSTRACT

This article elucidates the role of professionals as stakeholders in the Danish hospital field. The sociological new-institutionalism has illuminated the role of professions as carriers of rationalities and norms and their role in radical changes in organizational fields, but we are short of contributions that elucidate their role as stakeholders in connection with incremental changes in mature organizational fields.

First we focus on what interests professions can be expected to safeguard. We will argue that professions protect and expand their professional rationalities. In mature fields this must be done in interaction with the state apparatus that in numerous ways regulates the professions.

Second we assume that in mature organizational fields, dominated by professional interpretative schemes, the professions’ safeguarding of interests will be tied to their influence on the creation of new institutions within the existing institutional landscape in the field. More specifically we argue that the professions’ opportunities of influence depend on:

The existing constellationof institutions in the field.     

ORCHESTRATING EMERGENT CHANGE: THE ‘HOSPITALIST MOVEMENT’ IN US HEALTHCARE

The metaphor of ‘orchestration’ is applied to an emergent change whereby developing different versions of a resource to solve local problems with managing hospitalized patient care in the USA became conceived as a nationwide innovation. A pluralistic framework incorporates Abbott’s conception of a system of professions, a cultural and political perspective on interaction and the notion of ‘orchestration’ which is distinguished from leadership and management. Small‐scale research in diverse settings shows how key stakeholders including academic medical researchers orchestrated the coalescence of disparate practices into a unified movement, although working in a relatively decentralized healthcare system featuring a complex mix of public, private and voluntary sectors. Sufficient confluence between diverse interests was nurtured for widespread acceptance of a new ‘hospitalist’ role coordinating inpatient treatment. It is suggested that the metaphor of orchestration may have wider potential as a heuristic for understanding emergent change that becomes more complex as it spreads.     

Public Intellectuals and Think Tanks: A Free Market in Ideas?

The paper critically evaluates the thesis of the interchangeability between the think-tank public intellectual and the academic public intellectual. It suggests that this thesis, while endorsing the rise of the think-tank public intellectual, pronounces the salience of the intellectual-social critic and undermines the authority of academic public intellectuals. It is argued that the think-tank expert doubling as the public intellectuals could limit the political relevance of the academic public intellectual and that the think-tank expert’s monopolization of the public forum could present a threat to the quality of public debates. While recognizing that there are many contradictions inherent in the role of intellectual and that there are now numerous factors that hinder the abilities of academics to act as public intellectuals, the paper emphasizes public academic intellectuals’ contribution to the dynamics of public opinion and the quality of democratic standards. In today’s context, with the omnipresent of media, the new conditions of knowledge production, the neo-liberal ethos and the social prominence of think-tank experts, the sources of the academic public intellectual authority are in a continuous need for reinvestment.     

Three strategies for attaining legitimacy in policy knowledge: Coherence in identity,process and outcome

At a time when truth and facts are highly contested, understanding how knowledge gains legitimacy is crucial. Creating valuable policy knowledge involves navigating ‘a space between fields’, where actors and ideas from different social worlds come into play. This article outlines a novel set of strategies for attaining legitimacy within this space. Drawing on mixed‐methods analysis of interview and publication data from 12 development research organizations, the article argues that legitimacy centres around three primary types of ‘coherence’. Coherence in identity is the demonstration of ‘proper’ goals via negotiation of organizational and individual identity. Coherence in process is the demonstration of ‘proper’ processes through maintenance of independence, integrity and transparency. Coherence in outcome is the demonstration of ‘proper’ outcomes via creation of the ‘right’ products, audience and impact. Mastery of these three areas makes possible the production of credible, distinctive and significant knowledge.     

Norm-making,norm-taking or norm-shifting? A case study of Sino–Japanese competition in the Jakarta–Bandung high-speed rail project

This paper’s main aim is to contribute to the debate on the impact of China’s rise on the established norms and practices in the field of international development. To do so, it zooms in on a single infrastructure project, the Jakarta-Bandung high-speed rail line, which involved intense competition between China and Japan. Specifically, it examines how competition between China, a non-Western emerging power, and Japan, an OECD member, led to a recalibration of both China and Japan’s approaches to infrastructure financing in the region. The findings suggest that rather than straight convergence or competition between diverging models, there is an ongoing process of two-way adjustment between China, and representatives of the dominant global norms and practices. We also argue that to understand the implications of China’s participation in the field of international development, and its impact on the ‘rules of the game’ of global governance, researchers should avoid positioning inquiries within the premises of China’s one-directional impact on the development assistance regime. Rather, it is necessary to take into account a complex set of relationships including China, host countries and other ‘socialised’ actors, and the process of negotiation between them.     

Entrepreneurs,investors and the state: the public and the private in sub-Saharan African irrigation development

This article draws on ethnographic research in Tanzania to interrogate the discourse of ‘public’ and ‘private’ in sub-Saharan irrigation development. It contrasts the complexity of social and political relations with narratives suggesting that ‘private’ is necessarily opposed and superior to ‘public’. We argue that support for models of private-sector development obscures access to and control over resources and can result in the dispossession of those least able to resist this. Different interests of ‘entrepreneurial’ individuals and corporate investors and the ways in which these relate to the state are also glossed over. Conversely, the failure of the ‘public’ cannot simply be read from the chequered histories of irrigation schemes within which public and private interests intersect in complex ways.     

Symposium Introduction: Competency and Higher Civil Servants

‘Competency’ is a word that seems to have crept into the language of public administration and policy relatively recently, although largely under the radar of academic scholarship in Europe. This article introduces a symposium of papers that address key questions about competency management: how and why has it become popular and what are the implications of the spread of ‘competency’ approaches? As the introductory paper, it outlines the intellectual background to competency approaches and outlines three interpretations of their development. One interpretation sees them as a passing fad; a ‘difference’ interpretation sees them as a common label for widely varying patterns and practices; and a ‘sameness’ interpretation treats competency management as a symptom of broader politico‐administrative developments.     

The Social Embeddedness of Professions in Kyrgyzstan: an Investigation into Professionalism,Institutions and Emotions

The article examines how professions are socially constructed in Kyrgyzstan, paying particular attention to the moral sentiments and organisational capabilities of people working in the professions. It is suggested that the moral sentiments approach captures the tensions and conflicts of post-Soviet Kyrgyzstani professions, and identifies how professional practices can become ‘corrupt’. The article shows how professionals operate in difficult political and economic conditions, and how far they possess positive sentiments for effective action.     

EMERGING ISSUES IN PUBLIC ADMINISTRATION

This article briefly examines five subfields of the public administration literature in the context of the major changes which have occurred in each of those fields since the 1940s. Major changes include: the alleged shift to‘globalization’affecting comparative public administration; the spread of‘economic rationalism’in policy analysis; the new wave of‘managerialism’affecting the study of the public service; the transformation of administrative technique by‘informatization’; and the rise of legal formalization in some fields redrawing the traditional boundary Unes between law and administration. For each of these subfields of public administration, three types of‘emerging issues’are identified. Some of the trends discussed - particularly managerialization and juridification - seem to be in tension with one another, suggesting alternative possible futures for public administration. Moreover, since many of the intellectual and doctrinal shifts seem to reflect a reaction against the shortcomings of an earlier orthodoxy, a counter-reaction in the longer run cannot be ruled out.     

Regulation of armed conflict: critical comparativism

Abstract

This paper calls for comparative analysis of international humanitarian law and Islamic laws regulating armed conflict by focusing on the underlying assumptions and interests informing both systems (rather than on rule-based comparison). It argues that examination of the biases inherent to each legal system can potentially inform scholars to understand better the paradigms shaping each of them. In doing so, the paper builds on contextual and critical interpretations of both fields of law to assert the need for ‘critical comparativism’ rather than functionalist comparativism. Unlike functionalist comparativism, which treats international law as the ‘objective’ benchmark against which other legal traditions are measured, ‘critical comparativism’ treats the two legal systems examined as alternative manifestations of power structures which, when contrasted against each other, help shed more light on the inherent bias in each legal system.     

Russian NGOs and Their Struggle for Legitimacy in the Face of the ‘Foreign Agents’ Law: Surviving in Small Ecologies

Abstract

The essay investigates the survival strategies of foreign-funded Russian non-governmental organisations (NGOs) in the face of the so-called ‘foreign agents’ law of 2012. Conceptualising NGOs as autonomous social systems and drawing on two qualitative case studies of Russian NGOs in the fields of human rights protection, we show how these organisations manage to cope with the state’s withdrawal of legitimacy by creatively handling their diverse environmental dependencies. Through shifting the relative importance of different audiences and generating new sources of legitimacy, they have eventually created and maintained small supportive ecologies within the overall environment of a political regime that does not tolerate them.     

Behind China's World Trade Organization agreement with the USA

The ‘war on terror’ is widely regarded as instigating a major regression within the development of the international system. Processes of globalisation are being challenged, it is argued, by a reassertion of the sovereign power of nation-states, most especially the USA. In more overt terms this regression is represented as a ‘return’ of a traditional form of imperialism. This ‘return of imperialism’ thesis challenges the claims of theories developed during the 1990s which concentrate on the roles of deterritorialisation and the development of biopolitics in accounting for the constitution of the contemporary international order. In contrast this paper seeks to detail the important respects in which biopolitical forces of deterritorialisation continue to play an integral role within the strategies of power that make the war on terror possible. Rather than understanding the war on terror as a form of ‘regression’ it is necessary to pay heed to the complex intertwinings that continue to bind sovereign and biopolitical forms of power in the 21st century. Such an understanding is urgent in that it provides for different grounds from which to reflect on the processes by which international order is currently being reconstituted and to help think about how to engage in reshaping them.     

Trans-Regional Security Organisations and Statist Multilateralism in Eurasia

This paper argues that there is an emerging trans-regional security complex reaching from Russia through Central Asia to China. Shared security norms have resulted in statist multilateralism, that is, state-directed cooperation on shared interests while closely guarding distinct identities and specific political features. The paper outlines member states' key political values and shows how they ‘framed’ shared understandings about security. It then explains how security norms inform the institutional designs of the two main multilateral security organisations thereby directing the nature of cooperation, testing the argument in two key conflicts: in Kyrgyzstan and Afghanistan.     

Intellectuals and the Politics of Style

This article addresses the characteristic styles and modes of self-presentation used by such Victorian public moralists and intellectuals as William Morris, John Ruskin and Matthew Arnold in both their writing and in their appearances as public lecturers: these were all interventions that were aimed at provoking an audience into intellectual consideration and self-reflection. The article examines how questions about the style of these figures have shaped the response to their work both at the time and in the years since their deaths; thinking about why, in Raymond Williams’s words, they have produced ‘mixed feelings of respect and suspicion’. It considers how their versions of the combination of intellectual and public life could be thought about in our post-financial crisis present, at a moment when late nineteenth century debates about ‘the elites and the masses’ are re-emerging, but where also the figure of the intellectual is taking on a renewed interest as one possible point of encounter between these forces.     

The Rise of the Resilient Local Authority?

The term resilience is increasingly being utilised within the study of public policy to depict how individuals, communities and organisations can adapt, cope, and ‘bounce back’ when faced with external shocks such as climate change, economic recession and cuts in public expenditure. In focussing on the local dimensions of the resilience debate, this article argues that the term can provide useful insights into how the challenges facing local authorities in the UK can be reformulated and reinterpreted. The article also distinguishes between resilience as ‘recovery’ and resilience as ‘transformation’, with the latter's focus on ‘bouncing forward’ from external shocks seen as offering a more radical framework within which the opportunities for local innovation and creativity can be assessed and explained. While also acknowledging some of the weaknesses of the resilience debate, the dangers of conceptual ‘stretching’, and the extent of local vulnerabilities, the article highlights a range of examples where local authorities – and crucially, local communities – have enhanced their adaptive capacity, within existing powers and responsibilities. From this viewpoint, some of the barriers to the development of resilient local government are not insurmountable, and can be overcome by ‘digging deep’ to draw upon existing resources and capabilities, promoting a strategic approach to risk, exhibiting greater ambition and imagination, and creating space for local communities to develop their own resilience.     

Acknowledgement of the Secret Protocol of the German–Soviet Non-aggression Pact and the Declaration of State Sovereignty by the Union Republics of the USSR

In June 1989, the First Congress of People's Deputies of the Soviet Union established the Commission for Historical and Legal Estimation of the Soviet–German Non-aggression Pact of 1939. In the commission, representatives from Estonia, Latvia and Lithuania condemned the Soviet annexation of the Baltic States, prompting heated arguments regarding the invalidity of the related secret protocol of the pact with other members who continued to hold the traditional Soviet ideological view of the pact as something positive. The debate over the secret protocol had the further potential to extend to disputes over ‘recovery of lost territory’ amongst the Baltic States, Ukraine, Moldova, Belarus and Russia. This article analyses the arguments used by commission members, considering the interplay of national interests, how they balanced arguments between restoration of ‘state sovereignty’ and maintenance of borders, and how they finally compromised and concluded the commission's report.     

Marx’s critical political economy, ‘Marxist economics’ and actually occurring revolutions against capitalism

Abstract

Most revolutions against capitalism have occurred in ‘backward’ and Third World societies, and they have divided and disarrayed Marxisms in the West. One key reason, this paper argues, is intellectual. When, long ago, Marxists surrendered to the bourgeois challenge to Marx – neoclassical economics – developing, in place of Marx’s critical political economy, a ‘Marxist economics’, they lost touch with Marx’s analysis of capitalism as contradictory value production. That analysis could illuminate how capitalism’s contradictions drive its imperialist expansionism and how and why resistance to it must, equally necessarily, take national forms. As a result, major currents of Marxism in the West either have paid attention to imperialism and anti-imperialist resistance but without Marx’s analysis of capitalism as contradictory value production or have insisted that their (mistaken) conception of Marx’s analysis implies that capitalism has no necessary connection with imperialism. Neither tradition can actually develop Marxism to comprehend the actual historical record of revolutions since Marx’s time. Neither can inform new mobilisations against capitalism, whether in or outside its homelands. It is high time we return to Marx’s analysis of capitalism as value production and develop it.     

The Discourse of Development: has it reached maturity?

Like most other concepts in the social sciences, ‘development’ does not entail a commonly agreed upon meaning, context or programme of action. It is defined in different ways depending on the time, space, context, professional and organisational interests of the one who does the business of defining. The meaning of development has also undergone a remarkable transformation over the course of history from the Enlightenment concept of ‘Progress’ to encompass a great variety of human needs. This paper analyses how the contemporary discourse of development has reached a mature state and how it enables us to understand development in context- and culture-sensitive ways. It is now possible to determine what development means in different settings, and how to bring in material and non-material prosperity to people living in different contexts and cultures. After a theoretical discussion an empirical study in Sri Lanka is presented which attempts to arrive at a more refined context- and culture-sensitive definition of development. The paper argues that, in order to understand development at micro-settings, it is better to construct our own indexes of development rather than using global measures. It shows how the current state of the discourse of development can lend insights into construction of a development index.     

Philanthrocapitalism: rendering the public domain obsolete?

Engaging the lively debates about the next expression of neoliberalism, this study suggests that it is evolving into philanthrocapitalism. After a brief discussion of the trajectories from neoliberalism, the article addresses the core ideology of philanthrocapitalism. The central thesis explores how philanthrocapitalism is moving beyond the requirement of ‘business practices’ for recipients of donor funds, into enforcing ‘business rule’ on to the public domain. Although philanthrocapitalism is most debated in the fields of health care and education, this article uses empirical analysis of international agricultural policies trying to enlist Southern Africa policies. It explores how philanthrocapitalist rule is reducing transparency, participation and deliberation within the public domain, well beyond requesting efficient business practices for greater food security. It concludes with how smallholder farmers are actively organising to resist business rule over their genetic resources and farming practices.     

EVALUATION UNDER CONTRACT: GOVERNMENT PRESSURE AND THE PRODUCTION OF POLICY RESEARCH

Do governments lean on researchers who evaluate their policies to try to get them to produce politically useful results? Do researchers buckle under such pressure? This article, based on a survey of 205 academics who have recently completed commissioned research for government, looks at the degree to which British government departments seek to produce research that is designed to provide ‘political ammunition’, above all making them ‘look good’ or minimizing criticism of their policies. Looking at different stages in the research process – from deciding which policies to evaluate, shaping the nature and conduct of inquiry, and writing the results – the article finds evidence of government sponsors making significant efforts to produce politically congenial results. For the most part, researchers appear to resist these efforts, though the evidence base (researchers' own accounts of their work) suggests that this conclusion be treated with some caution.