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.     

THE ‘NEW PUBLIC GOVERNANCE’ AND EMPLOYABILITY SERVICES IN AN ERA OF CRISIS: CHALLENGES FOR THIRD SECTOR ORGANIZATIONS IN SCOTLAND

Third sector organizations (TSOs) have emerged as key players in the delivery of public services to assist jobless people to improve their employability and move from welfare to work. Drawing on in‐depth research with employability providers in Scotland, this article explores how TSOs have responded to the challenges of a rapidly changing public services environment. Specifically, we use the concept of the ‘New Public Governance’ to explore TSOs' relationships with UK, devolved and local government stakeholders. TSOs demonstrated a pragmatic approach to shaping their services to reflect the priorities of public funders, and identified some opportunities arising from the new emphasis on ‘localism’. However, the evidence suggests that opportunities for collaboration at times remained constrained by certain forms of ‘contractualism’ and top‐down performance management. Based on the evidence, lessons for future policy and practice are considered.     

THE ROLE OF EXTERNAL INSPECTION IN THE PUBLIC SERVICES: THE CASE OF THE UK TRAINING MARKET

We consider two interpretations of the role of external inspection in the public services in the UK in the context of publicly funded, work‐based training programmes for young people. The first is that inspection provides substantive information to buyers concerning training quality, thereby improving efficiency in the ‘training market'. The second is that it provides procedurally oriented reassurance concerning service quality to government and the public, irrespective of substantive quality. Evidence is drawn from the inspection procedures and reports of the Adult Learning Inspectorate between 2001 and 2005. The inspectors rated training providers on various attributes, some clearly procedural, others potentially substantive. We find that while inspectors took both procedural and substantive dimensions of training into account in judging the quality of a provider's services, they attached considerably more weight to procedural than to substantive attributes. In particular, they undervalued the trainee completion rate, despite its potential association with the substantive quality of training and the priority the government attaches to raising it. These results are interpreted as evidence of limited validity in inspection findings, which do little to resolve information asymmetries in the UK training market.     

ON THE BUREAUCRACY OF BUREAUCRACIES: ANALYSING THE SIZE AND ORGANIZATION OF OVERHEAD IN PUBLIC ORGANIZATIONS

Governments across the globe try to rebalance their budgets by rationalizing overhead operations. When overhead‐reducing policies are adopted, it is important to understand why some central government organizations have a higher overhead than others, and why organizational models to produce overhead efficiencies are used to different degrees. This study focuses on the Flemish context to analyse differences between central government organizations in the size and organization of two overhead processes: human resources management (HRM) and finance and control (FIN). Significant effects are found for autonomy, organizational size, spatial dispersion and budgetary stress, yet effects vary according to whether HRM or FIN is considered and whether the focus is on the size or the organization of HRM or FIN. Our findings have practical implications to get a process‐sensitive understanding of the size and organization of overhead, and theoretical implications as they cast light on factors that shape decision‐making in public organizations.     

CHANGE IN THE MANAGEMENT OF PUBLIC SERVICES

This article identifies the main themes in recent changes in public sector management and shows the extent of the challenge to past organizational assumptions. While recognizing the objectives of the changes could bring benefits if realized, it argues that there are a series of issues that are unresolved. The language of consumerism, the development of government by contracts, the form of performance management and the use of quasi-markets are seen as creating problems. These are seen as deriving from an attempt to apply approaches drawn from the private sector to the public domain. It is argued that they need to be balanced by approaches that recognize the values of the public sector.     

HOW NEW PUBLIC MANAGEMENT REFORMS CHALLENGE THE ROLES OF PROFESSIONALS

ABSTRACT

The article discusses the relationship between New Public Management reforms and professional roles in European countries. The author presents the traditional autonomous role of professionals and argues that this role is challenged in New Public Management reforms. Then the author looks more closely into the comparative European literature on New Public Management reforms to find general messages about the specific challenges for professionals. And the Danish way of implementing New Public Management reforms is introduced with a specific combination of decentralisation, managerialism and democratisation. Professionals are faced with all of these reform strategies and each of them raises important research questions in a study of reforms and roles. Finally the author presents the few European comparative studies on actual changes in professional role as a consequence of New Public Management reforms and the result is the upcoming of maybe a new interactive role and professional managers. The result calls for further studies into these new roles.     

NEW PUBLIC MANAGEMENT IN PUBLIC SECTOR ORGANIZATIONS: THE DARK SIDES OF MANAGERIALISTIC ‘ENLIGHTENMENT’

For many years the proponents of New Public Management (NPM) have promised to improve public services by making public sector organizations much more ‘business‐like’. There have been many investigations and empirical studies about the nature of NPM as well as its impact on organizations. However, most of these studies concentrate only on some elements of NPM and provide interesting, but often anecdotal, evidence and insights. Perhaps exactly because of the large amount of extremely revealing and telling empirical studies, there is, therefore, a lack of a systematic identification and understanding of the nature of NPM and its overall relevance. This paper contributes to a systematic identification and understanding of the concept of NPM as well as its multi‐dimensional impact on public sector organizations. First, the paper aims at (re‐) constructing a comprehensive taxonomy of NPM's main assumptions and core elements. Secondly, the paper tries to provide a more comprehensive and meta‐analytical analysis of primarily the negative consequences of NPM‐strategies for public sector organizations as well as the people working in them.     

THE LIMITS OF KNOWLEDGE MANAGEMENT FOR UK PUBLIC SERVICES MODERNIZATION: THE CASE OF PATIENT SAFETY AND SERVICE QUALITY

This article assesses the contribution of management of knowledge across organizational and professional boundaries towards improved public services. We empirically investigate the potential for knowledge sharing within the context of the NHS modernization agenda, taking as our focus the current ‘patient safety’ policy agenda. Specifically, we evaluate the introduction of a knowledge management system, namely the National Reporting and Learning System (NRSL) and its impact in the area of operating theatres within a university teaching hospital. We suggest that government policy in this area needs to reflect more upon limits to the management of knowledge and issues of the nature of knowledge, professional cultures and institutional power and politics.     

THE MANAGEMENT OF CHANGE IN PUBLIC ORGANIZATIONS: A LITERATURE REVIEW

This article presents a review of the recent literature on change management in public organizations and sets out to explore the extent to which this literature has responded to earlier critiques regarding the lack of (public) contextual factors. The review includes 133 articles published on this topic in the period from 2000 to 2010. The articles are analysed based on the themes of the context, content, process, outcome, and leadership of change. We identified whether the articles referred to different orders of change, as well as their methods and theory employed. Our findings concentrate on the lack of detail on change processes and outcomes and the gap between the common theories used to study change. We propose an agenda for the study of change management in public organizations that focuses on its complex nature by building theoretical bridges and performing more in‐depth empirical and comparative studies on change processes.     

CONTINUITY AND CHANGE: THE ROLE OF THE HR FUNCTION IN THE MODERN PUBLIC SECTOR

As the public sector has modernized and sought to become more efficient and cost‐effective, the effective and strategic management of people has received increasing prominence and there have been calls for the Human Resource (HR) function to play a more strategic role. However, not much is known about whether the role of the HR function has changed substantively. In this paper, we present empirical evidence from six matched‐pair public sector organizations in the UK to assess whether HR functional roles have changed, as envisaged, into a model more akin to the private sector. The findings highlight the complex and often contradictory nature of HR functional roles, and suggest that new and more strategic roles have not replaced traditional approaches but, rather, have been grafted on, giving rise to a variety of hybrid HR forms.     

TRANSFORMING PUBLIC SERVICES: CONTRACTING FOR SOCIAL AND HEALTH SERVICES IN THE US

Government contracting with private service organizations has grown rapidly in the United States in the last 25 years. Advocates of contracting hope that it will spur competition among service agencies, lowering costs and improving service quality. In practice, however, contracting departs significantly from this competitive model. Instead, government and private agencies develop long-term relationships which can be considered regimes governed by specific norms and expectations. These regimes profoundly influence the delivery of services and the politics of contracting. This article analyses these regimes in the context of the contested nature of public authority. The article concludes with suggestions for reforming public policy to improve the performance and effectiveness of contracted services.     

FRAMING AND COUNTER‐FRAMING NEW PUBLIC MANAGEMENT: THE CASE OF GERMANY

In this paper I explore the conflict between managerial and bureaucratic models of public sector management from the discursive perspective in institutional theory. Taking the under‐researched case of Germany, I conduct a textual analysis of seminal publications in the discourse on public sector reform and reveal the subversive framing conflict which accompanies the proliferation of private managerial models in the public sector. As the most general result, a frame which advocates the transfer of business‐like managerial practices clashes with a counter‐frame which opposes this managerialization. I elucidate how these competing frames are composed, which of their components are core and which are peripheral, how the frames relate to each other, and which broader discourses they exploit for legitimization purposes. The results imply that the often assumed superiority of managerial over bureaucratic control is constructed through discourse rather than being a law‐like regularity.     

INTRODUCTION: DETERMINANTS OF PERFORMANCE IN PUBLIC ORGANIZATIONS

The performance of public organizations is one of the key topics in public administration research and practice. This topic was examined at the 'The Determinants of Performance in Public Organizations II' conference held at the University of Hong Kong in December 2006. The conference was held in association with the Public Management Research Association . In the present symposium we introduce four of the articles presented at conference. The articles explore: network performance (Kenis and Provan), goal ambiguity (Lee et al .), environmental shocks (Meier and O'Toole), and diversity (Pitts and Jarry). Alongside this we spotlight the importance of this field and introduce three research themes—contingency theory, measurement and data, and analysis.     

NEW MODES OF GOVERNANCE IN ITALY AND THE NETHERLANDS: THE CASE OF ACTIVATION POLICIES

This article discusses the growing importance of operational reforms in the context of welfare state transformation processes, and the role that principles of new governance play in shaping these reforms. It focuses specifically on one social policy area considered crucial in reforming welfare states: the provision of activation services that aim at increasing the employability and labour‐market participation of people dependent on benefits or social assistance. The article argues that besides the reforms of the programmatic aspects of social policies and social services (formal policy reforms), reforms of the way in which policies and services are organized, administered and delivered (operational policy reforms) have received increasing attention as a ’second strand’ of welfare state reforms. It illustrates this by analysing and comparing reforms of the provision of activation services in two European countries: Italy and The Netherlands. The article not only reveals the growing emphasis in both countries on operational policy reforms which are to an important degree inspired by principles of new governance, but also shows significant similarities and differences in their concrete manifestations, which could be interpreted as pointing out processes of ‘path‐dependent convergence’.     

STRUCTURAL CHANGE AND PUBLIC SERVICE PERFORMANCE: THE IMPACT OF THE REORGANIZATION PROCESS IN ENGLISH LOCAL GOVERNMENT

Organization theory suggests that structural change has disruptive effects on managerial behaviour and organizational outcomes, and that these effects are likely to emerge in the period between the announcement and the commencement of the new structure. We evaluate the validity of this argument by analysing the performance of English county councils in the transition period before the voluntary restructuring of a sub‐set of these organizations. Disruptive effects are tested while controlling for a range of other variables, including the relative prosperity of the local population and the diversity of their service needs. The empirical results indicate that the performance of local authorities facing reorganization deteriorated prior to the onset of the new structures, and support the view that structural change has disruptive effects on organizational outcomes.     

THE RISE OF THE INTERMEDIATE LEVEL INSTITUTION IN BRITISH PUBLIC ADMINISTRATION: THE CASE OF THE ARTS AND TRAINING

During the 1980s there was both centralization and decentralization in the British policy process. The centre was to be responsible for broad policy whilst the institutions in closest contact with those who consumed or used a service were to be responsible for implementation. This style was, in part, a reaction to the perception that organized interests acted as a severe restraint on the centre. Experience, however, demonstrated government's dependence on the cooperation of organized interests and their intermediate organizations. This article argues that effective policy-making requires the formation of intermediate organizations linking macro- and micro-institutions. These organizations are vital for communication, representation and negotiation and therefore they inevitably constrain the centre's freedom. Effective policy requires a partnership between the centre and sub-centre via intermediate institutions and these institutions are likely to become more important as decentralization continues. The role of intermediate institutions are explored via case studies of training and arts policy.     

DOING BUSINESS IN THE TEMPLE? MANAGERS AND QUALITY ASSURANCE IN THE PUBLIC SERVICES

Quality' is now high on the policy agenda for many of our major public services. This article raises the question of what are the respective roles in securing quality of, on the one hand, professional service deliverers and, on the other, managers. It reviews a range of possible roles for managers and concludes that some of these are likely to be illegitimate and ineffective. Even the more appropriate roles will, however, often prove difficult to establish in practice. The article concludes with an examination of some possible key design features for successful relationships between managers and professional service deliverers. These are examined against the background of specific changes currently underway in the health care and education sectors.