CO-OPTATION, COMMODIFICATION AND THE MEDICAL MODEL: GOVERNING UK MEDICINE SINCE 1991

Self-regulation and autonomy are traditionally treated as distinctive elements of how professions are governed in contrast to other occupations. For medicine, these elements provide a collective medium of governance (through the institutions of professional self-regulation) and an individual medium (through the practice of 'clinical autonomy'). Both are reinforced by the intellectual dominance of the so-called 'biomedical model' of health and illness. Analysts generally agree that, in many countries, both self-regulation and clinical autonomy are under significant challenge. But it is less obvious that, in the UK at least, the biomedical model has effectively been co-opted for managerial purposes to support the commodification of medical care. Thus ideas that have traditionally been considered as supporting medical dominance have transpired to be a source of weakness for the profession.     

DEMOCRATIC SUBJECTIVITIES IN NETWORK GOVERNANCE: A Q METHODOLOGY STUDY OF ENGLISH AND DUTCH PUBLIC MANAGERS

Network forms of governance enable public managers to exercise considerable agency in shaping the institutions through which government interacts with citizens, civil society organizations and business. These network institutions configure democratic legitimacy and accountability in various ways, but little is known about how managers‐as‐designers think about democracy. This Q methodology study identifies five democratic subjectivities. Pragmatists have little concern for democracy. Realists regard networks as one of a number of arenas in which the politics is played out. Adaptors identify the potential for greater inclusiveness. Progressive Optimists think that network governance will fill the gap between the theory and practice of representative democracy, while Radical Optimists focus on its potential for enabling direct dialogue. Institutional design alone is not sufficient to enhance the democratic possibilities of governance networks. The choice of public manager is also salient. Adaptors or, preferably, Progressive or Radical Optimists should be selected for this role.     

Legal Ambiguity and the Politics of Compliance: Affirmative Action Officers' Dilemma

Equal employment opportunity and affirmative action mandates, like many other laws regulating organizations, do not clearly define what constitutes compliance. Thus compliance depends largely on the initiative and agenda of those persons within organizations who are charged with managing the compliance effort: in the case of civil rights, "affirmative action officers." This paper draws on case studies of affirmative action officers to suggest that the political climate within which affirmative action officers work, together with the officers' interpretations of the law, their role conceptions, and their professional aspirations have important implications for the nature and extent of organizational compliance with law. We conclude that compliance should be understood as a process that evolves over time rather than as a discrete event or non-event.