Ian Kirkpatrick

The new managerialism and public service professions : change in health, social services, and housing

Introduction Professions and Professional Organisation in UK Public Services Dismantling the Organisational Settlement: Towards a New Public Management The National Health Service The Personal Social Services Social Housing Conclusion: Taking Stock of the New Public Management

Introduction: Professions and organizations - a conceptual framework

This collection seeks to reconnect two separate streams of work on professional organizations and professional occupations. In particular the articles collected here identify two key themes: (1) the challenges and opportunities that professional organizations pose for established and emerging professionalization projects and (2) the extent to which professional organizations create, institutionalize and manipulate new forms of professionalism and models of professionalization. To this effect, this collection brings together a number of articles from a broad range of disciplines (sociology, management, healthcare, accountancy, law and geography), theoretical backgrounds and national contexts which explore the complex connections between professional occupations and organizations. Ce recueil cherche à reconnecter les travaux sur les organisations professionnelles et ceux sur les professions dont les objectifs de recherche divergent de plus en plus. Les articles présentés ici regroupent en particulier deux thèmes: (1) Les défis et opportunités que les organisations professionnelles présentent pour les projets de professionnalisation établis ou bourgeonnants et (2) la mesure dans laquelle les organisations professionnelles créent, institutionnalisent et manipulent de nouvelles formes de professionnalisme et de nouveaux modèles de professionnalisation. Dans ce but, ce recueil rassemble des articles d’un large spectre de disciplines (sociologie, gestion, santé, comptabilité, droit et géographie), d’écoles théoriques et de contextes nationaux qui explorent les relations complexes entre les professions et les organisations professionnelles. Esta colección de artículos busca reconectar con el trabajo sobre organizaciones profesionales y ocupaciones profesionales, puesto que estas agendas de investigación se han visto cada vez más desconectadas. En particular, los artículos recopilados en la presente identifican dos temas clave: (1) los desafíos y las oportunidades que las organizaciones profesionales plantean a los proyectos de profesionalización emergentes y establecidos y (2) el punto hasta donde las organizaciones profesionales crean, institucionalizan y manipulan nuevas formas de profesionalismo y modelos de profesionalización. A este efecto, esta colección recopila una amplia gama de artículos de diferentes disciplinas (sociología, administración, atención sanitaria, contabilidad, leyes y geografía), marcos teoréticos y contextos nacionales que explora la compleja relación entre ocupaciones profesionales y organizaciones profesionales.

Archetype Theory and the Changing Professional Organization: A Critique and Alternative:

In recent years there has been growing interest in analysing processes of change in professional service organizations drawing on the concepts of archetype theory. In this article, our primary goal is to question the validity of these ideas. A key weakness, we argue, stems from the continued legacy of functionalism in this approach and the limited role given to human agency. A further problem is the uncritical generalization of assumptions about professional organization and change, especially in the context of public services. These difficulties, we suggest, bring into question the usefulness of archetype theory as a general model for understanding change. They also point to the need to develop alternative approaches to these issues. In this article such an alternative is outlined, combining recent advances in the social theory dealing with the relationship between agency and structure with ideas from the sociology of professions.

Medicine and management in a comparative perspective: the case of Denmark and England

In health systems around the world the current trend has been for doctors to increase their participation in management. This has been taken to imply a common process of re-stratification with new divisions emerging between medical elites and the rank and file. However, our understanding of this change remains limited and it is open to question just how far one can generalize. In this paper we investigate this matter drawing on path dependency theory and ideas from the sociology of professions. Focusing on public management reforms in the hospital sectors of two European countries - Denmark and England - we note similarities in the timing and objectives of reforms, but also differences in the response of the medical profession. While in both countries new hybrid clinical management roles have been created, this process has advanced much further and has been more strongly supported by the medical profession in Denmark than in England. These findings suggest that processes of re-stratification are more path dependent than is frequently acknowledged. They also highlight the importance of national institutions that have shaped professional development and differences in the way reforms have been implemented in each country for explaining variation.

Non-Standard Employment in the Management and Professional Workforce: Training, Consultation and Gender Implications

Over the past decade, important changes have occurred in the occupational mix of the non-standard workforce, with a rising number of professionals and managers entering part-time and temporary forms of employment. However, while this shift is widely acknowledged, there remains some confusion regarding its consequences. One strand in the literature argues that, at higher occupational levels, the tendency for non-standard employees to experience marginalization at work will be far less pronounced or non-existent. A second strand argues that, regardless of occupational level, workers on part-time and temporary contracts will be treated unequally in various ways. In this article our aim is to explore this matter, drawing on data from the 1998 Workplace Employee Relations Survey. The analysis reveals that managers and professionals on non-standard contracts do become marginalized in terms of training opportunities and consultation at work, and that these outcomes are especially strong in the case of women. Finally, the managerial, national-level training policy and legal implications of the findings are discussed.

Transforming the professional archetype

The aim of this article is to question the idea that all professional service organizations are undergoing a process of inter-archetype transformation. This idea, originating in organizational archetype theory, is now being used to interpret contemporary processes of change in British and other public sector services. Drawing on an example of management UK restructuring in social services during the 1990s – that of local authority social services in the UK – two main problems with this thesis are identified. First, this service demonstrates that ‘radical’ change has not occurred and that older professional values and working practices persist. Second, it reveals how, in at least one part of the public sector in the UK, management reforms have been partly undermined by a specific constellation of institutions and practices. These observations call for questioning the proposition that inter-archetype change is what has occurred and that current reforms will inevitably have this sort of transformational effect.

A retreat from permanent employment?: Accounting for the rise of professional agency work in UK public services

The last five years have witnessed a steady growth in the use of agency workers to fill core professional roles in public sector organizations. Whereas in the past the use of agency workers was driven mainly by employer demands for improved flexibility, this current expansion is predominantly supply led occurring against a backdrop of increasingly tight labour markets. In this article our objective is to explore some of the factors that lie behind this change. Specifically, we raise questions about how far current trends can be explained using the ‘free agent perspective’ and the notion of portfolio careers. Focusing on one group of professionals in the UK public sector -local authority social workers -we find only limited evidence to support this interpretation. Instead, it is argued that current moves into agency work are in large part a reaction to increasing rigidities in the employment system and to deteriorating conditions of work.

Supervising Professional Work under New Public Management: Evidence from an ‘Invisible Trade’

This paper assesses the extent to which the new public management (NPM) project has succeeded in replacing the custodial mode of professional work supervision with a more bureaucratic approach. The paper conceptualizes the key components of each mode within two ideal types of professional work supervision. It then draws on findings from a study of local-authority social service departments to consider current arrangements against these ideal type configurations. The findings demonstrate that elements of the bureaucratic mode have emerged unevenly. So far, they have not displaced the emphasis that the supervisors of professional work place on protecting autonomy and limiting management control systems. This suggests that custodial approaches to the supervision of professional work may be more resilient than has been assumed within previous analyses of NPM.

The Worst of Both Worlds? Public Services without Markets or Bureaucracy

In recent years there has been growing support for the idea of developing collaborative network relationships between purchasers and providers in UK public services. Under the new Labour Government this idea found its way into policies aimed at promoting a ‘third way’ between markets and hierarchies in health and local government. This article addresses a number of concerns about these developments. Drawing on the wider management literature, it argues that recent discussions have largely under-stated the problems associated with relational contracting and networks. The author also considers why the option of a return to hierarchy has so far been dismissed and argues for a reversal of this tendency.

Clinicians on the board: what difference does it make?

Around the world clinical professionals have increased their involvement in the management of health services. However the evidence to suggest that these changes will lead to improved performance remains fragmented. In this paper we address this matter focussing on the impact of clinicians appointed to the boards of directors of English NHS hospital trusts. Although the number of clinicians involved in the strategic governance of hospital trusts is relatively low by international standards, they do appear to have an impact on overall performance. Drawing on published information from hospital trust annual reports, publicly available performance measures from the Healthcare Commission and data gathered by Dr Foster over a three year period (2006-9), the paper reports two main findings. First, the analysis reveals a significant and positive association between a higher percentage of clinicians on boards and the quality ratings of service providers, especially where doctors are concerned. This positive influence is also confirmed in relation to lower morbidity rates and tests to exclude the possibility of reverse causality (doctors joining boards of already successful organisations). Second, we do not find the same level of support for clinical professions such as nurses and other allied health professions turned directors.