Ivan Sainsaulieu

New Public Management and New Professionalism across Nations and Contexts

The professions in the West are undergoing unprecedented calls for greater accountability and efficiency in service delivery. This article links these changes to recent developments in institutional theory that emphasize shifting salience of technical over symbolic organizational environments. The analysis of the adaptations to these changes in French and British healthcare, Canadian education and US managerial consulting suggest that country-specific responses to neoliberal institutional pressures are highly path dependent. The article concludes by suggesting a research program for the future study of the cross-national responses of professional groups to neoliberal economic and political ideologies.

Comparing Health Professional Work Orientation in French and Canadian Hospitals: Structural Influence of Patients in Open and Closed Units

In this paper we present comparative qualitative data on the influence of patients on the relationship between health professionals and hospitals in France and Canada. We elaborate specifically on a typology that depicts the structural influence of patients in terms of open and closed communities. Our analysis reveals some key differences between the open and closed communities across the two countries. Health professionals in open communities in France were able to establish a stronger relationship with patients than those in Canada. Professionals in France described a weaker connection with their colleagues than in Canada, and this may be one of the triggers of stress, burnout and high turnover. There were more similarities among closed communities in Canada and France. Conceptualizing the structural influence of patients in terms of open and closed community ideal types is a useful heuristic device that moves the implicit and explicit influence of patients to the foreground of the analysis of the relations between health professions and organizations.