The changing world of professions and professionalism
This book brings together perspectives and analyses from sociological and organisational studies on the professions and professionalism. These are of particular relevance to our understanding of the contemporary globalised world of professional work and its organisation. The professions have long held a fascination for many of us and they are seen by many as not simply ‘jobs’ but as ‘vocations’. This assumption has meant, particularly in the past, that the study of professions has often had a normative emphasis. Yet, as Johnson (1972) famously pointed out, professions developed more as a means of controlling an occupation than necessarily as an altruistic service to others (although these may not be mutually exclusive). It is one of the challenges of researching the ‘professions’ that the term shares an everyday usage with the complex realities of those occupations variously identified as professions. One may wonder why this obfuscation continues. We could, for example, refer instead to ‘knowledge work’ or ‘expert occupations’ (Brint 1993; Reed 1996; Muzio et al. 2008) – extending the term to include the traditional as well as the newer professions. Yet the evidence and debates currently point to the newer expert occupations being identified as professions alongside the older ones, but not as professions as we have previously known them. To explain, Reed (1996, p. 586), for example, has identified financial and business consultants, project/R&D engineers and computer/IT analysts as examples of this expert group, which he refers to as entrepreneurial professions. This is, in part, because their control strategy is a market-based one. Others, including Muzio and colleagues (2008, p. 5, 2011), prefer the term expert occupations to apply to this group of occupations characterised as having ‘no mandatory [professional] membership or official credentials’ (Muzio et al. 2008, p. 5). Meanwhile, the older professions, particularly law and accountancy, have not remained unchanged, for they too have adapted to the conditions of late modernity (Giddens 1990; Reed 1996), increasingly becoming international, global, businesses. The world of the professions and professionalism is undergoing constant transformation as it responds to the market and economic ideologies that are promoting a different role for governments within many sectors (including, for example, higher education, health and social services) alongside the increasing task and technological complexities that also impact on the status and role of professionals.
The resilience of the professions as an influential form of occupational organisation is an intriguing one for it is in spite of the economic and policy challenges, including the financial crises that the public and private sectors everywhere have had to confront in recent decades. These realities, however, have transformed – in highly contested ways – the delivery of welfare-state services and with it the work of the health, educational and social care professionals. They have also contributed to the pressures to rationalise and marketise the delivery of professional services in the private sector and the concomitant growth of the managerial professional business (MPB) (Greenwood and Hinings 1993). This is a change in emphasis from collegiality to managerialism that at least ‘implies a contamination if not displacement of professionalism’ (Muzio and Kirkpatrick 2011, p. 394). There have also been serious questions raised around the question of trust and risk within professional organisations more generally (Brown and Calnan 2016, Chapter 9 of this volume), including law and finance. The latter concerns have led to the imposition of external, state-controlled, governance arrangements. All of these trends have major implications for the discourse around the professions and professionalism and have played a significant part in shaping the structure of this Routledge Companion. By way of introduction, we will set out, and thereby emphasise, the global context of professional work, preceded by a discussion on the growing diversity within those expert occupations known as professions.
While it is the case that there are various occupations and activities that are commonly referred to as professions or professional, when one ‘drills down’, one finds that these ‘professions’ do not always share common institutional arrangements or cognate histories. They are different ‘species’ of occupations whose professional status is as much a public appellation – or labelling – as it is one sought by the practitioners themselves. IT and computer specialists, for example, are commonly referred to as ‘professionals’ although many of them will not be members of a professional organisation (Muzio et al. 2008, p. 5). Moreover, in the UK at least, there is no legal compulsion for these specialists to have completed accredited programmes of training, nor any requirement for them to be registered (Dent 1996, pp. 59–60). It would appear that the maintenance of professional jurisdiction is not viewed as a major issue for the occupation in that it is organised more in line with the logic of entrepreneurial professionalism (Reed 1996) referred to earlier. On the other hand, nursing, which is widely organised as a profession, with legal recognition and registration, continues to pursue and consolidate its professionalisation through such strategies as advanced practice recognition (i.e. nurse practitioners) (Dent 2003, pp. 21–23). These two examples (computing and nursing) also illustrate a general point about the different contexts of professional work. Where the work is largely within the public sector, the autonomy and status of these professions have been influenced by their relations with the state to a greater extent than those in the private sector. By contrast, the professions working substantially in the private sector are far more directly shaped by the markets in which they operate. Much, although certainly not all, of the English-language literature on the professions has been distinctively Anglo-American. Burrage and Torstendahl (1990), Macdonald (1995) and, perhaps most significantly of all, Abbott (1988) have all emphasised the differences in organisation, traditions and institutional arrangements between continental Europe and Scandinavia compared to the UK, North America and Australasia. What has received less attention has been developments in the post-colonial world. Yet, given the globalisation of knowledge work and professional organisation (Faulconbridge and Muzio 2012), this is an oversight that is surprising. Here too was a world of another kind of ‘semi-professionalisation’ that ensured the white colonial doctor, lawyer and accountant maintained an ascendancy within the field. With the coming of independence in the mid twentieth century, the fate of the professionals took different trajectories in Asia than in Africa (see Part IV in this volume).
The changing world of professions and professionalism
Before the arrival of the neo-liberal politics and policies of Reaganism and Thatcherism ushered in during the 1980s, the professions were a disparate group of well-organised occupations with varying degrees of elite status and career security. Then the study of the professions would have been understood either in neo-Weberian terms of social closure or from a neo-Marxian labour process approach (Davies 1996, pp. 661–662; Ackroyd 2016, Chapter 1 in this volume). Although even then there was a growing fascination among scholars with Foucauldian analyses of professional activities, particularly in relation to the concepts of governmentality and surveillance (Johnson 1995; Fournier 1999). As has been described in detail in a number of treatises, the neo-Weberian approach emphasises the strategies of professions to restrict access and monopolise critical work activities as a means of establishing and maintaining high status and rewards. The neo-Marxian approach emphasises the issue of control over the work processes and the looming threat of ‘proletarianisation’, where occupational control is eroded (Dent 2003, pp. 27–30). The Foucauldian approaches initially pointed to the role of the professions in disciplining citizens in order that they become self-regulating (law-abiding, hard-working) members of society (Johnson 1995, p. 12). There is also important work being done on the influence of gender, exemplified by the work of Hearn et al. (2016, Chapter 4 in this volume), Witz (1992) and Davies (1996) reflecting a growing appreciation of the nuanced and context-sensitive way in which patriarchal inequalities play out within and between professions. A more contemporary intersectionality perspective which includes other key concerns with ethnicity or race, class and age has complicated and enriched our understanding of trends amongst the professions (Kuhlmann and Bourgeault 2008).
Whereas much of the literature on gender and the professions came from sociologists, other new developments were the product of organisational analysts. Probably the most significant example here has been the sociologically based version of new institutionalism that came to prominence in the 1990s (Powell and DiMaggio 1991), and the cognate archetype theory particularly associated with the works of Hinings, Greenwood and Cooper (e.g. 1999). Both of these related approaches have been extensively applied to the analysis of the professions within organisations, as in the case of Brock, Powell and Hinings’ (1999) very useful collection of studies on accounting, health care and law. Recent works have also explored further the notion of concomitant changes within professions and organisations to accommodate various institutional and technological changes (Noordegraaf 2011). Organisational researchers, including anglo-governmentalists like Rose (2000) and critical realists, including Reed (2016, Chapter 14 in this volume), also pay attention to how professions become mobilised by broader political and ideological forces that shape their roles and work. These works suggest that the day-to-day life of professionals is increasingly conditioned by what is happening within organisations – organisations being conceived here as a mediating space between broader social forces and the reality of work.
Generally, the neo-liberal policies of deregulation within the economy and labour markets have proven to be a real test for many professions in both the private and public sectors. For those working within the private sector, these policies created apparently wondrous – but in some cases disastrous – opportunities for those working within banking and finance – as witnessed in the 2008 banking crisis (e.g. Posner 2011; Haslam 2016, Chapter 16 in this volume), while within the public sector what became known as new public management (NPM) has been the primary neo-liberal instrument that has changed the scripts for those professionals working within the organisations of the welfare state and radically reoriented their autonomy (Dent and Barry 2004).
This autonomy became subject, for the first time, to explicit controls and governance – and their work has become subject to an increasing standardisation delineated by national guidelines and protocols, whether they are social workers, school teachers, nurses or hospital physicians. All these managerial innovations have changed the work situations of the professionals in the public and private sectors, but they have not eradicated them; nor do they look likely to do so.
Much of this discussion can be interpreted as addressing the question: to what extent, in this neo-liberal era, have the professionals been subjugated to managerial, performative, controls? Power (1997) argued, for example, that the medical profession had been colonised by medical audit. Conversely, it is possible that some professionals themselves have colonised the managerial roles (Thomas and Hewitt 2011), and this links directly with the debate around the role of the ‘hybrid’ within the professions (Muzio and Kirkpatrick 2011, p. 392; Noordegraaf 2015; Kirkpatrick 2016, Chapter 12 in this volume).
There are a range of possibilities here. Hybrids may be professionals with managerial responsibilities who exercise their responsibilities in the interests of their professional colleagues. Alternatively, they may fulfil their managerial role more corporately and in line with the broader management agenda. A third possibility is the hybrid professional/manager, fulfilling a syncretic role within the professional organisation as, for example, within a law or accountancy firm organised as a managed professional business (MPB) (Hinings et al. 1999) or an acute hospital (Dent et al. 2012). In general terms, the variations in professionals’ approach to managerial roles are shaped by whether they are – broadly speaking – ‘middle’, or ‘senior’ management roles, for the latter may offer an alternative career path away from professional work while the former is firmly embedded within it. Examples here might be doctors as heads of clinical directorates (middle-management role) vs a doctor as the CEO or director of a large hospital.
This debate around ‘hybridisation’ reflects elements of earlier, sociological, ones around the putative dilution of professional autonomy encapsulated in the deprofessionalisation (Haug 1975) and proletarianisation (McKinlay and Arches 1985) theses (which have been briefly summarised by Freidson 1994, pp. 133–136 and Macdonald 1995, pp. 61–63), in the sense that the involvement in management might be assumed to weaken professional autonomy. Alternatively, hybridisation may reflect a wholly new negotiated professional order, one characterised by new forms of internal stratification and segmentation. These are developments presaged in Freidson’s argument (Freidson 1994, p. 142) and they reflect an extension of Bucher and Strauss’ (1961) concept of professional segmentation (later extended by Carpenter (1977) and Melia (1987)). Certainly, the classic dichotomy of profession vs bureaucracy has long since broken down, with multiple consequences on the status, roles and legitimacy of professionals as new hybridised forms have emerged reflecting this new context.
Another noticeable development in the wake of neo-liberalism – and the global economic crises – has been the increased interest and concern over the issue of trust. Giddens (1990, p. 88) asked the question:
[W]hy do most people, most of the time, trust in practices and social mechanisms about which their own technical knowledge is slight or non-existent?
(emphasis in the original)
He suggests that a ‘hidden curriculum’ within formal education is the likely cause. This issue of trust has become increasingly important within the public sector, largely because of the impact of NPM, and with it the pressure for greater performativity, as well as the subsequent movement towards the new governance (Newman 2001, pp. 86–95; Osbourne 2006). We make no assumption here that professionalism exhibited high levels of integrity in earlier times, only that with the new governance arrangements, the issue of trust receives even greater attention. As Brown and Calnan point out in this volume (2016, Chapter 9), we have seen a paradigm shift towards a new regulatory regime in relation to many professions. No longer is the issue of trust implicit; instead, the professionals increasingly have to make it clear why trust in them is justified, for example in the publication of performance data. This is something that has been developing widely within the area of medicine and health care. All of this change is suggestive of a realignment of the institutional and organisational logics of professionalism and managerialism. This has led to a range of responses, including synergetic collaboration evidenced, for example, in the oft-cited exemplary health professional model of Kaiser-Permanente in the United States (e.g. Dent, Kirkpatrick and Neogy 2012). This is an example that caught the attention of health policy people, particularly in the UK, for it seemed to offer an innovative model useful for the UK’s National Health Service (NHS) to emulate (Light and Dixon 2004). The attraction was its cost effectiveness and its integrated system of proactive health care which emphasises keeping people healthy. This approach thus saves money as fewer people then become sick (Light and Dixon 2004, p. 763). What perhaps has been less widely recognised is that the doctors within this health maintenance organisation (HMO) work much more closely with management than is the case elsewhere in the USA, or indeed in other health-care systems. For the Kaiser-Permanente HMO, this working relationship proved to be particularly helpful when its survival was seriously challenged in the 1980s. Subsequently, the doctors took on even greater involvement in management with the establishment of ‘physician-managers’ selected by central management and responsible to them (Dent et al. 2012, p. 115). This ‘hybridisation’ has proven an attractive model for other organisations (Noordegraaf 2015; Kirkpatrick 2016, Chapter 12 in this volume), although it needs to be distinguished from the contested co-existence of historically established collegial practices alongside the newer managerialist ones, in a situation identified as ‘sedimentation’ by Cooper et al. (1996). Metaphorically, the older collegial practices equate to a stratum of rock laid down in a previous geological age which may break through the more recent managerial ‘strata’ in disruptive ways. Unlike rocks, however, this version of ‘sedimentation’ operates on a much shorter timescale and is readily observable in hospitals and universities, where collegial and managerial practices may co-exist uneasily together (Kitchener 1999, p. 198; Dent et al. 2012, p. 117).
Recent sociological research has responded to these developments, among others, by placing changes in the professions in the context of governance and highlighting the bonding of professionalism and other forms of governing. Several authors discuss the role of professional groups as active players in the NPM and leadership models (Burau and Bro 2015; Kuhlmann and Von Knorring 2014). These developments in the sociology of professions show many overlaps with ‘(neo-)institutionalist’ concepts, as described previously, and they open the door for closer connections of professions with organisation science and management studies, thus mirroring changes in governance (Bourgeault and Merritt 2015; Currie et al. 2012; Denis and van Gestel 2015; Kirkpatrick et al. 2015; Leicht 2015; McGivern et al. 2015; Muzio and Kirkpatrick 2011; Numerato et al. 2011; Suddaby and Viale 2011).
The linkage of the professions with governance creates a new appeal to organisation and management studies, as described previously. Hence, the focus on macro- and meso-level dimensions of governance is not as novel as it might seem at first glance. Moreover, contemporary debates draw on a classic strand of scholarship that placed the professions in the contexts of state regulation (including complex forms of ‘governmentality’) and citizenship (Bertilsson 1990; Johnson 1995; Torstendahl and Burrage 1990). Viewed through this lens, the embeddedness of the professions in wider ‘modernisation agendas’, like public sector reforms and new modes of citizenship (Kuhlmann et al. 2016, Chapter 2 in this volume), and the regulatory power of professions and professionalism as a host for knowledge production, ethics and trust comes into view (Burau and Bro 2015; De Vries et al. 2009; Kuhlmann 2006; Tonkens and Newman 2011; see also Brown and Calnan 2016, Chapter 9 in this volume, and Carvalho and Santiago 2016, Chapter 10 in this volume).
This most recent strand of research into the professions also embodies professions–state connections but expands the scholarly debate in different ways. This includes transformations of the concept of ‘state’, geographical expansion and cross-country comparison. For instance, globalisation and new emergent forms of transnational governance can be researched through the lens of professionalism and professions (Faulconbridge and Muzio 2012; Seabrooke 2014; Wrede 2012). The concepts of profession and professionalism developed in mature welfare states and Anglo-American countries are now applied to emergent service economies in other countries and areas of the world (Bonnin and Ruggunan 2013). Furthermore, international research and cross-country comparative approaches into the professions and professionalism are gaining significance (Allsop et al. 2009; Kuhlmann et al. 2015).
If anything, the professions and professionalism and their analysis have experienced something of a renaissance but in ways more compatible with the prevailing managerial ideology. Freidson, in his book on professionalism as the ‘third logic’, made a cogent argument for the continued ‘[o]ccupational control of the division of labor’ (2001, p. 59) for that group of specialists we typically call professionals. But this is now even more subject to ongoing negotiations around jurisdiction (p. 60). Thus we find changing boundaries in specialisation, for example, as between nursing and medicine, academic research and teaching, law and legal-advice work. But we also see a shift in management–professions relations over the issue of leadership (see Reed Chapter 14 in this volume) and, as Fournier (1999) pointed out a few years ago, the notion of professionalism is now being employed extensively as a managerial motivational tool and linked to new forms of leadership (Denis and van Gestel 2015). The professions have had to adapt to the radical changes of the new millennium; there have been changes, quite radical ones too, but they are still with us. The question is as much about the ‘why’ as it is about the ‘how’ this is possible.
Conclusion and outline of contents
We have made a case here as to how professions and professionalism are not fixed concepts but reflect a fluid set of institutional arrangements. They are, as Burrage, Jarausch and Siegrist (1990, p. 207) very usefully pointed out, subject to changes depending on the specific jurisdictional relations within and between occupations and professions and the state as well as employers and clients – and the country within which they are situated.
This Companion to the Professions and Professionalism has been designed and written in order to address the question of ‘what are and whither go’ the professions and professionalism in this new, rapidly globalising age. It is organised into five parts covering the elements we have identified. Each part is preceded by an introduction by one of the editors to provide an overview of its authors and contents.
Part I provides an assessment of contemporary theory and institutional practices internationally. Ackroyd provides a detailed account of the sociological and organisational theories, while Kuhlmann, Agartan and Von Knorring, Tonkens, and Hearn et al. each provide research-based analyses of current developments in the crucial areas of governance, and involvement of service users and citizens, as well as, crucially, gender and diversity. This section closes with Saks’ review of the theories of power in the analysis of the profession.
Part II provides in-depth approaches into governance as an umbrella concept under which we can explore developments in the professions and changing modes of professionalism. Burau begins with introducing the concept of governance through professions as experts, while McDonald and Spence discuss new forms of managing the performance of professions and Poutanen and Kovalainen illustrate the new connections between the professions and entrepreneurialism. Meanwhile, Brown and Calnan remind us about the building of trust through professionalism, and Carvalho and Santiago illustrate the persistence and change in the role of knowledge as the core of professionalism.
Part III deals with the relationship between organisations, management and the professions. Hinings looks at works in the last thirty years on the restructuring of professional organisations. Kirkpatrick analyses the emergence of hybrid roles that combine professional and managerial roles in organisations. Leicht analyses the professionalisation of management and its implications for other professions. Reed assesses the implications for professionals of a call for more leadership in public sector reforms. Finally, Denis and Van Gestel explore the theme of professionals in organisational change.
Part IV addresses the interface of global and local professionalism particularly within emerging economies. The section begins with Haslam’s analysis of the role and global reach of accounting, finance and banking professionals. Next, there are three case studies of the unique context of local professionalism in South Africa, India and Russia. Bonnin and Ruggunan describe how the key changes in South Africa are part of the post-apartheid project of racial and, to a lesser extent, gendered transformation. In India, Ballakrishnen details how professionalism is being reorganised in the face of the globally focused nature of professional work. We then travel to the Russian Federation with Iarskaia-Smirnova and Abramov, who argue that one must understand the historical changes that occurred before, during and after state socialism in order to understand Russian professions today. The final chapter in this section by Bourgeault, Wrede, Benoit and Neiterman provides an overview and conceptual model for the analysis of the migration and integration of expert labour.
Part V concludes the volume with a series of case studies across a range of professions. Each of these discusses current issues that challenge their jurisdictions and autonomy in the different ways identified in the earlier parts of the Companion. The chapters variously integrate the themes of governance, management and international comparison and the implications for our current understanding of the sociology of professions and professionalism.
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