Governing through professional experts
Following the neo-Weberian perspective, professions have long been understood as a form of social closure (Freidson, 1970, 2001). At the micro level, professions use highly specialized knowledge as stepping stones for practising with relative autonomy and for dominating the division of labour in their respective fields of work. At the macro level, professions seek to create shelters from both state interventions and market forces. In contrast, this chapter focuses on the societal embeddedness of professions and analyses how professional expertise can be used as a source for governing in contemporary societies. The perspective on embeddedness opens up for study the multiple ways in which professions are connected to society, and vice versa. This includes questions about governing and about the specific processes structuring professional fields, policies and organizations.
As the next section argues, embeddedness is on the rise for a number of reasons. Changes in society, government politics, as well as in science and the professions themselves, highlight the governing potential of professional experts. The remainder of the chapter discusses how to conceptualize this development in theoretical terms and introduces four perspectives: governmentality, welfare governance, organization studies and gender. The governmentality perspective highlights governing through the institutionalization of expertise, how this is predicated on both autonomy and control as well as historically contingent. The welfare-governance perspective draws attention to sector-specific strategies of governing through institutional adaptations that are part of a complex knowledge–power knot, where professions are both agents and under pressure as well as subject to policy and country contingencies. The organization-studies perspective is concerned with governing through the agency of professions in processes of organizational change, where professions pursue their interests in specific organizational contexts. Finally, the gender perspective stresses the salience and ambivalences of governing through professions, where highly gendered contingencies limit the potential for governing.
The underlying argument is that the nature of both professions and government has been changing. In relation to the first point, Brint (1994), for example, suggests that professions have moved from being social trustees to being professional experts. As social trustees, the legitimacy of professions is built on a combination of possessing expert knowledge and practising to the greater good of society. As professional experts, professions still draw legitimacy from their knowledge, but only to the extent that knowledge and its underpinning credentials prove their value in relation to organizational functions and market forces (Brint, 1994). The nature of knowledge is more formally than socially important (see Chapter 10 by Carvalho and Santiago).
There are a number of reasons for the greater embeddedness of professions in societies (Brint, 1994). Among others, professions have grown in size and the ensuing internal competition has made professions more fragmented. For example, following the expansion of higher education since the 1960s, stratification among universities has increased. Within the profession of university academics, there are growing divides, for example between elite and rank-and-file academics or between predominantly research and predominantly teaching active academics. This, together with different ways of critiquing professionalism, has weakened the institutions supporting social trustee professionalism, especially its underlying moral fabric.
A prominent example of the weakening moral fabric of professionalism is a number of severe cases of medical malpractice in the UK in the late 1990s, which led to a radical overhaul of the system of professional self-regulation more generally (Fenton & Salter, 2009). Medical performance came to be regulated externally to a greater extent in the form of the government’s clinical governance policy and the General Medical Council’s revalidation policy. By extension, the perspective of professional expertise raises questions about the political influence of professions and, more specifically, what influence professions enjoy under what circumstances (Brint, 1990). Professional experts thus become an integral part of the question ‘who governs?’.
This is also the focus of recent contributions to the science studies literature. Maasen and Weingart (2005), for example, are concerned with the interdependence of the relations between science and politics. They see this as the consequence of a twofold development, whereby science has become more democratic and politics has become more scientific. On the one hand, through the greater availability of information, for example through the internet, scientific knowledge is demystified and also is subject to greater critical scrutiny. Institutionally, one consequence is that user representatives are increasingly included in expert committees, sitting side by side with professional experts. On the other hand, the policy process increasingly draws on expert knowledge to legitimize interests and decisions. One indication of this is the notion of evidence-based policy-making and the use of expert panels.
The interdependent relations between science and the political system give rise to different types of mutual references. Examples of such coupling are: the proliferation of expertise to legitimate political/business decisions; the ubiquity of experts reflecting an increasing specialization of knowledge; the diversity of institutional bases for individual experts well beyond universities; the explicit use of partisan rather than ‘objective’ knowledge to support specific sets of political/business interests; and the commodification of knowledge whereby expert advice is supplied without demand. Based on the case of interdisciplinary research, Maasen and Lieven (2006) highlight the double-edged nature of the interdependence between science and politics: it strengthens the public accountability of science, but this comes at the price of greater control of science. The concrete measures employed are continuous monitoring and reporting as well as the accomplishment of visible results, which also fit well the overall move towards an audit society (Maasen & Lieven, 2006).
In parallel with the move of seeing professions as embedded in society, the view of the nature of government has also changed. Policy analysis and public administration have traditionally focused on government as an organizationally distinct entity. With reforms of the public sector since the 1980s, the nature of government has been in a state of flux. The reforms have drawn on softer, less openly hierarchical forms of governing and have also to a greater extent included sub-central/supranational levels of governing together with actors from beyond the public sector (Kooiman, 2000; Kazepov, 2010). More recent contributions to the literature thus focus on governance instead of government, which they see as a complex process. Governance spans different levels and, in addition to hierarchy, also draws on other forms of coordination, especially networks but also markets (Bell & Hindmoor, 2007; Dingeldey & Rothgang, 2010; Osborne, 2010).
In relation to the second point, the shift in perspective from government to governance has opened the view for professions and their potential contribution to governing (see Chapter 2 by Kuhlmann et al.), especially as mediators between welfare states and citizens (Noordegraaf, 2011). For example, in her study of the modernization of healthcare in Germany, Kuhlmann (2006) critically examines the remaking of professionalism (and especially medical professionals) in the context of the new modes of governing. Similarly, Duyvendak and colleagues (2006) assess how new welfare policies in the Netherlands concerned with contractualization/accountability, managerialism and privatization/marketization offer a springboard for both questioning and redefining the influence of professionals in welfare services. Indeed, from a broader comparative perspective, Kuhlmann and Burau (2008) argue that, in relation to healthcare, the new regulatory tools at the same time increase the control of clinical practice and offer a lever for reasserting medical power.
Professions and governmentality
One way to conceptualize governance through professional experts is the notion of governmentality (Johnson, 1995; Fournier, 1999). This goes back to Foucault’s (1979) view of governing as a highly complex activity, or rather set of activities, which encompasses different institutions, procedures, tactics, calculations, forms of knowledge and technologies. Professions are part and parcel of governmentality: they represent the institutionalization of expertise, which in turn is a condition for the exercise of political power. For example, states create professions to respond to specific problems of governing and, as such, professions become part of the formation of states.
For Sweden, Evertsson (2000) shows how the creation of a centrally planned welfare state opened new professional fields for female welfare professions and how the state was quick to establish relationships with occupational groups whose skills appeared to be particularly suitable in the welfare political context. In this process of governing, states depend on professions and their autonomy as much as professions depend on the intervention of the state (Johnson, 1995). In this way, the notion of governmentality offers a deeper understanding of the nature of the independence between states and professions in processes of governing.
While Johnson’s perspective is primarily historical, Fournier (1999) more clearly positions professions in the context of contemporary governments. As she explains, liberal government is about both autonomy and control and more specifically about the government of autonomous conduct. Governing concerns the structuring of domains of possibility for action and subjectivity, and in this process governing also constitutes free-willed subjects (Fournier, 1999). The overall legitimacy of this form of governing rests on an argument about working in the name of truth. At the same time, truth claims need to be legitimate and meaningful vis-à-vis those whose lives are governed by such truths.
Expertise offers a specific form of legitimization of such truth claims, and contemporary societies are characterized by the proliferation of expert knowledge. For example, in relation to patient safety reforms in England, Waring (2007, p. 164) argues that the emergence of ‘safety science’ offers a knowledge base that allows managers to legitimately evaluate clinical performance. Such forms of knowledge are embedded in professional competences and this helps to further legitimize truth claims (Fournier, 1999). Importantly, competence relates not only to knowledge but also to practice or conduct, and professions have to inscribe themselves in a network of accountability. For example, Pickard (2010) shows that the development of geriatric medicine in the United Kingdom after the Second World War was predicated not only on the availability of new knowledge about the possibilities for treating older people but also on the use of this knowledge for discharging older people from long-stay beds.
In summary, the governmentality perspective sets the focus on governing through the institutionalization of expertise, and on how this is predicated on both autonomy and control. The perspective also stresses the historical contingency of governing arrangements.
Professions and welfare governance
Another way to conceptualize governance through professional expertise is the concept of governance. In comparison to governmentality, the governance perspective has emerged from public administration and accounts for specific strategies of governing. As welfare states are a major area of governance, and as professions play a key role in the definition and delivery of welfare services, the main focus of the literature is on welfare governance. Clarke and Newman (1997) present professions as one of the three building blocks of the governance of the post-war welfare state; the other two are bureaucracy and democratic accountability. This building block is based on a double logic of representation, whereby bureaucracy serves the ‘public interest’, whereas professions have a focus on the ‘public good’. Professionalism is not only an occupational strategy that defines the entry into a profession and negotiates its power but also an organizational strategy (Clarke & Newman, 1997). As such, it shapes how relationships and power in organizations are coordinated. For example, hospitals have traditionally been organized based on medical specialties and this reflects the dominant position of doctors in the health division of labour.
Clarke and Newman (1997, pp. 63–64) contrast the post-war settlement with new public management (NPM) reforms since the 1980s, whose rhetoric built on a frontal attack on ‘professional (welfare) bureaucracies’. The main focus was on the ‘fundamental’ problems of the existing governing regime, and this offered a stepping stone for presenting the qualities of management. Indeed, this became a recurring discursive figure and, for example, as part of its modernization of the public sector, the New Labour government labelled public sector professions as part of an old-fashioned ‘producer monopoly’ (Newman, 2001, p. 83).
What are the implications for the role of professions in welfare governance? A linear perspective predicts displacement, or rather subordination, whereby welfare governance comes to be dominated by managers and professionals are marginalized. However, in practice, the picture is more mixed, and Clarke and colleagues (2007) see public sector change as a process of institutional adaptation. This goes hand in hand with strategies of co-option, whereby NPM redefines professional concerns in managerial terms (Clarke & Newman, 1997). For example, over the last decades, reforms of elderly care in the Nordic countries have redefined quality, from quality as care delivered by highly trained professionals to quality as user choice and measurable standards (Dahl & Rasmussen, 2012).
Contemporary welfare governance is more hybrid in nature and professions continue to play an important role, although under different terms. Professions are part of relevant networks, but together with public and other non-public agencies; there is also space for new occupational groups at the same time that the boundaries of established professions are becoming softer (Newman, 2013). For example, Newman (2001) suggests that for welfare professions in the United Kingdom, the management of performance under New Labour included elements of both managerial control and professional self-control. Measuring outputs through performance indicators and specifying process through standards were examples of the former, whereas the growing focus on quality was associated with the latter.
In their comparative study of the management of medical performance in four European countries, Burau and colleagues (2009) also find that professional self-regulation is combined with other forms of governance, especially based on the logic of hierarchy. The assertion of public controls was the main challenge underlying pre-reform arrangements, but the extent to which hierarchy gains in strength and how this affected the overall balance with professional self-regulation varies among countries. In the United Kingdom, the reforms have generated more hierarchy, challenging the parallel regime of professional self-regulation. In Italy, instead, the strengthening of hierarchy is less extensive and, above all, incomplete. The situation is similar in Denmark, except that there hierarchy is complete. The strengthening of hierarchy is also moderate in Germany but coincides with a weakening of professional self-regulation.
The specific constellations of governing arrangements reflect differences in macro-institutional contexts, especially related to the healthcare state and its relative centralization as well as the nature of medical authority. For example, in the United Kingdom, the combination of the entrenched command-and-control healthcare state and highly centralized governing arrangements has given the government extensive governing capacities, and all the new regulatory agencies operate at arm’s length from each other as quasi-government bodies.
Also, with a similar healthcare state, Denmark sees the introduction of a national systematic standards-based programme. Yet, following the focus on consensus-finding in the context of highly decentralized governing arrangements, this is a public body, which functions as a coordination hub for public authorities at sub-central and central levels. Similarly, in Germany, subjecting the component parts of the system of joint self-administration to tighter substantive and procedural regulation reflects a healthcare state that has traditionally been more decentralized corporatist. Here, the governing capacities of the state are mainly related to defining (and redefining) the overall framework in which joint self-administration operates; this includes both procedural and substantive issues and is achieved by initiating legislation.
Welfare governance and institutional adaptation
Contemporary welfare governance puts professional knowledge into new contexts, where professions are both agents and under pressure. Conceptually, Clarke and colleagues (2007; also Newman, 2013) present the idea of the knowledge–power knot to capture more fully the complex position of professions in welfare governance. Welfare governance is a process of institutional adaptation, interpretation and translation; this is shaped by a set of interdependent dynamics, which can be thought of as the four corners of a diamond. The two axes represent the main forces in public services, which originate from the relations between government and the public and from the relations between professions and organizations respectively.
The specific accommodations between the four corners are highly context dependent (Newman, 2013), but are variations arising from the following interplay: ‘the public places new expectations, government makes new demands, organizations tighten managerial logics, occupations become more uncertain’ (Newman, 2013, p. 45). For example, Harrison (2002, p. 465) argues that changes in health policy in England since the late 1990s have led to the emergence of ‘scientific-bureaucratic medicine’. This was a response to a variety of pressures: the inherent element of control corresponded very well to the heightened managerial ambitions of the government developed as part of NPM reforms since the 1980s, as well as to the quasi-market structures of the healthcare service; and control further addressed the concerns of the public following high-profile cases of medical malpractice, which also left the medical profession with considerable uncertainty about the system of professional self-regulation.
The welfare governance perspective draws attention to sector-specific strategies of governing through institutional adaptation that are part of a complex knowledge–power knot, where professions are both agents and under pressure as well as subject to policy and country contingencies.
Professions and organizational studies
The previous two perspectives have in common that they focus on the macro level of governing and examine the role of professions in this process. In contrast, the literature on organization studies of professions has the meso level of organizations as its starting point and analyses how professions contribute to maintaining and changing organizations (Muzio & Kirkpatrick, 2011; see also Chapters 11 to 15 in Part III of this Companion). This perspective is particularly relevant as NPM reforms draw on softer, non-hierarchical as well as decentralized forms of governing (Kazepov, 2010; Kuhlmann & Burau, 2015). Organizations have thus become important arenas for governing; indeed, they are increasingly conceived as policy instruments to bring about change and improvements in the public sector.
Like the literatures on governmentality and welfare governance, interdependence is also a central concern of the organizational-studies perspective. This builds on a view of organizations as interrelated systems of professions (Kirkpatrick & Ackroyd, 2003). For example, Kirkpatrick and colleagues (2011) suggest that the formal health division of labour is shaped by both the projects of professions and the rational design of managers. In this respect, management itself has become an increasingly contested issue and the central question is who controls management and in what ways; as discussed in more detail below, professions have become more management-minded (Noordegraaf, 2011). At the level of actors, professions emerge as agents of organizational change as much as organizations offer a platform for professional development (Muzio & Kirkpatrick, 2011). Numerato and colleagues (2012) illustrate this in their discussion of co-optation of healthcare management by doctors: management first and foremost involves doctors who employ a complex set of tactics. This process does both: it secures centrally and managerially defined goals, and it allows sufficient leeway to reinforce medical professionalism.
Within this body of literature, there are different types of research. One set of studies analyses the changing role and nature of professions in the dynamics of organizations. For example, Muzio and colleagues (2013; similarly Suddaby & Viale, 2011) take processes of institutionalization as their starting point and thereby highlight the broader role of professions in constructing, organizing and ordering social life. Following on from this, changes in professional projects naturally have repercussions in the organizational fields where professions work and indeed can lead to endogenous organizational change (Suddaby & Viale, 2011, p. 425).
Institutionalization thus offers a switchboard for the development of both organizations and professions, and from this switchboard professions emerge as key agents of institutional change. This encompasses a range of roles (Scott, 2008): cultural-cognitive agents, who offer conceptual tools to define issues; normative agents, who provide norms, standards and principles to guide human action; and regulative agents, who take part in the formulation, implementation and interpretation of rules and regulations. Further, Suddaby and Viale (2011) identify the different strategies professions employ when acting as institutional agents. This may include: opening up new spaces for the expertise of professions; populating existing organizational spaces with new actors; and redrawing boundaries and rules governing a specific organizational field.
In contrast, Noordegraaf (2007) examines the relations between organizations and professions through the notion of hybridity. This describes a situation where professions are not merely embedded in organizational contexts but deeply connected to organizations. More specifically, contemporary professionalism encompasses different approaches to governing, drawing on managerial, market as well as professional logics. This allows for diverse roles in the maintenance and change of organizations. A powerful example is the ambivalent role of epidemiological knowledge, which at the same time is rooted in and can strengthen the logic of professionalism, and can be connected to the logic of management and be used as a means of external control (Numerato et al., 2012). At the level of actors, this may be reflected in the emergence of manager professionals and professional managers, who in their practice navigate between those different logics of governance, and who thereby connect professional practice and organizational actions in new ways.
Noordegraaf (2011) further specifies the role of professions in organizations by introducing the notion of organized professionalism. Here management-minded professionals become engaged in managing multiplicity by making connections to broader organizational, economic or political demands. The task of organizing professional work is increasingly managerial in nature as it has to address external changes relating to working conditions, multi-professionalism and new risks. This is underlined by Waring and Currie (2009) in their case study of knowledge management of medical doctors in the United Kingdom. The authors find that managerial expertise can in fact become detached from managers as persons/roles and instead can become part of professional practice. At one level, this helps to maintain professional autonomy, while at another level, it makes professional practice and identities increasingly managerial.
Postma and colleagues (2014) further expand on the concept of organized professionalism. Based on a case study of neighbourhood nurses in the Netherlands, the authors argue that organizing work does not necessarily always come from above. Instead, organizing work can be an intrinsic part of professional practice, but which has received a new meaning in the face of changes in organizational conditions and policies. This is what the authors call ‘articulation work’ (Postma et al., 2014, p. 61).
Interplay between professions and organizations
Another set of studies takes one step back and explores what determines the specific interplay between professions and organizations. Comparisons across different professions or countries typically highlight variations and at the same time offer a lever for analysing the contexts which help account for the very same variations. For example, Kirkpatrick and colleagues (2009) compare relations between doctors and managers in Denmark and England. The authors suggest that the specific stratifications emerging in hospitals reflect different legacies of state–professions relations, which in turn shape the collective strategies of doctors and their willingness to engage with management at the level of organizations.
Similarly, in a study of hospital governance in six European countries, Kuhlmann and colleagues (2013) identify three patterns of control which exhibit different degrees of integration. The differences relate not only to organizational but also to macro-level contexts, namely the governance structures of hospitals and the institutional characteristics of healthcare states respectively.
In summary, the organization-studies perspective is concerned with governing through the agency of professions in processes of organizational change, where professions pursue their interests in specific organizational contexts.
Governing through experts builds on embeddedness, but it does not stop with governmentality, welfare governance and organizations. Instead, embeddedness also includes society at large and the gendered structures of society. In fact, as the literature on welfare service professions suggests, governing through gender is highly salient and, as such, also highlights the ambivalences of governing through professional experts.
The traditionally gendered nature of many occupational fields has meant that women-dominated welfare professions like social workers, nurses and midwives have been a prime leverage point for governing, for example in connection with the building of the welfare state. This particularly applies to the universalistic (welfare) states in Nordic countries, where states have been proactive in creating extensive educational opportunities, public sector jobs and work-related social rights (Evertsson, 2000). As a result, welfare service professions enjoy a strong position in these countries. Nevertheless, in other countries, the state also plays an important role as potential ally, enabling and actively supporting professional projects of welfare service professions (Henriksson et al., 2006). For example, Sandall et al. (2001) examine the changing occupational role and status in the social structure of healthcare in four countries and conclude that states are central to supporting and protecting the jurisdictional claims of midwives. The specific stance the state adopts vis-à-vis welfare service professions reflects broader political and cultural systems that affect women’s caring work (Benoit & Heitlinger, 1998).
However, the (historically) tight relationship with the state and its governing activities also means that welfare service professions became more closely tied to government agendas. For example, in relation to Finland, Henriksson et al. (2006) suggest that the marketization of welfare services from the 1990s onwards has resulted in a substantial weakening of the welfare service arenas and the scope of professional projects. Similarly, in their comparison of the impact of neoliberalism on maternity services in Australia and Canada, Benoit and colleagues (2010, p. 480) find that ‘state concepts of market relations contribute to commodifying labour and birth through initiatives that maintain an obstetrical monopoly over childbearing, enhancing rather than presenting alternatives to medical dominance’.
These examples are potentially problematic as governing through professional experts more or less explicitly builds on some degree of congruence of interests and corresponding projects. A sustained disconnect between the two parties is likely to lead to conflict and undermine the sustainability of governing arrangements in the long term. Hence, the crucial question is to what extent welfare service professions and professions more broadly can take advantage of policy reforms. This ability is likely to be contingent and therefore vary considerably.
The notion of professional experts as introduced by Brint (1994) sets focus on the deep-seated embeddedness of professions in society, and professions move centre stage concerning questions about the ‘who’ and the ‘how’ of governance. As the science-studies literature emphasizes, knowledge emerges as an important switchboard in such processes, whereby science is becoming more politicized in as much as politics is becoming more scientific. Changes in governments and politics help to further sustain this development, as they involve a greater openness to new ways of governing and the multiple roles professions can play in this.
However, the four theoretical perspectives introduced in this chapter define the embeddedness of professions in different ways. The literature on governmentality focuses on the macro level and conceptualizes embeddedness as the institutionalization of expertise, whereby professions become a condition for governing. The literature on welfare governance also remains at the macro level, but has a more sector-specific focus; it conceives embeddedness through processes of institutional adaptation, interpretation and translation, which places professions in a complex knowledge–power knot. In contrast to the first two, the literature on organizational studies is concerned with the meso level and sees embeddedness in the agency of professions in processes of organizational change. The literature on gender in relation to welfare service professions spans across macro and meso levels and stresses the salience of embeddedness and its ambivalences.
Embeddedness represents the basic infrastructure for governing through professional experts, but this raises questions about the relative potential of this form of governing. Here all four theoretical perspectives stress that the ability to govern is closely related to the existence of professional opportunities. The literature on governmentality argues that governing is predicated on both professional control and autonomy. In a similar way, governing within the frame of the knowledge–power knot introduced by the literature on welfare governance puts professions under pressure and also involves them as agents. As the literature on organizational studies emphasizes, organizational change occurs through professions pursuing professional development. The literature on gender in relation to welfare service professions confirms this but also highlights the limits of this potential.
In summary, the literature suggests there is considerable potential for governance through professional experts. At the same time, the four bodies of literature agree that this governing potential is highly contingent. The literature on governmentality highlights historical contingencies and in particular the specific characteristics of liberal government. The literature on welfare governance points to policy-related contingencies as well as contingencies related to the system-level differences across countries. The main focus of the literature on organization studies is on contingencies related to different organizational contexts, while the literature on welfare service professions stresses the highly gendered nature of such contingencies. Importantly, contingencies make it more difficult to predict the specific governing potential, but they do not necessarily undermine the potential to govern through professional experts.
In terms of future research, it is therefore important to set more explicit focus on the potential of governing through professional experts and to use the full range of available conceptual perspectives.
References
Bell, S. and A. Hindmoor (2007) Rethinking governance: The centrality of the state in modern society. Cambridge: Cambridge University Press.
Benoit, C. and A. Heitlinger (1998) ‘Women’s health care work in comparative perspective: Canada, Sweden and Czechoslovakia/Czech Republic as case examples’. Social Science & Medicine, 47 (8), pp. 1101–1011.
Benoit, C., M. Zadoroznyi, H. Hallgrimsdottir, A. Treloar and K. Taylor (2010) ‘Medical dominance and neoliberalisation in maternal care provision: The evidence from Canada and Australia’. Social Science & Medicine, 71(3), pp. 475–481.
Brint, S. (1990) ‘Rethinking the policy influence of experts: from general characterizations to analysis of variation’. Sociological Forum, 5(3), pp. 361–385.
Brint, S. (1994) In an age of experts: The changing role of professionals in politics and public life. Princeton, NJ: Princeton University Press.
Burau, V., D. Wilsford and G. France (2009) ‘Reforming medical governance in Europe: What is it about institutions?’. Health Economics, Policy and Law, 4(3), pp. 265–282.
Clarke, J. and J. Newman (1997) The managerial state: Power, politics and ideology in the remaking of social welfare. London: Sage.
Clarke, J., J. Newman and N. Smith (2007) Changing publics and changing public services. London: Sage.
Dahl, H. M. and B. Rasmussen (2012) ‘Paradoxes in elderly care: The Nordic model’. In A. Kamp and H. Hvid (eds), Elderly care in transition: Management, meaning and identity work, pp. 29–49. Copenhagen: Copenhagen Business School Press.
Dingeldey, I. and H. Rothgang (eds) (2010) Governance of welfare state reform: A cross national and cross sectoral comparison of policy and politics. Cheltenham: Edward Elgar.
Duyvendak, J. W., T. Knijn and M. Kremer (eds) (2006) Policy, people, and the new professional: De-professionalisation and re-professionalisation in care and welfare. Amsterdam: Amsterdam University Press.
Evertsson, L. (2000) ‘The Swedish welfare state and the emergence of female welfare state occupations’. Gender, Work and Organization, 7(4), pp. 230–241.
Fenton, L. and B. Salter (2009) ‘Competition and compromise in negotiating the new governance of medical performance: The clinical governance and revalidation policies in the UK’. Health Economics, Policy and Law, 4(3), pp. 283–303.
Foucault, M. (1979) ‘On governmentality’. Ideology and Consciousness, 6, pp. 5–22.
Fournier, V. (1999) ‘The appeal to “professionalism” as a disciplinary logic’. Sociological Review, 47(2), pp. 281–307.
Freidson, E. (1970) Profession of medicine: A study of the sociology of applied knowledge. New York: Dodd, Mead.
Freidson, E. (2001) Professionalism: The third logic. Chicago, IL: University of Chicago Press.
Harrison, S. (2002) ‘New Labour, modernisation and the medical labour process’. Journal of Social Policy, 31, pp. 465–485.
Henriksson, L. S. Wrede and V. Burau (2006) ‘Understanding professional projects in welfare service work: Revival of old professionalism?’. Gender, Work and Organization, 13(2), pp. 174–192.
Johnson, T. (1995) ‘Governmentality and the institutionalization of expertise’. In T. Johnson, G. Larkin and M. Saks (eds), Health professions and the state in Europe, pp. 7–24. London: Routledge.
Kazepov, Y. (2010) ‘Rescaling social policies towards multi-level governance in Europe: some reflections on processes at stake and actors involved’. In Y. Kazepov (ed.), Rescaling social policies: Towards multilevel governance in Europe, pp. 35–72. Aldershot: Ashgate.
Kirkpatrick, I. and S. Ackroyd (2003) ‘Archetype theory and the changing professional organization: A critique and alternative’. Organization, 10(4), pp. 731–750.
Kirkpatrick, I., P. K. Jespersen, M. Dent and I. Neogy (2009) ‘Medicine and management in a comparative perspective: The case of Denmark and England’. Sociology of Health and Illness, 31(5), pp. 642–658.
Kirkpatrick, I., M. Dent and P. K. Jespersen (2011) ‘The contested terrain of hospital management: Professional projects and healthcare reforms in Denmark’. Current Sociology, 59(4), pp. 489–506.
Kooiman, J. (2000) ‘Societal governance: levels, models and order of social-political interaction’. In. J. Pierre (ed.), Debating governance: Authority, steering, and democracy, pp. 138–164. Oxford: Oxford University Press.
Kuhlmann, E. (2006) Modernising health care: Reinventing professions, the state and the public. Bristol: Policy Press.
Kuhlmann, E. and V. Burau (2008) ‘The “healthcare state” in transition: national and international contexts of changing professional governance’. European Societies, 10(4), pp. 619–634.
Kuhlmann, E. and V. Burau (2015) ‘“Soft governance” and the knowledge-bonds in professionalism: Case studies from the healthcare sector in Germany’. In E. Pavolini and T. Klenk (eds), Restructuring welfare governance: Marketization, managerialism, and welfare state professionalism. Cheltenham: Edward Elgar.
Kuhlmann, E., V. Burau, T. Correia, R. Lewandowski, C. Lionis, M. Noordegraaf and J. Repullo (2013) ‘A manager in the minds of doctors: A comparison of new modes of control in European hospitals’. BMC Health Services Research, 13, p. 246.
Maasen, S. and O. Lieven (2006) ‘Transdisciplinarity: A new mode of governing science’. Science and Public Policy, 33(6), pp. 399–410.
Maasen, S. and P. Weingart (2005) ‘What’s new in scientific advice to politics?’. In S. Maasen and P. Weingart (eds), Democratization of expertise? Exploring novel forms of scientific advice in political decision-making, pp. 1–19. Dordrecht/London: Springer.
Muzio, D. and I. Kirkpatrick (2011) ‘Introduction: professions and organizations – a conceptual framework’. Current Sociology, 59(4), pp. 389–405.
Muzio, D. D. Brock and R. Suddaby (2013) ‘Professions and institutional change: Towards an institutionalist sociology of the professions’. Journal of Management Studies, 50(5), pp. 699–721.
Newman, J. (2001) Modernising governance: New Labour, policy and society. London: Sage.
Newman, J. (2013) ‘Professionals, power and the reform of public services’. In M. Noordegraaf and B. Steijn (eds), Professions under pressure: The reconfiguration of professional work in changing public services, pp. 41–54. Amsterdam: Amsterdam University Press.
Noordegraaf, M. (2007) ‘From “pure” to “hybrid” professionalism: Present-day professionalism in ambiguous public domains’. Administration and Society, 39(6), pp. 761–785.
Noordegraaf, M. (2011) ‘Risky business: how professionals and professional fields (must) deal with organizational fields’. Organization Studies, 32, pp. 1349–1371.
Numerato, D., D. Salvatore and G. Fattore (2012) ‘The impact of management on medical professionalism: A review’. Sociology of Health & Illness, 34(4), pp. 626–644.
Osborne, S. P. (2010) ‘The (new) public governance: a suitable case for treatment?’. In S. P. Osborne (ed.), The new public governance: Emerging perspectives on theory and practice of public governance, pp. 1–16. London: Routledge.
Pickard, S. (2010) ‘The role of governmentality in the establishment, maintenance and demise of professional jurisdictions: The case of geriatric medicine’. Sociology of Health & Illness, 32(7), pp. 1072–1086.
Postma, J., L. Oldenhof and K. Putters (2014) ‘Organized professionalism in healthcare: Articulation work by neighbourhood nurses’. Journal of Professions and Organization, 1(2), pp. 61–77.
Sandall, J., I. L. Bourgeault, W. J. Meijer and B. A. Schüecking (2001) ‘Deciding who cares: winners and losers in the late twentieth century’. In R. De Vries, C. Benoit, E. R. van Tejlingen and S. Wrede (eds), Birth by design: Pregnancy, maternity care, and midwifery in North America and Europe, pp. 117–138. New York: Routledge.
Scott, W. R. (2008) ‘Lords of the dance: Professions as institutional agents’. Organization Studies, 29, pp. 219–238.
Suddaby, R. and T. Viale (2011) ‘Professions and field-level change: Institutional work and the professional project’. Current Sociology, 59(4), pp. 423–442.
Waring, J. (2007) ‘Adaptive regulation and governmentality: Patient safety and the changing regulation of medicine’. Sociology of Health & Illness, 29(2), pp. 163–179.
Waring, J. and G. Currie (2009) ‘Managing expert knowledge: Organizational challenges and managerial futures for the UK medical profession’. Organization Studies, 30(7), pp. 755–778.