Trust in professions is inherently linked to the special position that professions have within our societies. This special position is based on two foundations: their unique expert knowledge and their commitment to public service and societal values (Evetts, 2006; Freidson, 2001). Professionalism as a governance mechanism (cf. Freidson, 2001) is therefore particularly appropriate for tasks and task environments that may be characterized as factually complex – there is uncertainty about what and how things work – and normatively homogeneous with no contested standards and values (Bannink, 2013; Matland, 1995; Noordegraaf & Abma, 2003). This chapter focuses on public professionals, i.e. professionals performing public tasks, like doctors, nurses, teachers or social workers. Public tasks are (partly) funded by the government, even though there may be parallel private markets such as in private education or private health care. It excludes professions that are (primarily) privately funded like consultants, lawyers or engineers.
Over the past decades, however, the values that professionals have committed to have become increasingly contested in the context of many professions, and in particular for public professionals. These value conflicts arise in two distinct ways. First, more has become known about the actual behaviour and norms of professionals; in particular, more transgressions have reached the media where personal interests trumped professional or societal interests and the societal values were not upheld. Even if the most serious transgressions were cases of occasional bad apples (e.g. general practitioner Harold Shipman in the UK or neurologist Jansen Steur in the Netherlands), this reflected on the profession as a whole and questions arose about the quality of the professional control system. In other cases it was less individual professionals but more the complex system that let citizens down, examples in child protection are the deaths of Baby P. in the UK or Savannah in the Netherlands. Second, cultural and social changes in society and changes in risk perceptions (Beck, 1992) have made it more difficult to agree on the societal or public values that should be central to professions (Evetts, 2006). As a result of all these developments, trust in professionals declined.
The response of many governments and employer organizations has been to impose more controls with the aim to restore trust in professions, but the effects are equivocal. This increase in controls coincided with the introduction of New Public Management reforms that stimulated management by measurement (Noordegraaf & Abma, 2003; Pollitt, 2003) and most of the controls imposed took the form of managerialism. Different authors see different causal relations here, which is not the focus of this chapter. This chapter focuses on trust in public professionals and their profession. It is inevitable to see this in the context of how public professionals are controlled, through self-control within the profession (professionalism) or increased output control systems such as managerialism or a combination of the two.
When talking about trust in public professionals it is important to specify whose trust in professionals we are talking about. Ultimately the main concern is client’s trust in public professionals. Traditionally the pure professions (Noordegraaf, 2007) were granted the discretion to put in place systems of self-control so that clients could trust in those professional controls. These self-control systems consisted of extensive education and training, continuous retraining and socialization within professional associations where a shared work culture is developed and maintained. Malfunctioning professionals are spotted early on and sanctioned (Evetts, 2006; Freidson, 2001; Rueschemeyer, 1983). Such a system of self-control is only granted by regulators, employer organizations or managers as long as it delivers what these actors want: if the profession helps solve important social problems with its expertise and does so in line with dominant social values. So the other trustors are regulators and employer organizations. When client trust declines, regulators and employer organizations often feel the need to step in and impose controls on public professionals and their professions in order to restore and safeguard client trust in professionals. I show that over the past decades this dynamic has occurred in many public professions and review the literature on how these changes in control systems have been implemented and perceived, and with what consequences. Most of these control systems have taken the form of managerialism.
The chapter starts with a conceptual analysis of trust in public professionals and their professions, followed by a review of the challenges to trust in public professionals and their professions. After that I present the results from a semi-systematic literature review and find that there are two patterns for how the relationship between professionals and their employers and regulators has evolved over the past decades. In the first dominant pattern, the relationship between public professionals and their managers, employers and regulators is seen as an adversarial struggle: it is professional autonomy versus managerial control; while in the second, more collaborative pattern, we see practices emerging where professional autonomy is felt to still be present together with increased managerial control. This analysis shows the contingent nature of the relationship between trust and control (Sitkin, 1995). I propose that Weibel and Six’s model (2013) provides the theoretical basis for identifying the conditions for trust in professional autonomy and managerial control to strengthen each other in support of professionals intrinsic motivation.
Research on professionalism and professions goes back at least a century and is quite diverse. The same is true for research on trust. The perspectives on the relationship between the two concepts has changed over time as Evetts (2006) shows in her overview.
Historically, professionalism was a concept that was reserved for occupational systems with professional associations controlling access to the profession, organizing the educational system, setting standards and with formal powers to sanction malfunctioning members. This occupational organization for professional groups combined control of the labour market with informal cooperation and control within employing organizations, also called double closure (Ackroyd, 1996, p. 599). Freidson (2001) called professionalism the third logic, next to hierarchy and market. Professionalism is about handling knowledge and expertise that is special because it takes effort, training and time to acquire. This makes it legitimate for professionals to be sheltered from market laws and bureaucracy (Freidson, 2001).
In recent years the debate about who was seen as a professional and who was not has received more attention. The orthodox insisted that only occupations that had achieved certain privileges in terms of self-control were professions, whereas others argued that it was more relevant to focus on the requirements for the task and the ways in which these tasks could be controlled so as clients could trust the professionals performing the tasks. Evetts (2006, p. 519) rightly concludes that the debate should move on from definitional questions which are ‘a time-wasting diversion’. Professions may be characterized by extensive specialized education and training to acquire the necessary knowledge and expertise; sustained by an occupational community of peers with a shared identity and values; their decision-making is based on a professional ethical code; they operate altruistically and are motivated by universalistic values (di Luzio, 2006; Evetts, 2006, 2011; Noordegraaf, 2015; Rueschemeyer, 1983). Whether they have professional courts for sanctioning malfunctioning peers, or whether they can control the entry into their profession and have a legally underpinned privilege to regulate the content of the working process, is of less relevance (Evetts, 2006). In their work with clients they have discretion and professional autonomy to decide the best course of action for that particular client situation (Hasselberg, 2013; Rueschemeyer, 1983).
In the functionalist model of professionalism, trust in professions is the answer to the central problem of social control of professional work (di Luzio, 2006; Evetts, 2006; Rueschemeyer, 1983). The problem of social control arises because the knowledge-based competence is held by experts, while this competence is accepted as relevant for societal problems which are important to those involved because of the interests involved. The work the experts perform is grounded in values that are important to many (Rueschemeyer, 1983). In this functionalist model, professions, individual professionals and their associations are seen to strike a deal with society in which they provide competence and integrity, ‘commitment to a service ethos’ (Rueschemeyer, 1983, p. 44) in exchange for trust of client and community.
In trust research, trust in professions is seen as a form of institutional-based trust (Zucker, 1986) and more specifically role-based trust (Kramer, 1999). It goes beyond mere interpersonal trust to also include trust in the system of professional social control that guides the behaviour of individual professional workers.
Trust has been studied in many different academic disciplines and this has resulted in many different definitions (see other chapters in this volume). Dietz (2011) provides a useful overview of the trust process distinguishing between (1) trustworthiness: the beliefs, (2) the trust decision and (3) trust-informed actions (see also Dietz & Den Hartog, 2006). ‘[T]here is always an assessment (however thorough) of the other party’s trustworthiness which informs a preparedness to be vulnerable that, in genuine cases of trust, leads to a risk-taking act’ (Dietz, 2011, p. 215). Variations in trust definitions can often be traced back to whether authors define trust as an attitude or belief, or as an action. Trust implies that there is uncertainty about the trustee’s future behaviour. Möllering’s key point regarding trust is that none of the three bases that he identifies – reasons, routines or reflexivity – can ever provide certainty about the trusted party’s future actions and therefore, trust inevitably involves a leap of faith in which the ‘irreducible social vulnerability and uncertainty [are suspended] as if they were favourably resolved’ (Möllering, 2006, p. 111). When clients consult professionals they are particularly vulnerable as they are not in a position, as a lay person, to judge the trustworthiness of the professional, while their questions are usually ‘of vital importance to individual lives’ (di Luzio, 2006, p. 551).
Authors have proposed many different categorizations for the dimensions of trustworthiness (see other chapters in this volume) and this chapter uses the overall distinction between competence or ability on the one hand, and intentions, goodwill or value-congruence on the other (Sako, 1998; Sitkin & Roth, 1993; Weibel, 2007). This is appropriate since, as we have seen, the em phasis of professionalism is on both the special expertise of the professional and the difficulty for lay persons to assess that expertise; as well as on the normative dimension of the professional’s good will to the client and broader society. However, clients often do not know enough about the professional as an individual to provide enough basis to take Möllering’s leap of faith. But if they can trust in the system of professional control, then they may be able to take the leap. This is what Kramer’s notion of role-based trust is about: it ‘constitutes a form of depersonalized trust because it is predicated on knowledge that a person occupies a particular role in the organization rather than specific knowledge about the person’s capabilities, dispositions, motives, and intentions’ (Kramer, 1999, p. 578). Role-based trust falls in the broader category of person or firm-specific institutional-based trust which rests on being a member of a specific subculture ‘within which carefully delineated specific expectations are expected to hold, at least in some cases based on prior socialization’ (Zucker, 1986, p. 63). In this conceptualization, professionalism is seen as ‘an alternative formal source of information about how much an individual could be trusted. Extensive socialization, emergence of licensing standards across the country, and creation of professional associations all increased the certainty of performance characteristics’ (Zucker, 1986, p. 94).
Trust in public professionals is a multilevel construct (cf. Kroeger, 2012; Kroeger & Bachmann, 2013; Möllering, 2006; Sydow, 2006): trust exists at the interpersonal level, where the ‘face work’ (cf. Giddens, 1990) takes place and at the system level that is independent of specific individuals, in other words the institutional-based trust in the profession. In his review of the literature on trust in institutions, Möllering (2006) notes that both Simmel and Luhmann suggest that trust in systems is not much more than an assumption that a system is functioning, and a willingness to place trust in that system without placing trust in people. Luhmann (1979) adds that system trust includes the assumption that everybody else also trusts the system. In his conceptualization, experts, in our case the professionals, play the role of controlling the system to ensure its proper functioning. Giddens (1990) also gives experts a central role to play in system trust, but in his conceptualization they are the representatives of the system at the ‘access points’ where the trustor experiences the system, which in our case is also the professional. What is missing in these conceptualizations is attention to different perceptions of when a system is ‘functioning’. This is a value-laden concept and therefore different perceptions may exist leading to value conflicts.
Professionalism as the third logic of social coordination and control seemed to have been operating satisfactorily until roughly the second half of the twentieth century. Satisfaction with professional competence has remained high, but the values and standards became increasingly contested. One dimension of this value conflict is that more became known about the actual behaviour and norms of professionals, in particular more transgressions have reached the media where personal interests trumped professional or societal interests and the societal values were not upheld. Even if the most serious transgressions were cases of occasional bad apples, this reflected on the profession as a whole and questions arose about the quality of the professional control system. And as Hardin (2002) noted, having more knowledge about how authorities actually operate is likely to lead to a decrease in trust. This may not be a problem, ‘indeed, it may even be a sign that citizens are becoming increasingly sophisticated about the conditions of trust’ (Warren, 1999, p. 6). So increased sophistication, partly due to better education, may have triggered the change in trust in professions, rather than a change in professional performance; we do not know.
Social and cultural changes in society have also meant that values and standards have become more diverse and contested. Trust in authorities, like professions, declined. Professions were no longer able to tell the rest of society what is good and right for it (Evetts, 2006). And when value congruence decreases distrust is more likely (Bijlsma-Frankema, Sitkin, & Weibel, 2015; Sitkin & Roth, 1993). This dynamic is particularly fierce for public professionals whose tasks have always been characterized by high goal ambiguity and value conflict. These cultural and social changes led to increased criticism on all government activities, not just those performed by public professionals (Pollitt, 2003). This led to a programme of reforms called New Public Management (NPM) of which managerialism was the one that had most impact on public professionals.
From the 1980s, NPM reforms were introduced to improve the effectiveness and efficiency of public service delivery for public professionals. Where possible the actual public service delivery was contracted out to private, third sector or public organizations with performance management targets; this was called marketization (Pollitt, 2003). Within the organizations performing the public tasks, managerialism was introduced based on the same performance targets. The idea was that those actors (organizations and professional workers) that deliver the public service should not be prescribed by policy makers how to do their job, but only what to achieve. This would stimulate innovation and efficiency (Pollitt, 2003) and ensure goal clarity (i.e. value congruence).
In theory, managerialism might have been plausible as a governance mechanism for public professionals in practice however, there were many complications. First, given the dominance of the neoliberal and market ideology in NPM reforms, efficiency and economic values were seen as dominant preferences in the performance targets that were set (Noordegraaf & Abma, 2003), which ran counter to professional values of service to clients. Second, in theory setting clear targets sounded good, but in most public services, quality was a contested concept and goal ambiguity was the norm (e.g. Bijlsma-Frankema et al., 2015; Bolton, 2004; Cooke, 2006; Flynn, 2002; Noordegraaf & Abma, 2003). And third, even where agreement could be reached about what quality entailed, it proved difficult to measure it as a performance indicator, so proxy indicators were often used. Ample research exists, though, that you get what you measure, so if you do not measure exactly what you want, you get perverse effects (see the classic Kerr, 1975).
Most research conducted on the impact of the introduction of managerialism and marketization has a binary focus on either advocating a return to professionalism or going beyond professionalism (Noordegraaf, 2011). Noordegraaf (2011) argued, however, that this is too limited a focus and misses the explanation of why managerialism and marketization were introduced. He identified three bundles of non-economic external influences: changing work preferences due to demographic conditions, calls for multi-professional work forms due to changing social realities, and the omnipresence of risks and incidents. These changes impact on what professionals have traditionally called secondary aspects of professional service – ‘efficiency, communication, cooperation, safety, reputation management and so on’ (Noordegraaf, 2011, p. 1365) – and make these aspects more important. Taken together these changes call for what Noordegraaf called organized professionalism, in which organizational and professional features are combined rather than opposed. De Bruijn and Noordegraaf (2010) argued that it is inevitable that managers get more influence over professional practices given the changes in society and professions’ slow response to these changes. But also, some of the changes that professions need to make to adapt to their changing environment imply more collaboration between professionals and managers, in other words more organized professionalism. Introducing managerialism in the form of management by measurement based on hard data that are knowable, identifiable and comparable, however, is not appropriate for professional tasks that are characterized by high factual complexity – we do not know the issues – and simultaneously highly contested values and goal ambiguity (Noordegraaf & Abma, 2003).
In the semi-systematic literature review presented below, the studies show different reforms to the control arrangements of public professionals and their professions (variations of managerialism) and variations in the results of those reforms.
Empirical research into trust relations between professional workers and their manager, employer and regulators is scattered across many different academic fields and, as a consequence, across many publication outlets. This makes it difficult to do a proper systematic review of the literature, so I cannot and do not claim to be complete or exhaustive. I searched within the Web of Science database in the Social Science Citation Index between 2000 and 2015, selecting English language journal articles. I used the search terms combinations Trust* AND profession* AND manag*; and Trust* AND profession* AND govern*. This generated more than 1000 hits. Next 16 research areas were selected that focused on public tasks, such as public administration, sociology, health care, education, social work. This generated 600–700 sources that were scanned by title and abstracts; when in doubt they were saved for the next step. The selection was based on whether the article focused on the relationship between professional workers and their manager, employer and/or regulator. Also, the term trust was often used in its legal form such as NHS trust. This selection step generated a list of 178 sources for which the PDF’s were downloaded and searched in full on what was said about trust and regulation; often the reference to trust or professionals was only in passing, rather than the focus of the study. In total 27 sources found through this search process were used in the literature review. Table 20.1 provides a descriptive overview in terms of industry/sector, which method was used and which trust relationships are covered. Where relevant to the analysis, some other sources were added.
Two patterns emerged of how governance arrangements were perceived by public professionals: adversarial or collaborative relationships between professionals and their managers. A similar distinction seems to have been made by Adler and Borys (1996) who distinguished coercive from enabling controls. The studies reviewed fall roughly equally in the two patterns, but from the analysis and the broader literature, it becomes clear that the dominant pattern was the adversarial one. In this pattern, either managers ‘win’ and get (more) power over professionals, or professionals ‘win’ and have the power for discretion over how they interact with citizens in the delivery of their public task. I interpret this as managerialism with its managerial control versus professionalism with its professional autonomy. It also meets most of the explanatory factors that Sitkin and Roth (1993) identified for the failure of legalistic remedies for trust. In the other pattern, studies showed that more collaborative relationships between public professionals and their managers were possible. It was suggested that this collaborative pattern led to better public service quality than the adversarial pattern. When analysing those studies I found support for the conditions that Weibel and Six (2013) identified for trust and control to strengthen each other. These conditions emphasize how controls are developed and implemented (see Long and Weibel, this volume).
The dominant pattern in the governance arrangements in the literature appears to be based on the assumption that there is an inevitable power struggle between professionals and their managers, employers and regulators. It is managerialism with its managerial control versus professionalism with its professional autonomy. This is reminiscent of the dominant perspective in the relation between trust and control: that they are substitutes (Das & Teng, 2001; Weibel, 2007). When you trust you cannot control; and when you control you cannot trust. Controls are seen as signs of distrust. NPM reforms triggered a strong distrust discourse. For example, audit generates ‘an ever-increasing spiral of distrust of professional competence’ (Flynn, 2002, p. 163), or audit ‘implies a culture of distrust’ (Cooke, 2006, p. 976). Empirical studies showed that the introduction of managerialism has been met ‘with distrust by the staff’ (Bolton, 2004, p. 322). In many studies, managerialism is seen as a form of control that is based on ‘organized distrust’ (e.g. Avis, 2003; Cooke, 2006; Flynn, 2002; Gilbert, 2005a). Quite often the reforms were introduced after incidents in the public service delivery had hit the media, highlighting the public’s vulnerability to the competence and goodwill of public professionals delivering the public service. Policy makers or organizational leadership responded to these incidents with new regulation and audits.
Empirical research into the impact of NPM reforms on public professionals and the relationship between public professionals and their managers therefore predominantly stressed the adversarial relationship (e.g. Bargagliotti, 2012; Bijlsma-Frankema, Sitkin, & Weibel, 2015; Bolton, 2004; Brown & Calnan, 2011; Gilbert, 2005b; Harrison & Smith, 2004; Hoecht, 2006; Lasky, 2005). Managerial discourses are critical of professionals and their activities and trust in professionals comes under pressure (e.g. Gilbert, 2005a). Professional opinions are criticized for representing the interests of professions rather than the interests of clients/citizens; in this way both managerial and professional discourses claim to represent the interests of clients (Gilbert, 2005b). Several studies also investigated the impact of managerialism on outcomes to clients and found no improvement or even lower outcomes (e.g. Cooke, 2006; Lasky, 2005), for example because the risk analysis system in child care social work may actually obscure risks to children (Pithouse et al., 2012).
These studies cover a wide range of fields such as social work, education and health care. In social work, Ruch (2012) emphasized the rational-cognitive foundations of managerialism – privileging ‘cognition, rationality and predictability’ – and contrasted these with the professional foundations of social work, ‘the holistic understanding of human beings that encompasses all dimensions of behaviour’ including the emotional, irrational and unpredictable (Ruch, 2012, p. 1317). In education, performance management, as part of managerialism, has been claimed to encourage ‘masculinist and bullying forms of management’, has led to closer surveillance and operated ‘within a blame culture’ (Avis, 2003, p. 324). In higher education, stricter quality-control regimes were shown to have led to loss of professional autonomy and ‘rituals of verification’ instead of fostering trust (Hoecht, 2006, p. 541). More importantly, these new control systems may very well be detrimental to innovative teaching and learning.
Table 20.1 Characteristics of studies found in literature search
| Source | Sector | Type of study | Relationship | Type of pattern |
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| Dixon-Woods, Yeung, and Bosk (2011) | Medical profession UK | Public debate analysis | Professionals and their managers, regulators | Adversarial |
| Flynn (2002) | Health care UK | Critical essay | Professionals and their regulators | Adversarial |
| Freeman, McWilliam, MacKinnon, DeLuca, and Rappolt (2009 | Health care Canada | Qualitative | Professionals and their managers, regulator and professional bodies | Adversarial |
| Friedman (2011) | Teaching Israel | Qualitative | Professionals, supervisors and school leaders | Adversarial |
| Gilbert (2005a) | Nursing | Qualitative | Professionals and their managers | Adversarial |
| Gilbert (2005b) | Nursing | Qualitative | Professionals and their managers | Adversarial |
| Hirvonen (2014) | Welfare | Qualitative | Professionals and their clients | Adversarial |
| Hoecht (2006) | Higher education | Qualitative | Professionals and their managers | Adversarial |
| Lasky (2005) | Education | Qualitative/ quantitative | Professionals and their clients | Adversarial |
| Liljegren (2012) | Social work | Qualitative | Professionals and managers, regulator and clients | Adversarial |
| Pithouse et al. (2012) | Social work | Qualitative | Impact of risk analysis system on child safety | Adversarial |
| Sellman (2006) | Nursing | Essay | Professional and clients | Adversarial |
| Sheaff et al. (2003) | Health care | Qualitative | Professionals and their managers | Adversarial |
| Anand, Chhajed, and Delfin (2012) | Health care | Quantitative | Professionals and their managers | Collaborative |
| Auer, Schwendimann, Koch, De Geest, and Ausserhofer (2014) | Health care | Quantitative | Professionals and their managers | Collaborative |
| Avis (2003) | Education | Essay | Professionals and their managers, regulators | Collaborative |
| Bargagliotti (2012) | Health care | Conceptual | Professionals and their managers | Collaborative |
| Blomeke and Klein (2013) | Education | Quantitative | Professionals and their managers | Collaborative |
| Bolton (2004) | Health care | Qualitative | Professionals and their managers, regulators | Collaborative |
| Brown and Calnan (2011) | Health care | Essay | Professionals and their managers, regulators | Collaborative |
| Cooke (2006) | Health care | Qualitative | Professionals and their managers | Collaborative |
| Ghamrawi (2011) | Teaching Lebanon | Qualitative | Professionals and their managers | Collaborative |
| Harrison and Smith (2004) | Health and social care | Essay | Professionals and their managers, regulators | Collaborative |
| Marshall, Mannion, Nelson, and Davies (2003) | Health care | Qualitative | Professionals and their managers | Collaborative |
| Mastrangelo, Eddy, and Lorenzet (2014) | Education | Quantitative | Professionals and their managers | Collaborative |
| Nyhan (2000) Paille, Grima, and Bernardeau (2013) | Public sector | Quantitative | Professionals and their managers | Collaborative |
| Public sector | Quantitative | Professionals and their managers | Collaborative | |
In health care, several studies concluded that trust in professionals had declined and that the controls that were introduced were based on distrust, often leading to perverse effects. Some studies pointed to the lack of moral agency in managerialism that led to a deficiency in social engagement, which was seen as central in good health care (e.g. Brown & Calnan, 2011). In nursing, the introduction of practice protocols and audit procedures had not been able to establish claims of successful control of nursing practice; quality of nursing and control of the nursing labour process remained a contested domain (Bolton, 2004). Brown and Calnan (2011) contrasted the ‘checking-based’ audit culture with a ‘trust-based’ model. They argued, in line with others, that this checking-based audit culture is fundamentally flawed in driving quality and performance, while the trust-based model would, in their eyes, be more capable of ‘acknowledging the meaning, complexity and the specificities inherent to professional work’ (Brown & Calnan, 2011, p. 19).
Summarizing these studies, the way in which public professionals were managed within their organizations was perceived by public professionals as managerial control based on distrust. It led to greater social distance (Sitkin & Roth, 1993). It was experienced as demotivating, driving out their (professional) intrinsic motivation to help vulnerable citizens, and often stimulated only ritualistic compliance to the controls and taking away time from client interaction to satisfy the increased administrative demands (e.g. Avis, 2003; Cooke, 2006). It sometimes even led to increased risks to clients (Pithouse et al., 2012) or reduced innovation (Hoecht, 2006). Managerial controls took away professional autonomy, often to the detriment of the quality of the public service that the professionals were providing.
In contrast to this dominant adversarial pattern, a more collaborative pattern emerged that showed a predominantly collaborative relationship between public professionals and their managers. These studies showed that such governance arrangements led to more committed and more intrinsically motivated professionals (Anand et al., 2012; Ghamrawi, 2011; Nyhan, 2000). How may these studies be analysed to better understand their commonalities and underlying mechanisms?
Sitkin (1995) pointed to the contingent nature of the relationship between trust and control. Controls that do not match task requirements (Adler & Borys, 1996) and/or the values and identity of those controlled (Bijlsma-Frankema et al., 2015) are generally perceived as distrusting, leading to the adversarial pattern identified as dominant in professional contexts. When, on the other hand, controls match those task requirements and values and identity, trust and control are perceived as complementary to each other (Bijlsma-Frankema et al., 2015; Das & Teng, 2001; Sitkin, 1995; Weibel, 2007). Long and Weibel (this volume) emphasize that the process of design and implementation of the control system (the how) may be more important than the what. The analysis in this chapter shows how both the how and the what are important. Through a collaborative process, control systems were agreed that meet the conditions for managerial controls to strengthen trust in professional autonomy.
Weibel and Six’s model (2013) helps structure the conditions found in the studies in the second more collaborative pattern. This model formulates the conditions for when and how managerial trust and control may complement each other in strengthening employees’ intrinsic motivation. This model is based on self determination theory (SDT; e.g. Ryan & Deci, 2000; Stone, Deci, & Ryan, 2009). SDT’s focus is on the intrinsic importance of work, which is relevant for public tasks and has been shown to be particularly relevant for tasks that are simultaneously complex and ambiguous (Stone et al., 2009). According to SDT, human beings have three core psychological needs: autonomy, competence and relatedness. Individuals feel autonomous when they experience a sense of choice and volition. Autonomy is not independence; one may feel autonomous while being (inter)-dependent on others. Individuals may feel supported in their competence development when they perceive that they can develop new skills and mental frames. Their need for relatedness is about the desire to experience satisfying and supportive social relationships; in work contexts these relationships are with colleagues and managers. Mutual understanding, trust and respect are important here (Stone et al., 2009; Weibel, 2007; Weibel & Six, 2013). Central in this theory is the notion that professionals will be more intrinsically motivated, self-determined, to do what is expected of them by their organization when they feel more autonomous, supported in their competence development and trusted by their managers and organization.
Weibel and Six (2013) found support for the proposition that the more control systems are designed in dialogue between professionals and their managers, the more professionals will feel self-determined and the more trust is experienced. Control is about setting standards or performance indicators; monitoring those standards and indicators; judging whether the standards or indicators have been met; and deciding interventions (sanctions and rewards) (e.g. Weibel, 2007). The more professionals and management together make sense of the monitoring results and judge and decide possible interventions, the more likely it is that professionals feel autonomously motivated and the more trust is experienced. Research into the perverse effects of performance management systems, and how to mitigate these effects, provided support for the important role of dialogue in the design and execution – including interpretation – of performance controls (De Bruijn, 2007).
In education, the studies found in the search showed the need for dialogue across a range of stakeholders, because different views need to be heard to find the creative responses needed to deal with today’s radical uncertainty (Avis, 2003). And when teachers engaged in a professional dialogue in their schools with colleagues and school principals, they got the chance to build more congruence between their classroom goals and the overall goals that govern the school system (Ghamrawi, 2011). Also, teaching quality improved when teachers perceived more autonomy (e.g. Blomeke & Klein, 2013).
In health care, several studies found a ‘negotiated order’ or new forms of consultation as they studied the relationship between managerialism and professional autonomy (Bolton, 2004; Brown & Calnan, 2011; Thomas & Hewitt, 2011). Quality-assurance mechanisms that were developed locally by professionals were more effective and seen as more legitimate (Brown & Calnan, 2011). Autonomy was shown to have positive effects on nurses’ work engagement (Bargagliotti, 2012) and on frontline worker commitment to continuous improvement (Anand et al., 2012).
In relation to the need for competence development, Weibel and Six (2013) proposed that learning-oriented and constructive feedback by managers to professionals strengthened professionals’ intrinsic motivation. Several studies found in the search supported this. Teaching quality improved when teachers received more frequent appraisals (Blomeke & Klein, 2013) and more constructive feedback about failures was conducive to developing a safety culture in health care (Auer et al., 2014). More generally, constructive feedback from managers to professionals strengthened intrinsic motivation and had a positive effect on quality of public service delivery (Ghamrawi, 2011; Nyhan, 2000). Professional reflection was seen as important as it had a positive effect on how the complexity and ambiguity of the public task were dealt with (e.g. Brown & Calnan, 2011).
The need for relatedness is about the experience of mutual understanding, trust and respect. Weibel and Six (2013) proposed that governance focused on intrinsic work engagement and manager trust in professionals positively affected professionals’ intrinsic motivation. The positive effects of manager trust in professionals was found in studies across the board (Anand et al., 2012; Blomeke & Klein, 2013; Cooke, 2006; Ghamrawi, 2011). Professionals’ trust in their managers or organization also showed positive effects (e.g. Anand et al., 2012; Blomeke & Klein, 2013; Ghamrawi, 2011). Trust among professionals was also seen as having a positive effect on motivation, work engagement and quality of service delivery (Avis, 2003; Brown & Calnan, 2011; Ghamrawi, 2011). The need for a culture of trust is regularly mentioned (e.g. Ghamrawi, 2011; Harrison & Smith, 2004). Direct manager involvement in professional work helped professionals’ perception of support and helped reduce manager reliance on audits, ‘I can gain far more knowledge about the quality of a [hospital] ward by working on it than I could on a thousand audits’ (Cooke, 2006, p. 980).
Summarizing, despite the wealth of studies that show that the implementation of managerialism in professional work has often led to adversarial relations and further decrease in trust, there is a growing body of studies across many public professions that empirically support the proposed model by Weibel and Six (2013), identifying the conditions for trust and control to complement each other. Managers and professionals need to work together to deal with the simultaneous complexity and ambiguity, developing shared understandings of the expected performance – what is quality of service? – and agreeing on ways of working and accountability.
Public professions are trusted to organize their own professional controls in order to safeguard their unique expert knowledge and their commitment to public service and societal values. In the second part of the twentieth century, however, these societal values were increasingly contested and trust in professionals and their professions came under pressure. Since trust in professionals and their profession is role-based trust – a form of institutional-based trust – the institutions on which it is based are important. Traditionally these were professional controls (professionalism), but in response to the (perceived) decline in trust in professionals, their managers, employers and/or regulators have introduced managerial controls (managerialism).
This chapter has analysed studies that investigated the effect of managerialism on public professionals and their work. Two distinct patterns emerged, an adversarial and a collaborative approach to improving the institutional bases for trust in public professionals. In the adversarial pattern, managerial controls were imposed on professionals in ways that were perceived as distrusting and inappropriate because the quality of public service was deemed to deteriorate. In the collaborative pattern, relationships between professionals and their managers are more collaborative and may be characterized by trust based on actual interactions, mutual understanding and respect; both ‘parties’ acknowledge and respect each other’s role in the delivery of public services. The governance arrangements in this pattern may be conceptualized as manager trust and control complementing each other to stimulate professionals’ intrinsic motivation, in line with Weibel and Six’s (2013) model. Through dialogue, and other forms of constructive interaction, managers and professionals develop shared understandings of quality of service and other facets of the expected outcomes, and agree on the design and execution of work practices and accountability procedures. Continuous professional development and organizational learning are stimulated via constructive feedback and reflection. This results in and is supported by trust: manager trust in professionals, professionals’ trust in manager/organization, trust among professionals and more generally a trust culture within the organization.
The proposition to be tested in future research is that professional work in the twenty-first century is best governed by a collaborative arrangement in which manager trust and control complement each other in stimulating professionals’ intrinsic motivation. The conditions identified in Weibel and Six’s (2013) model were supported in a wide range of empirical studies. Further research is needed to test the proposition to its full extent.
Also, so far the focus has been on the impact of the institutions – the controls – on the quality of professional work and the motivation of professionals, but we do not know the impact of these controls on client trust in professions: the real test. Recent developments in public governance focus on co-production and co-creation of public services between public professionals and clients. If the dialogue and trust found to be important between public professionals and their managers and regulators are extended to also include clients, then values congruence is more likely, even if it becomes more localized, and this most directly influences client trust in professions.
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