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Topic 5 Reading Ordering A Profession – Swedish Nurses Encounter New Public Management Reforms Notes

Accounting Notes > Accounting in the New Public Sector Notes

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"Ordering a profession - Swedish nurses encounter new public management reforms" (Blomgren, 2003)

"ORDERING A PROFESSION - SWEDISH NURSES ENCOUNTER NEW PUBLIC MANAGEMENT REFORMS" (BLOMGREN, 2003)

INTRODUCTION

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"New Public Management" (Hood, 1995) An expectation had been that the reforms would lead to a decentralized health care system where the financial responsibility would be allocated to a level closer to the patient o i.e. the head nurses Roots in the profession's internal constitution has a structure that is not coherent but heterogeneous o Hence the contradictory responses from different people In the American context Scott et al. (2000) have called the transition a 'decline of Professional dominance' and 'advance of Managerial-Market orientation' Just as we might expect to find conflicting groups within an organization (Cyert and March, 1963), we might also expect to find competing segments within a profession (Bucher and Strauss, 1961) Ongoing ordering process within a profession aimed at establishing and defending different ideas of identity (Law, 1994) Two ideas of a nurse: o As an expert in caring o As an administrative leader
? Longer history within the profession according to Lannerheim (1994) Role of a professional should not be seen as finally settled agreements, rather as ordering processes

NEW PUBLIC MANAGEMENT REFORMS AND HEALTH CARE PROFESSIONALS

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The aim of the reforms should not be seen simply as improving public sector services in general, but also as attempts to redistribute power and control (Kurunmaki, 2000) Shifted emphasis from professional standards and expertise towards more explicit and measurable standards of performance provided by different accounting techniques (Hood, 1995) Could be seen as signaling decreasing trust in the professional and a limitation in their possibilities of self-management Blurring of professional boundaries that occurred when UK doctors became clinical directors adopted medical manager hybrid roles by accepting increased commercial and managerial responsibility (Kitchener, 2000) It is likely that factors such as the design, implementation, and context of the reform, as well as the history, position and knowledge-system of the professional might have consequences for the encounter o Can link this to the current reforms of the NHS where the culture and history is portrayed to be at risk by campaigners

ORDERING PROCESSES AND THE HETEROGENEITY OF PROFESSIONS

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Heterogeneity of professions (Abbott, 1988) Swedish nursing profession has 3 best recognized segements: o Mini-doctors o Administrative leaders o Experts in caring

THE HETEROGENEITY OF THE SWEDISH NURSING PROFESSION

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