'Not everything that can be counted counts and not everything that counts can be counted'– towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re‐evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.     

Managerialism in the Australian public health sector: towards the hyper-rationalisation of professional bureaucracies

This paper draws on qualitative case-study research to discuss the impact of managerialism on the work organisation of public sector health professionals in Australia. The case studies included 71 semi-structured interviews with a broad range of public sector health professionals (predominantly nursing and allied health professionals, with some doctors and managers). The data are used to examine the implications of managerialism for the organisation of professional (public) bureaucracies. The findings show that while health professionals were able to exert their agency to influence managerial processes, the incorporation of managerial strategies into professional practice placed constraints upon professional autonomy. The impact of managerialism on professional bureaucracies is examined using the neo-Weberian framework of hyper-rationality, an ideal type derived from a combination of four forms of rationality identified in Weber's work: practical, formal, substantive and theoretical rationality. Applied to the social organisation of health-care work, this paper critically examines the utility of the hyper-rationality ideal type, noting its limitations and the insights it provides in conceptualising the impact of managerialism on professional (public) bureaucracies.     

Equal opportunities policies and nursing employment within the British National Health Service

AIMS: The National Health Service (NHS) is the largest employer in Western Europe and the largest employer of minority ethnic workers in Britain. This paper is concerned primarily with an examination of the experiences of nurses from minority ethnic groups. BACKGROUND: Recent research evidence suggests that many minority ethnic nurses face racial harassment from patients and colleagues and that there are continuing problems in recruitment and promotion. The Macpherson Report on the enquiry into the murder of black teenager Stephen Lawrence has stimulated a wide ranging discussion of institutional racism throughout the public sector in the UK, including the NHS. DISCUSSION: This paper discusses the continuing failure of equal opportunities policies to have a sustained impact on the experiences of minority ethnic nurses and discusses a number of reasons for the lack of progress of such policies. It examines the reasons why health care organizations might adopt equal opportunities policies and the pragmatic reasons why implementation has been both slow and patchy. It goes on to consider the concepts of managing diversity and ethnic managerialism as new tools to theorize equal opportunities and considers some of the continuing problems inherent in current strategies.     

A literary approach to managerial discourse after the NHS reforms

The 1990 NHS and Community Care Act can be seen as the culmination of the importation into the UK National Health Service of ‘business’ language. This has entailed struggles between the values of new general managers and the traditional professions and unprecedented attention to issues of ‘measurement’. A recent study of NHS Trusts involved three yearly rounds of interviews with managers and the administration of questionnaires to the nursing workforce in the same areas. Although the main intentions of the research lay in gauging the job satisfaction of the workforce and describing the managers', approaches to organisational strategy, the way that each group used language soon emerged as an area of interest and as a pointer to the foundational values and epistemologies of each group. An approach to the texts of interviews and questionnaire responses was informed partly by an analysis of discourse, elaborated by Foucault and others and partly by deconstraction, an approach usually associated with literary texts. The approach to analysis is based on the realisation that language is structured in a way that reflects existing power relations and that attention to metaphor and other rhetorical devices can give insight into these discourses. After briefly introducing the policy context and a particular approach to literary texts, this paper offers analysis of how managers talked about measurement and financial constraints.     

Patient or consumer? The colonization of the psychiatric clinic

Information is given a privileged place in the psychiatric clinic, as illustrated by the prevalence and volume of data to be collected and forms to be completed by psychiatric nurses. Information though is different to knowledge. The present paper argues that information is part of a managerial discourse that implies commodification whereas knowledge is part of a clinical discourse that allows room for the suffering of the patient. Information belongs to the discourse of managerialism, one that positions the patient as customer/consumer and in doing so renders them unsuffering. The patient's suffering is silenced by their construction as a consumer. The discourse of managerialism seeks a complete data set of information. By way of contrast, another discourse, that of psychoanalysis offers the institution the idea that there are always holes, gaps, and uncertainty. The idea of uncertainty, gaps, things remaining unknown and a limit sits uncomfortably with the dominant discourse of managerialism; one that demands no limits, complete data sets, and many satisfied customers. This market model of managerialism denies the potential of the therapeutic relationship; that something curative might be produced via the transference. In addition, the managerialist discourse potentially positions the patient as both illegitimate and unsuffering.     

Caring holistically within new managerialism

This article explains the attempts of nurses to practice humanistic, holistic care in line with their professionalizing strategy. Ideally, the intention of nurses is to broaden their concerns beyond the physiological needs of patients, thereby circumventing biomedical control over their work. However, the author argues that resource constraints, and the coalescing of biomedical and managerial definitions of patients, suggest that holistic notions of care are subjected to a new form of calculus and normalizing technology. Critically, nurses are more preoccupied with the day-to-day struggle to free up resources for healthcare, in particular bed spaces, and to pre-empt the problem of bed blocking. Such work suggests that the "emptying of beds" is not just a symbol of accomplishment for nursing work. From the governmentality theory of Foucault, the administration of "beds" has become part of the managerial power/knowledge discourse and an instrument for making nurses toe the financial bottom-line.     

Neoliberalism and the government of nursing through competency‐based education

Competency has become a key concept in education in general over the last four decades. This article examines the development of the competency‐based movement with a particular focus on the significance it has had for nursing education. Our hypothesis is that the competency movement can only adequately be understood if it is analyzed in relation to the broad societal transformation of the last decades—often summarized under the catchword neoliberalism—and with it the emergence of managerial models for Human Resource Management (HRM) for the reorganization of social services. Classical professions, which were characterized under welfarism by an esoteric knowledge based on ethical norms, have now become marketable commodities that can be evaluated in the same way as other commodities. We want to underline that while this development is still under way, it is the concept of competency that was the decisive political instrument enabling this profound change. With the widespread implementation of competency‐based education that now governs nursing knowledge, the development of a critical, oppositional perspective becomes more challenging, if not entirely impossible. We will be focusing primarily on nursing education in Canada, although we maintain that it has relevance for nursing internationally.     

Professional discourse and service cultures: an organisational typology developed from health and welfare services for people with learning disabilities

This study focuses upon the effect of social policy upon a particular area of service provision. It is influenced by the Foucauldian concept of governmentality and the proposition by Lewis et al. that social policy needs to be understood in local contexts. Only through understanding the partial and fragmented impact of policy can we gain a clear insight into the outcomes for users. The study is undertaken through an exploration of the micro politics of organisations providing health and welfare services for people with learning disabilities. It involves an approach to discourse analysis that focuses upon text developed from interviews with service providers, which is brought into contact with published literature in an iterative process. The interpretation of the text produces four themes: power, trust, citizenship and managerialism. The development of these themes and a further holistic interpretation of the text suggest an emerging organisational typology. A typology based upon different articulations of the themes noted that work to produce particular outcomes for service users.