Problematizing the mobilization of hospital directors

Steven Griggs

pp. 117-138

in: David R. Howarth, Jacob Torfing (eds), Discourse theory in European politics, Basingstoke, Palgrave Macmillan, 2005

Abstract

For much of the post-war period, narratives of health policy change characterized public health care systems in Europe as stable professionalized policy networks, dominated by medical professionals and typified by incremental change, if not policy inertia, and political consensus (Harrison, Hunter, and Pollitt, 1990, pp. 6-8). Hospital managers were content to work as "diplomats' (Hunter, 1994, pp. 441-2), concentrating on conflict-avoidance and consensus-building in public hospitals, whilst developing alternative administrative hierarchies that did not encroach into the domain of medical freedom (Steudler, 1973). However, the changing policy priorities of cost containment and efficiency have called into question many of the assumptions structuring this 'shared vision" of public health care systems. Indeed, the politics of cost containment has become widely synonymous, not with stability and consensus, but rather with the driving antagonisms of competing elites, not least the emerging challenge posed by managerial rationalizers to the dominance of medical professionals. No longer content to work as "diplomats' or hospital managers, and keen to maximize their collective interests through the sponsorship of cost containment, they have contested the professional autonomy and control of the workplace exercised by medical professionals (Alford, 1975; Wistow, 1992).