In this article we analyse an institutional transformation of Swedish health care that is underway. We combine the recent work from the ‘Governmentality’-tradition with contributions by John Meyer and associates. The latter is used to explain how these changes are rendered as necessary and natural. The main part of our analysis concerns how the institutional construction of rationalized agency is instrumented. To accomplish that, Dean’s (1999) categories technologies of agency and technologies of performance are used to conceptualize some of the means and principles mobilized in the ongoing institutional transformation of Swedish health care. Firstly, we display the emergence of a complex landscape of new actors, arenas and new practices that regulate and coordinate medical practice. Secondly, various attempts to imbue agency into the patients are analysed as an example of a technology of agency put to use. The conclusions present a more comprehensive picture of governing through new forms of agency. Technologies of agency are closely intertwined with appeals to common goods, the formation of new arenas and forms of expertise.
Armstrong D. (2002) ‘Clinical Autonomy, Individual and Collective: The Problem of Changing Doctors’ Behaviour’, Social Science and Medicine55: 1771-1777.
2.
Barry, A. (2001) Political Machines—Governing a Technological Society. London: The Anthlone Press.
3.
Bejerot, E. and Hasselbladh, H. (2003) ‘Nya kontroll- och maktrelationer inom sjukvården (New Relations of Control and Power in Health Care)’, Arbetsmarknad and Arbetsliv9(2): 107-127.
4.
Bejerot, E. and Hasselbladh, H. (2006) ‘Diskursiv Stängning, enrollering och Materialisenng—en studie av TQM i ett landsting (Discursive Closure, Enrolment and Materialization—A Study of TQM in a County Council)’, Nordiske Organisasjansstudier8(2): 7-38.
5.
Bloomfield, B. P. and Vurdubakis, T. (1997) ‘Visions of Organization and Organizations of Vision: The Representational Practices of Information Systems Development’, Accounting, Organizations and Society22(7): 639-668.
6.
Boli, J. and Thomas, G. M. (1999) Constructing World Culture—International Nongovernmental Organizations Since 1875. Stanford, CA: Stanford University Press.
7.
Bourdieu, P. (1998) Practical Reason: On the Theory of Action. Oxford: Polity Press.
8.
Burchell, G., Gordon, C. and Miller, P. (1991) The Foucault Effect. Studies in Governmentality. Chicago, IL: The University of Chicago Press.
9.
Calnan, M. (1988) ‘Towards a Conceptual Framework of Lay Evaluations of Health Care’, Social Science and Medicine27(9): 927-933.
10.
Castoriadis, C. (1987) The Imaginary Institution of Society. Cambridge: Polity Press.
11.
Chua, W. F. (1995) ‘Experts, Networks and Inscriptions in the Fabrication of Accounting Images: A Story of the Representation of Three Public Hospitals’, Accounting, Organization and Society20(2/3): 111-145.
12.
Clarke, J. and Newman, J. (1997) The Managerial State. London: Sage.
13.
Cleary, P. D. and McNeil B. J. (1988) ‘Patient Satisfaction as an Indicator of Quality Care’, Inquiry25: 25-36.
14.
Cleary, PD., Edgman-Levitan, S., Walker, J., Gerteis, M. and Delbanco, T. (1993) ‘Using Patient Reports to Improve Medical Care: A Preliminary Report from Ten Hospitals’, Quality Management in Health Care2(1): 31-38.
15.
Dean, M. (1999) Governmentality—Power and Rule in the Modern Society. London: Sage.
16.
Deetz, Stanley A. (1992) Democracy in an Age of Corporate Colonization. Developments in Communication and the Politics of Everyday Life. New York, NY: State University of New York Press.
17.
Deetz, S. (2003) ‘Reclaiming the Legacy of the Linguistic Turn’, Organization10(3): 421-429.
18.
Delbanco, T. (1996) ‘Quality of Care Through the Patient’s Eyes. Satisfaction Surveys Are Just the Start of an Emerging Science’, British Medical Journal313: 832-833.
19.
Dent, M. (1999) ‘Professional Judgement and the Role of Clinical Guidelines and Evidence-Based Medicine (EBM): Netherlands, Britain and Sweden’, Journal of Interprofessional Care13(2): 151-164.
20.
Dent, M. (2003a) ‘Managing Doctors and Saving a Hospital: Irony, Rhetoric and Actor Networks’, Organization10(1): 107-127.
21.
Dent, M. (2003b) Remodelling Hospitals and Health Professions in Europe. Medicine, Nursing and the State. New York, NY: Palgrave Macmillan.
22.
Doolin, B. (2003) ‘Narratives of Change: Discourse, Technology and Organization’, Organization10(4): 751-770.
23.
Drori, G. S., Meyer, J. W., Ramirez, F. O. and Schofer, E. (2003) Science in the Modern World—Institutionalization and Globalization. Stanford, CA: Stanford University Press.
24.
Ds 2002. Vad säger brukarundersökningar och andra mått på kvaliteten? (What Do User Surveys Tell Us About Quality). Ds 2002:23. Stockholm: Fritzes.
25.
Einevik-Bäckstrand, K., Brommels, M. and Maathz, G. (2002) Att styra utifrån en beställarroll (To Control From the Position of the Purchasers), rapport no 4. Göteborg: Centrum för hälso- och sjukvårdsanalys (CHSA).
26.
Fakta (1996) ‘Patientens upplevelse saknas i kvalitetsbedömningar (Patients’ Opinions are Lacking in Quality Assessments)’, Fakta35/21Nov: 5-5. Stockholm: Stockholms läns landsting.
27.
Foucault, M. (1972/1991) The Archaeology of Knowledge. London: Routhledge.
28.
Foucault, M. (1977) Discipline and Punish. Penguin: Harmondsworth.
29.
Freidson, E. (2001) Professionalism: The Third Logic. On the Practice of Knowledge. Chicago, IL: The University of Chicago Press.
30.
Garpenby, P. (1999) ‘Resource Dependency, Doctors and the State: Quality Control in Sweden’, Social Science and Medicine9(3): 405-424.
31.
Government Plan of Action for Health Care (1999/2000) Nationell handlingsplan för utveckling av hälso- och sjukvården (National Plan of Action for the Development of the Health Care Sector). Proposition 1999/2000:21. Stockholm: Regeringen.
32.
Hansen, L. and Adam, K. (2004) Från Forskningsprojekt till kvalitetsverktyg (From Research Project to Tools of Quality Management), Arbetslivsrapport nr 22. Stockholm: National Institute for Working Life.
33.
Hasselbladh, H. and Kallinikos, J. (2000) ‘The Process of rationalization: A Critique and Re-appraisal of Neo-institutionalism in Organization Studies’, Organization Studies21(4): 697-720.
34.
Hood, C. (1995) ‘The “New Public Management” in the 1980s: Variations on a Theme’, Accounting, Organizations and Society20(2/3): 93-109.
35.
Hood, C., James, O., Peters, B. G. and Scott, C. (2005) Controling Modern Government—Variety, Commonality and Change. Cheltenham: Edward Elgar.
36.
Inoue, K. (2003) Vive la Patiente! Disscourse Analysis of the Global Expansion of Health as a Human Right. Doctoral Dissertation, Department of Education. Stanford, CA: Stanford University.
37.
Jacques, R. (1996) Manufacturing the Employee—Management Knowledge from 19th to the 21st Centuries. London: Sage.
38.
Jepperson, R. L. and Meyer, J. W. (1991) ‘The Public Order and the Construction of Formal Organizations’, in W. W. Powell and P. J. DiMaggio (eds) The New Institutionalism in Organizational Analysis, pp. 204-223. Chicago, IL: The University of Chicago Press.
39.
Kallinikos, J. (2003) ‘Work, Human Agency and Organization Forms: An Anatomy of Fragmentation’, Organization Studies23(4): 595-618.
40.
Kallinikos, J. (2004a) ’Deconstructing Information Packages: Organizational and Behavioural Implications of Large Scale Information Systems’, Information Technology and People17(1): 8-30.
41.
Kallinikos, J. (2004b) ‘The Social Foundations of the Bureaucratic Order’, Organization11(1): 13-36.
42.
Kooiman, J. (1993) Modern Governance: New Government-Society Interactions. London: Sage.
43.
Kragh Jespersen, P., Nielsen, L. L. M. and Sognetrup, H. (2002) ‘Professions, Institutional Dynamics, and New Public Management in the Danish Hospital Field’, International Journal of Public Administration25(12): 1555-1574.
44.
Kurunmäki, L. (1999) ‘Professional vs Financial Capital in the Field of Health Care—Struggles for the Redistribution of Power and Control’, Accounting, Organizations and Society24(2): 95-124.
45.
Llewellyn, S. (2001) ‘Two-Way Windows: Clinicians as Medical Managers’, Organization Studies22(4): 593-623.
46.
Manley, J. (2001) ‘The Customer is Always Right? Customer Satisfaction Surveys as Employee Control Mechanisms in Professional Service Work’, in A. Sturdy, I. Grugulis and H. Willmott (eds) Customer Service. Empowerment and Entrapment, pp. 157-169. New York, NY: Palgrave.
47.
Meyer, J. W., Boli, J. and Thomas, G. M. (1987) ‘Ontology and Rationalization in the Western Cultural Account’, in G. M. Thomas, J. W. Meyer, F. O. Ramirez and J. Boli (eds) Institutional Structure - Constituting State, Society and the Individual, pp. 12-37. Newbury Park, CA: Sage.
48.
Meyer, J. W. (1994) ‘Rationalized Environments’, in W. R. Scott and J. W. Meyer (eds) Institutional Environments and Organizations, pp. 28-54. Thousand Oaks, CA: Sage.
49.
Miller, P. and O’Leary, T. (1987) ‘Accounting and the Construction of the Governable Person’, Accounting, Organizations and Society12(3): 235-265.
50.
Miller, P and Rose, N. (1990) ‘Governing Economic Life’, Economy and Society19(1): 1-31.
51.
Nelson, E. C., Hays, R. D., Larson, C. and Batalden, P. B. (1989) ‘The Patient Judgment System: Reliabiltiy and Validity’, Quality Review Bulletin15(6): 185-191.
52.
Osborne, T. (1993) ‘On Liberalism, Neoliberalism and the ‘Liberal Profession’ of Medicine’, Economy and Society22(3): 345-356.
53.
Pettersen, I. J. (2001) ‘Hesitation and Rapid Action: The New Public Management Reforms in the Norwegian Hospital Sector’, Scandinavian Journal of Management17(1): 19-39.
54.
Pollitt, C. and Bouckaert, G. (2000) Public Management Reform—A Comparative Analysis. Oxford: Oxford University Press.
55.
Power, M. (1997) Audit Society: Rituals of Verification. Oxford: Oxford University Press.
56.
Press, I. and Ganey, R. F. (1989) ‘The Mailout Questionnaire as the Practical Method of Choice in Patient Satisfaction Monitoring’, Journal of Health Care9(1): 67-68.
57.
Rombach, B. (1990) Kvalitet i offentlig sektor (Quality in the Public Sector). Stockholm: Norstedts.
58.
Rehnberg, C. (1997) ‘Sweden’, in C. Ham (ed.) Health Care Reform: Learning from International Experience, pp. 64-86. Buckingham: Open University Press.
59.
Rhodes, R. A. W. (1997) Understanding Governance. Buckingham: Open University Press.
60.
Riksrevisionsverket (The Swedish National Audit Office) (1996) Statens tillsyn over hälso- och sjukvård. En effektivitetsre-vision (Governmental Control in Health Care Sector. An Audit on Efficiency), report 23. Stockholm: Riksrevisionsverket.
61.
Riksrevisionsverket (The Swedish National Audit Office) (2002) Att påverka utan att styra. Statens informativa insatser inom hälso- och sjukvårdsområdet (To Influence Without Controlling. Information Achievements by the Government in the Health Care Sector), report 4. Stockholm: Riksrevisionsverket.
62.
Rose, N. (1989) Governing the Soul: Technologies of Human Subjectivity. Routledge: London.
63.
Rose, N. (1999) Powers of Freedom. Cambridge: Cambridge University Press.
64.
Searle, J. R. (1995) The Construction of Social Reality. New York, NY: Free Press.
65.
Sheaff, R., Marshall, M., Rogers, A., Roland, M., Sibbald, B. and S. Pickard (2004) ‘Governmentality By Network in English Primary Health-Care’, Social Policy and Administration38(1): 89-103.
66.
SOU (1997) Patienten har rätt (The Patient is Right). Delbetänkande av Kommittén om hälso-och sjukvårdens finansiering och organisation (HSU 2000), SOU 1997:154. Stockholm: Fritzes.
67.
Spri (The National Institute of Rationalising Health Care) (1999) Patienternas erfarenheter—en utgångspunkt för förbättringsarbete (The Patients’ Experiences—A Point of Departure for Improvements). Stockholm: Spri.
68.
Sturdy, A., Grugulis, I. and Willmott, H. (2001) Customer Service. Empowerment and Entrapment. Hampshire: Palgrave.
69.
Talbot-Smith, A. and Pollock, A. M. (2006) The New NHS—A Guide. London: Routledge.
70.
Tanenbaum, S. J. (1999) ‘Evidence and Expertise: The Challenge of the Outcomes Movement to Medical Professionalism’, Academic Medicine74(7): 757-763.
71.
Townley, B. (1994) Reframing Human Resource Management. London: Sage.
72.
Whitehead, M., Gustafsson, R.Å. and Diderichsen, F. (1997) ‘Why is Sweden Rethinking its NHS Style Reforms?’British Medical Journal315: 935-939.
