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PROFESSIONS, INSTITUTIONAL DYNAMICS, AND NEW PUBLIC MANAGEMENT IN THE DANISH HOSPITAL FIELD

ABSTRACT This article elucidates the role of professionals as stakeholders in the Danish hospital field. The sociological new-institutionalism has illuminated the role of professions as carriers of rationalities and norms and their role in radical changes in organizational fields, but we are short of contributions that elucidate their role as stakeholders in connection with incremental changes in mature organizational fields. First we focus on what interests professions can be expected to safeguard. We will argue that professions protect and expand their professional rationalities. In mature fields this must be done in interaction with the state apparatus that in numerous ways regulates the professions. Second we assume that in mature organizational fields, dominated by professional interpretative schemes, the professions’ safeguarding of interests will be tied to their influence on the creation of new institutions within the existing institutional landscape in the field. More specifically we argue that the professions’ opportunities of influence depend on: The existing constellationof institutions in the field. The degree of competitionamong new and old institutions. The existing political-administrative structure. The power relationsbetween actors in the field. Our empirical cases concern two attempts of institutional innovation in the Danish hospital field. In this field, attempts are made during the 1980s and the 1990s to introduce a series of innovations inspired by the New Public Management (NPM) strategy. We have examined two such innovations: Unambiguous managementand systematic quality development. The professionals have been able to maintain the dominant professional interpretive schema through a combination of central and local safeguarding of interests that has barred the two NPM inspired innovations from being disseminated effectively into the field. Another reason why the NPM strategy does not seem to have great impact in the two cases is, we think, that a coherent strategy was never formulated in Denmark. The two case analyses support our assumptions and are not conflicting with the conclusions of others on radical changes in organizational fields.1-4 We conclude that the four factors contribute to explain the success of the professionals. They might also be useful as general factors explaining the influence of the professions on the field dynamics and institutionalization in mature organizational fields. Another conclusion is that we should be very careful to generalize about the influence of the professionals from one country to another. Even if professional rationalities were alike, the institutional constellation and competition, the administrative structures and power relations differ strongly from one country to another. This might explain the different outcomes of NPM strategies in profession dominated fields in various countries.