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Professions and the Pursuit of Transparency in Healthcare: Two Cases of Soft Autonomy

Contemporary professions are increasingly challenged to open up to scrutiny from the outside. Earlier research is focused on two main types of responses and consequences: colonization by a managerial logic of self-monitoring and decoupling of auditing and professional practice. This paper describes a different type of response which implies that professionals get actively involved in monitoring their own activities, without losing their professional autonomy. Two cases from Swedish healthcare were investigated: accreditation at a hospital laboratory and the national quality registries. In both cases, professional involvement took the form of translation and negotiation in expert networks, restrained by a certain resistance towards external monitoring, but driven by an interest in legitimizing and developing professional work. The resulting situation is characterized as a `soft autonomy' which combines professional internalization of originally non-professional auditing ideas with maintained professional control over evaluation criteria.