Professionals and Policy

Management Strategy in a Competitive World

Mike Bottery

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136064685
• Edition: 1
• Topic: Betriebswirtschaft
• Subtopic: Business allgemein

By means of case studies in schools and hospitals, this text describes and evaluates the current issues faced by both education and health professionals. It argues that much can be learned by comparing the experiences of the two groups, and suggests ways in which education and health workers can respond positively to the changes of recent years to ensure that essential services are maintained and improved.

Chapter 1

The Limiting of Vision

It should not be too surprising if many professionals throughout the Western world see government legislation, institutional functioning and the activities of their own occupations in rather selective terms. This can be explained partly in terms of time pressures, partly in terms of personal interest, and partly in terms of societal culture: in economies predicated upon the creation of highly (and necessarily) differentiated occupations, backed up by value systems which prize specialization, there is little encouragement for the individual to take a view beyond his or her own field. In a world of such differentiation, only when people are occupationally or personally affected are the full implications of such changes likely to be appreciated.

Nevertheless, if individuals fail to see the occupational forest for their individual trees, they fail to realize that the same issues may affect them all. Professionals in particular have much to learn from the experiences of others at the present time, especially by examining changing conceptions of themselves and their work, and also in the way in which they are managed. Unsurprisingly, perhaps, these two aspects are connected: how a particular body of professionals is managed will affect its own and the wider public's conception of what its members do. From this, it inevitably follows that in an era of change like the present, a major issue will be what a professional does or ought to be doing, for there are going to be conflicting views on this, depending upon the standpoint taken. The evidence presented in this book strongly suggests that for many professionals working in the public sector, changes at an institutional and societal level are constraining both their vision and their practice, and ultimately their role within society; they are failing to locate their problems within a wider ‘ecological’ context which would enable them to understand the causes and effects of such problems more clearly. Moreover, professionals in the state sector who may have conceptualized their work as being primarily for the benefit of the community as a whole are finding that institutional and legislative change make this increasingly difficult. Finally, professionals in all areas of the public sector who have thought of themselves as being entitled to a degree of autonomy in order to exercise professional judgement for the benefit of the community find that this autonomy and decision-making is increasingly being constrained.

If lack of time and interest, as well as aspects of professional culture, all tend to constrain practitioners’ vision, current legislative and institutional changes are exacerbating this situation, and are changing the character of what professionals in the public sector do in ways which are ultimately damaging not only for themselves but for society as a whole. Yet while such constraining of vision may not be noticed by all, other aspects of change are being felt, and many professionals are experiencing considerable personal and occupational distress which has major effects upon their life at home, their enjoyment of the job, their health, and their ability to do the job. Another purpose of this book, then, is to describe this, and to suggest potential remedies.

CHANGING CONCEPTIONS OF THE PROFESSIONAL

Much of the above-mentioned distress comes, it will be argued, directly or indirectly from the legislative and institutional challenges to the way in which many public sector professionals have conceptualized their work. Broadly speaking, many see their work as requiring considerable dedication, commitment and hard work, for much of the time under unique circumstances; all of this, they feel, should entitle them to a considerable amount of autonomy in their working practices. Many would describe their work on this basis as ‘professional’ work, perhaps never realizing that the debate over the meaning and purpose of ‘professionalism’ is not new, even if the agonizing today is as acute as it has ever been. Indeed, an examination of the history of the professions over the last hundred years reveals it as a history of differing ideas of occupational purpose in which present debates need to be situated to be fully understood. One must therefore go back at least as far as the convergence of opinion between two intellectual giants, Durkheim and Tawney, if one is to understand this. Both of these seminal thinkers were concerned with what they perceived as a major nineteenth-century problem, the advent of industrialization and the increasing influence in society of the capitalist entrepreneur, who, as far as they could see, was motivated by little else than profit and self-interest. For Durkheim (1957, pp. 11, 12) when social constraints are removed, ‘nothing remains but individual appetites, and since they are by nature boundless and insatiable, if there is nothing to control them, they will not be able to control themselves’. Perhaps surprisingly, the solution was to be the promotion of the influence of the professional. For Tawney (1921, pp. 94, 95):

The difference between industry as it exists today, and a profession is, then, simple and unmistakable. The essence of the former is that its only criterion is the financial return which it offers to its shareholders. The essence of the latter is that though men enter it for the sake of livelihood, the measure of their success is the service which they perform, not the gains which they amass.

Both Tawney and Durkheim believed, then, that restraint upon individual excess could come from the increased exposure to the critical gaze of colleagues within a ‘profession’. While the virtual professionalization of everyone entailed in such a vision has not happened, there can be little doubt that it placed professionals upon an ethical pedestal, a position occupied for some considerable time. It is not, then, too surprising that before the 1960s the literature on professionals was fairly uncritical, with writers like Carr-Saunders and Wilson (1933) and Marshall (1939) painting a fairly generous and optimistic picture of professional practice. By examining the life and work of those at the top of their respective trees, and by uncritically accepting that these same individuals were motivated primarily by the expert and altruistic nature of the work , they suggested that professionals might be well paid, but that their work was essential, and that the well-being of the client was ensured by the way in which professionals held to clear codes of ethics.

Further, it is not really surprising that such beliefs should then inform attitudes towards professionalism in the development of welfare states in the Western world. These welfare states were initially seen as being successful precisely through being underpinned by the self-sacrificing attitudes of professionals in the treatment of clients (see Bertilsson, 1990). While there may be many today who see this partial, rose-tinted view of professionals as a little naive, it is nevertheless understandable given the cultural assumptions about professionals before and during the creation of welfare states. Indeed, on both sides of the Atlantic the media continued this benign portrayal of professionals: Dr Kildare, Dr Finlay, Joe Friday, Dixon of Dock Green and Sidney Poitier in To Sir with Love all had a pristine quality about them which, it was implied, applied to all other professionals, a proposition seldom questioned except at the personal level. Professionals, the media suggested, existed to serve the public, and for many of the public the question of what professionals did or should do seldom went further.

Yet if ‘service’ was the key concept in the definition of the professions, it was nevertheless only one amongst many which over the years have been suggested as the defining characteristics of ‘professionals’. Indeed, if there was a change in the academic literature since the 1950s, it was to a greater interest in attempting to describe the key criteria underpinning the concept of professionalism. Indeed, at least 17 different criteria in this ‘trait’ approach have been claimed at one time or another as describing professional behaviour (Bottery, 1994), though much of the debate has centred around three concepts:

•that of expertise (the possession by an occupational group of exclusive knowledge and practice);

•that of altruism (an ethical concern by this group for its clients);

•that of autonomy (the profession's need and right to exercise control over entry into, and subsequent practice within, that particular occupation).

It is interesting to note that on the basis of these kinds of analyses, occupations like teaching, the police and nursing were only accorded by writers like Etzioni (1969) the role of ‘semi-professionals’, for according to this critique, they failed to meet a number of criteria derived from an examination of the ‘accepted’ professions, such as lawyers, and doctors. Yet, as Torstendahl (1990) points out, there is a considerable degree of undeclared presupposition here, for on what basis are lawyers and doctors accorded such a title, and others excluded, save that this is how one chooses to define ‘professionalism’? Similarly, the strategy of describing an occupation as movement towards ‘professionalization’ has the same problems, the movement being built around an already idealized concept of ‘profession’, which in turn is derived from an analysis of what individual writers take to be ‘proper’ professions. It is this kind of arbitrariness which in part led many writers on professionalism (e.g. Freidson, 1984; Lawson, 1990) to declare such soil increasingly exhausted.

MODERN TIMES: PROFESSIONALS IN THE CONTRACTING WELFARE STATE

This questioning of the usefulness of this ‘trait’ approach has largely coincided with quite major changes in society, most notably to do with the ability of countries to pay for welfare states, and critiques by right-wing thinkers like Hayek (1944) concerning whether universal welfare states are indeed the right way to organize provision for the major services within society. Unsurprisingly, perhaps, as the role of the welfare state has been questioned, so has the role of the professional, not only within the welfare state but within private practice as well. Writers like Collins (1990), for example, suggest that one needs to look beyond the analysis of the respective traits of occupations, and instead examine how the power exercised by these occupations enables them to exercise ‘occupational closure’, allowing only those individuals they validate to practise, thereby increasing their ability to influence matters in society with regard to the area of their professional practice, and, not unimportantly, to increase their financial remuneration. In so doing, such writers suggest that if the key words used to describe professionalism in an earlier period were expertise and ethics, and the key questions concerned the rights of other occupations to be classified in similar terms to those of medicine and law, and to be granted their status, the more recent key words need to be monopoly and power, and the key questions need to be concerned with the ways in which different occupational groups monopolize access to certain categories of work, and exclude others from such work in order to control the supply of this service to the public, and thus increase its value, its status and their benefit. There is little doubt that this sea change in key words and key questions has affected general public attitudes to professionals, and, unsurprisingly, has challenged professionals’ conceptions of themselves.

Now there is, of course, no reason why the two orientations should be incompatible, but it should not be too surprising if not only the public, but also politicians from both the left and right of the political spectrum, have viewed professionals in an increasingly sceptical manner, the left on an agenda concerned with the increased empowerment of citizens (which it is claimed professionals have failed to advance), and the right on an agenda of promoting greater consumer choice through the destruction of entrenched and freedom-reducing monopolies (monopolies which, it is claimed, professionals have advanced). The result in many countries has been a rash of legislation which, among other things, has introduced greater competition for the services that professionals provide, begun drives for the accumulation of facts and figures regarding their performance in order to accurately assess their comparative performance, and restricted budgets of professionals in the public sector in order to induce them to become more efficient.

As already suggested, such changes in the orientation of studies of professionalism have not occurred within a vacuum. One spur has been a fundamentally ethical attack upon the notion of the universal welfare state. As long ago as 1944 Friedrich Hayek in The Road to Serfdom argued that Communism and Fascism were in fact not that different, as they both sought to centralize power in the hands of the few, and that social democracies were proceeding down that very same road. They had all abandoned, he argued, ‘that freedom in economic affairs without which personal and political freedom has never existed in the past’ (Hayek, 1944, p. 10). The institution of welfare state legislation, he argued in a later book, in the quest for greater equality, ‘necessarily leads to a greater transformation of the spontaneous order of free society into a totalitarian system conducted in the service of some coalition of organised interests’ (Hayek, 1973, p. 2). Few in 1944 were prepared to listen to him, for major recessions and high levels of unemployment in the 1930s, as well as the sacrifices of a World War, followed by an overwhelming Labour victory at the general election of 1945, led even the mainstream of the Conservative party to accept the necessity of an interventionist state.

However, thirty years later the effects of oil price rises in the 1970s, recessions in most Western economies and the apparent inability of Keynesian economics to deal with them led a Labour government in 1976 to the adopti...