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Managerialism in the Australian Public Health Sector: Towards the Hyper-Rationalisation
of Professional Bureaucracies
J.Germov
Sociology of Health and Illness.
2005.
Vol. 27.
No. 6.
P. 738-758.
This paper draws on qualitative case-study research to discuss the impact of managerialism
on the work organisation of public sector health professionals in Australia. The
case studies included 71 semi-structured interviews with a broad range of public
sector health professionals (predominantly nursing and allied health professionals,
with some doctors and managers). The data are used to examine the implications of
managerialism for the organisation of professional (public) bureaucracies. The findings
show that while health professionals were able to exert their agency to influence
managerial processes, the incorporation of managerial strategies into professional
practice placed constraints upon professional autonomy. The impact of managerialism
on professional bureaucracies is examined using the neo-Weberian framework of hyper-rationality,
an ideal type derived from a combination of four forms of rationality identified
in Weber's work: practical, formal, substantive and theoretical rationality. Applied
to the social organisation of health-care work, this paper critically examines the
utility of the hyper-rationality ideal type, noting its limitations and the insights
it provides in conceptualising the impact of managerialism on professional (public)
bureaucracies.
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