The gender subtext of new public management-based work practices in Swedish health care

Hedegaard, Joel and Ahl, Helene (2013) The gender subtext of new public management-based work practices in Swedish health care. Equality, Diversity and Inclusion: An International Journal, 32 (2). pp. 144-156. ISSN 2040-7149

Abstract

Purpose – The purpose of this paper is to propose a theoretical framework for researching gender equality implications of Clinical Microsystems, a new public management-based model for multi-professional collaboration and improvement of health care delivery. Design/methodology/approach – The paper draws on literature from gender in organizations, new public management, multi-professional collaboration and organizational control to critically analyze the Clinical Microsystem model. Findings – While on the surface an egalitarian and consensus-based model, it nevertheless risks reinforcing a gendered hierarchical order. The explicit emphasis on social competencies, on being collaborative and amenable to change risks, paradoxically, disfavoring women. A major reason is that control becomes more opaque, which favors those already in power. Practical implications – The paper calls for researchers as well as practitioners to incorporate concerns of equality in the work place when introducing new work practices in health care. For research, the authors propose a useful theoretical framework for empirical research. For practice, the paper calls for more transparent conditions for multi-professional collaboration, such as formalized merit and advancement systems, precisely formulated performance expectations and selection of team members based strictly on formal merits. Originality/value – A gender analysis of a seemingly anti-hierarchical management model is an original contribution, adding to the literature on Clinical Microsystem in particular but also to critical studies on new public management. Moreover, the paper makes a valuable practical contribution in suggesting ways of avoiding the reproduction of gender inequalities otherwise implied in the model.