{"id":325,"date":"2014-05-25T13:33:45","date_gmt":"2014-05-25T13:33:45","guid":{"rendered":"http:\/\/nome.unak.is\/wordpress\/?p=325"},"modified":"2016-03-30T22:10:38","modified_gmt":"2016-03-30T22:10:38","slug":"has-the-competition-among-professions-in-the-nordic-welfare-states-intensified-a-danish-case","status":"publish","type":"post","link":"https:\/\/nome.unak.is\/wordpress\/09-3\/c73-conference-paper\/has-the-competition-among-professions-in-the-nordic-welfare-states-intensified-a-danish-case\/","title":{"rendered":"Has the Competition among Professions in the Nordic Welfare States Intensified? A Danish Case"},"content":{"rendered":"\n\n\n\t
\n\n\t\t<\/i><\/span> <\/a>\n\n\t<\/div>\n\n\n\n\n\n

 <\/p>\n

1. Introduction and analytical framework <\/span><\/b><\/p>\n

Professionals such as social workers, administrators, doctors, economists, accountants, teachers, lawyers and nurses are core employees in the public sector in modern welfare states for the provision, production, delivery and management of the welfare services.<\/span> By definition, professionals need to have autonomy in order to exercise discretion to provide people with the best possible services (Lipsky, 1980; 2010; Mintzberg, 1983; Winter & Nielsen, 2010). In other words, if professionals possess a sufficient amount of autonomy to exercise discretion based on their profession\u2019s standards, norms and values, they can and will design the provision, production and delivery of the services to create the best fit possible between the services provided and the individual citizen\u2019s needs. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Jespersen and Wrede (2009, pp. 155-156) define the following three types of autonomy.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

1. Traditional professional autonomy\u00a0 <\/span><\/i><\/p>\n

With traditional professional autonomy, professionals have a monopoly on particular jobs as well as specific management positions in certain public welfare institutions (called \u2018double social closure\u2019). They also have the authority to define and solve clients\u2019 problems. When professional autonomy exists, mono-professions are additionally the norm regarding the provision, production, delivery and management of the welfare services. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

2. Framed autonomy<\/span><\/i><\/p>\n

With framed autonomy, the autonomy is more limited and emphasis is put on the accountability of the professionals. There are also political and administrative demands regarding economic efficiency in the daily operations professionals perform. In framed autonomy, the various levels of management define the problems and solutions, the professions\u2019 norms and standards are thus subordinate to the organization. Consequently, framed autonomy reflects an era of new public management (NPM).<\/span><\/p>\n

\u00a0<\/span><\/b><\/p>\n

3. Competitive autonomy<\/span><\/i><\/p>\n

With the rise of competitive autonomy, monopolies dissolve. As a result professionals coming from different professions are involved in decision-making processes on the provision, production, delivery and management of welfare services to the citizens as end-users. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

According to Jespersen and Wrede (2009, p. 173), developments in the hospital\/health care sector in the Nordic countries have moved from traditional professional autonomy towards competitive autonomy via framed autonomy. From the perspective of institutional logics (Friedland & Alford, 1987; Meyer & Hammerschimd, 2006; Thorton et al., 2012; Thorton & Ocasio, 2008), this development reflects a shift from the logic of street-level bureaucracy (SLB) being highly dominant to a situation where there is competition between the logic of SLB and the logic of NPM, which has further evolved to the current situation, where several different logics compete. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Due to space limitations, this article focuses on the following four logics of management in the public sector: SLB, NPM, Weberian bureaucracy (WB) and new public governance (NPG). Table 1 presents a basic summary of what comprises these logics.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Table 1: Institutional logics of the public sector<\/i><\/span><\/p>\n\n\n\n\n\n\n\n
Primary management logic<\/span><\/b><\/td>\nWeberian bureaucracy\u00a0<\/span><\/b>(WB)<\/span><\/b><\/td>\nStreet-level bureaucracy (SLB)<\/span><\/b><\/td>\nNew public management\u00a0 (NPM)<\/span><\/b><\/td>\nNew public governance (NPG)<\/span><\/b><\/td>\n<\/tr>\n
Fundamental logic <\/span><\/i><\/td>\nThe state<\/span><\/td>\nThe profession<\/span><\/td>\nThe market<\/span><\/td>\nThe local community<\/span><\/td>\n<\/tr>\n
Cultural symbolism<\/span><\/i><\/td>\nUnity of the State, the public ethos, rules, obligations and rights <\/span><\/p>\n

\u00a0<\/span><\/p>\n

\u00a0<\/span><\/td>\n

Vocation, professionalism, hands-on approaches, professional ethos and ethics, practice-orientated knowledge <\/span><\/td>\nFormation of contracts and marketisation of the public sector, competition, self-interest as a significant criterion for prioritisation and decision making<\/span><\/td>\nReliance and competition, mutual dependency, the pluralistic state,\u00a0<\/span>governance networks, cooperation and competition<\/span><\/td>\n<\/tr>\n
Materialised practice <\/span><\/i><\/td>\nHierarchy, top-down management, centralisation, standardisation, economics of scale, division\u00a0<\/span>of labour<\/span><\/td>\nBottom-up management, coping strategies, discretion, production and delivery of public welfare services provided in cooperation with consumers<\/span><\/td>\nIntra- organisational management, focus on input and service output based on the preferences of the citizens, the citizen as costumer<\/span><\/td>\nIntra-organisational governance, focus on\u00a0<\/span>service processes and outcomes<\/span><\/td>\n<\/tr>\n
Theoretical origin<\/span><\/i><\/td>\nThe ideal type<\/span>of bureaucracy<\/span><\/p>\n

\u00a0<\/span><\/td>\n

Front-line bureaucracy<\/span><\/td>\nRational choice, market economy<\/span><\/td>\nNeo-corporatism<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\u00a0<\/span><\/p>\n

Viewing Jespersen and Wrede\u2019s (2009, p. 173) conclusions on developments in the hospital\/health care sector in the Nordic countries using the theories on institutional logics as a framework means the situation being dealt with now involves several competing logics. The fact that there is competition among different institutional logics paves the way for two possible scenarios: 1) struggles and conflicts among professions; and 2) constructive co-operation among the professions. Naturally, people and society as a whole prefer the latter, which is why the political-administrative system demands that public managers do their best to promote the second scenario.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Consequently, two important questions must be asked:<\/span><\/p>\n

1) Is the development from traditional professional autonomy towards competitive autonomy \u2013 from a mono logic towards multiple logics \u2013 in the hospital\/ health care sector in the Nordic countries part of a more general development? <\/span><\/p>\n

2) Can and will public managers promote the second scenario of constructive co-operation that would be of benefit to people and society? <\/span><\/p>\n

\u00a0<\/span><\/p>\n

The following three-step analysis addresses these two questions.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

The first step<\/i> involves a case study that examines whether or not the development from traditional professional autonomy towards competitive autonomy \u2013 from a mono logic towards multiple logics \u2013 in the hospital\/health care sector in the Nordic countries also exists in other public welfare sectors. The case involves the disabled and the socially disadvantaged in Denmark. Developments involving this group of recipients of welfare services are described and analysed based on a document analysis by Pedersen and Hammer (2012), but are also examined based on data from a study comprising a national survey of managers (Pedersen, 2007). Data from 13 qualitative interviews with managers whose work involves this group were also studied (Pedersen and Aagaard, 2013). <\/span><\/p>\n

The second step <\/i>is a case study that investigates if and how public managers promote the second scenario of constructive co-operation. The same group of recipients of welfare services is looked at as in the first step, but this time the analysis is based on qualitative interviews with top managers. Finally, the third step<\/i> provides a discussion that attempts to answer the two questions presented above.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

2. The sector of disabled citizens and the socially disadvantaged<\/span><\/b><\/b><\/p>\n

This section introduces and analyses developments concerning the field of disabled citizens and the socially disadvantaged in an attempt to frame and compare Wrede and Jespersen\u2019s conclusions about the hospital\/health care sector. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

2. 1. Why disabled citizens and the socially disadvantaged are of interest <\/span><\/b><\/p>\n

Professionals who work with this group of people deal with society\u2019s most vulnerable citizens, which is why this group is of high priority for politicians, taxpayers in general and, as this article will show, the media, which often tends to focus on showing how local authorities have difficulties in providing an acceptable level of service. Managers whose work deals with this group must also cope with wicked problems that are particularly complex and involve policy issues that are not easily solvable. Strategic uncertainty<\/i> is also a feature of dealing with this sector due to, as this article will show, the many actors involved and their various professions and inherent logics. This, in turn, means that problem-solving strategies can differ greatly. Another feature is the institutional uncertainty<\/i> that arises due to decisions being made on multiple levels and in different places, ranging from, for example, reform initiatives implemented by the government to frontline decision making at the managerial level and\/or among social workers (Klijn et al., 2003, pp. 193-194).\u00a0 <\/span><\/p>\n

\u00a0<\/span><\/p>\n

In addition to being of high priority politically and among the Danish population in general, this group is very costly to society. A serious challenge for the semi-professionals involved in social work and the treatment of this group is that they have, as yet, failed to provide evidence-based data demonstrating the effectiveness of the services they provide. The services they provide are often viewed as expensive and as severely intervening in people\u2019s lives (Konnerup, 2009, pp. 103-104). This situation has contributed to the emergence of a competitive relationship among the professions that involve this group.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

This article shows how budget management difficulties and general developments in this sector influence the level of competition among professions in Denmark, which in turn, underlines the need for constructive co-operation among professions in a multi-logic environment.\u00a0 \u00a0<\/span><\/p>\n

\u00a0<\/span><\/p>\n

2. 1. 1. Disabled citizens and the socially disadvantaged in Denmark<\/span><\/b><\/p>\n

Following the Structural Reform of 2007, local authorities in Denmark gained full responsibility for the sector concerning disabled citizens and the socially disadvantaged (Madsen, 2014, p. 40; Olsen and Rieper, 2007). As a whole, around ten percent of the Danish population belongs to this group, which means it represents the second largest welfare-oriented sector for local authorities. With DKK 40 billion being spent annually, it is the second most costly field in Denmark (Ministry of Finance, 2009, p. 6; Pedersen and Hammer, 2012, p. 49). Over the years, this sector has put a severe financial strain on public budgets, leading to a period of ever-growing central budget allocations to local authorities. In 2010, when the government finally declared that no further budget allocations would be made, it launched a plan to stabilise the budgetary control of local authorities in this area (Ministry of Finance, 2010). <\/span><\/p>\n

\u00a0<\/span><\/p>\n

The disabled and socially disadvantaged are generally divided into two groups:<\/span><\/p>\n

1) Adults<\/i> who are physically challenged or suffer from mental disorders and addiction, intellectual disabilities, autism, brain damage or mental disabilities. Services for this group include e.g. shelters, safe-houses and crises centres for women.<\/span><\/p>\n

2) Children and youth<\/i> who are at risk. Services for this group include e.g. foster care and care centres (Framework Agreement, 2014, p. 4). <\/span><\/p>\n

\u00a0<\/span><\/p>\n

2. 2. Developments in Denmark for disabled citizens and the socially disadvantaged, 1970\u20132014<\/span><\/b><\/p>\n

This section looks at this sector in light of Jespersen and Wrede\u2019s conclusions to determine whether a shift from traditional professional autonomy towards competitive autonomy in the hospital\/health care sector in the Nordic countries has occurred. We will also examine whether a shift has taken place from a mono logic towards multiple logics concerning this sector.\u00a0 <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Basic societal values in the 1970s concerning the group of interest\u00a0 <\/span><\/b><\/b><\/p>\n

As part of a decentralisation strategy implemented by the Danish government in the 1970s, it was decided that the provision of the services to disabled and socially disadvantaged citizens should be based on individual assessments carried out by semi-professionals (e.g. social workers). The semi-professionals were to make use of their autonomy and discretion in the field, and in decision-making processes, combining the service outputs of the sector with citizens\u2019 needs. As a result of this strategy, SLB logic dominated this sector for decades. Until the turn of the century, in fact for almost three decades, a mono logic was prominent for this group and remained largely intact as no appreciable initiatives influenced by the logic of NPM were implemented in the 1980s, or even in the 1990s (Aagaard and Pedersen, 2013, pp. 26-27). <\/span><\/p>\n

\u00a0<\/span><\/b><\/p>\n

\u00a0<\/span><\/b><\/p>\n

\u00a0<\/span><\/b><\/p>\n

Public sector reforms\u00a0 <\/span><\/b><\/p>\n

From the 1990s until today, more than 20 major public sector reforms were implemented in Denmark. After the 2007 Structural Reform, the area under study was constituted in a new set up, granting the current 98 municipalities in Denmark full responsibility for the provision and financing of services relevant for this group. The basic idea behind the structural reform largely represented the rationale of the NPM logic of decentralisation in the hopes of securing an efficient delivery of services by providing citizens as consumers with better and cheaper welfare services. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Another example of NPM logic that had a growing impact on the rationale of the reforms in the Danish welfare state at that time was the policy that people were free to choose a service provider, e.g. the hospital or school they preferred. Another example that involves this sector was the launching of the web-based Tilbudsportalen<\/i>, an online catalogue of service providers that contains a description of their services and prices, which allows local authorities to select the most appropriate services given the needs of the citizens (Fakta om Tilbudsportalen<\/i>). The reason for establishing Tilbudsportalen<\/i> was to encourage competition among suppliers to achieve better and cheaper services for the citizens as end-users. A study by Aagaard and Petersen (2013, p. 28), however, shows that implementation of the Tilbudsportal<\/i> failed to significantly increase competition or reduce costs. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Another recent reform initiative involving the disabled and socially disadvantaged concerns the governmental aim of increasing the inclusion of children with special needs in the municipal primary and lower secondary school in Denmark rather than special schools (Egelund et al., 2013, p. 12). This reform can be seen as a gradual \u201cnormalisation\u201d of aspects of specialised public welfare services. It has resulted in a focus on cross-disciplinary co-operation among various professions, organisations and other players (Danish Evaluation Institute, 2011, p. 57), e.g. between teachers and parents, teachers and social workers and at the level of management. Activities resulting from the reform enforce the logic of NPG, which has an inherent focus on values such as co-operation, self-reliance and a solution-oriented use of governance networks.<\/span><\/p>\n

\u00a0<\/span><\/p>\n

Semi-professionals, e.g. teachers, nurses, daycare staff and social workers, are typically associated with the logic of SLB (Lipsky, 2010), whereas full-professionals, e.g. economists, lawyers and administrators, are associated with the logic of the WB (Lerborg, 2010). In Denmark, both semi-professionals and full-professionals have been hostile to the logic of NPM for decades (Pedersen and Rendtorff, 2010), which is why the overall implementation of NPM in the Danish welfare state has proven to be quite limited (Pedersen, 2010; Pedersen and L\u00f6fgren, 2012).<\/p>\n

<\/span><\/p>\n

Full-professionals, however, have absorbed many of the performance elements of NPM, which are now widely implemented by both state and local authorities. As a result, the full-professionals have gradually turned WB into a neo-bureaucracy, which entails combining WB with modern, top-down performance management (Pedersen, 2010). Overall, the public sector reforms work as a framework for the autonomy of professionals (defined in NPM terms as server demands) on economic efficiency in the daily operations they perform. Consequently, it is possible to observe a development from traditional professional autonomy to a framed autonomy, as well as a shift from domination by a mono logic to a today\u2019s situation, which comprises multiple logics. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

The financial crisis<\/span><\/b><\/p>\n

From 2007-2009, a considerable budget deficit appeared in the municipalities in general, but particularly for the sector being studied. The government saw this as unacceptable, especially because the financial crises had reached Denmark by 2009. With the overall state budget severely strained and the financial stability of the Danish welfare state threatened, tough budget constraints were implemented and top-down cuts in the public sector in general and in the group under study were carried out. There was a move from a more \u201cgentle\u201d budgetary control of welfare expenses in the municipalities to a much more stringent economic policy. In order to restore the economic situation as well as to be able to achieve further control of the consumption of resources by local authorities, the WB logic was further strengthened (Pedersen and Hammer, 2012). Along with the enhancement of the WB logic, more requirements arose for documenting the efficiency of the service outputs of the professional institutions. The economic challenges led to a further strengthening of the WB logic, both in its old and new form.<\/p>\n

<\/span><\/p>\n

As a result, semi-professionals were faced with a completely different setting, where the WB logic dominated their work life much more and challenged the logic of SLB. Rationales excluded from the SLB logic, such as budget management and performance measurement, were now \u2013 and continue to be \u2013 incorporated in social work. At the same time, there was (and continues to be) on-going political demand for individually based provisions of welfare services; as such, the SLB logic remains. This has meant a shift towards a much more competitive autonomy as well as towards more multiple logics.<\/span><\/p>\n

\u00a0<\/span><\/b><\/p>\n

High priority cases in the mass media<\/span><\/b><\/p>\n

In recent years several aforementioned cases of abuse of children and youth believed to be protected by local authorities and semi-professionals have been covered by the mass media, threatening the legitimacy of the welfare state, which, among other reasons, gains its legitimacy by taking care of society\u2019s most vulnerable citizens (Esping-Andersen, 1990). A work in progress concerning the consequences of such high profile cases in the mass media concludes that a strengthening of WB continues to occur because of such cases. The study indicates that the Danish government has thus turned to reforms that involve both more legislation and more control measures in response to the cases. The study also shows that the same mechanism based on the logic of bureaucracy is found in the municipalities, which on a decentralised level implement more control measures in an effort to regain control and to ensure the re-establishment of legitimacy in the organisation. This process of bureaucratisation has intensified in recent years due to the influx of high profile cases, severely challenging the logic of SLB. Because WB logic forms the basis for the general reaction and solutions to the aforementioned, that same logic is being challenged as new cases continue to appear in spite of WB-based efforts to prevent them. As a result, these cases severely challenge the logic of WB and SLB (Nielsen, 2014). <\/span><\/p>\n

\u00a0<\/span><\/p>\n

Digitisation<\/span><\/b><\/p>\n

A new era of digitisation has been introduced in the Danish welfare state in recent years. Along with Local Government Denmark and the Danish Regions, the Danish government has commenced the implementation of the \u201ceGovernment Strategy of 2011- 2015\u201d, which is called \u201cThe digital path to future welfare\u201d. The digitisation reform is being proclaimed as a long-sought-after solution to future demographic issues in which the financial stability of the current level of public welfare is threatened due to demographic changes in population. There will be a much larger number of elderly citizens in need of care relative to the number of people who work and pay taxes. With the implementation of IT solutions for frontline casework involving vulnerable groups of children and young people, as well as people with disabilities, the rise of the digitisation era is also visible with regard to the area under study. Intended to improve quality and be financially beneficial, various systems have been developed and implemented widely throughout the municipalities (eGovernment Strategy, 2011). The logic of NPM and WB can be found in the efforts to reform the welfare state based on digitisation in the sense that the WB logic is present in the implementation of digitisation programmes as a means of controlling the quality of the services delivered by measuring the degree to which the practices of social workers live up to current legislation. The implementation of IT systems also serves as a means for securing and measuring the level of performance and efficiency, which reflects the logic of NPM. The combined existence of these two logics reflects the emergence of a neo-bureaucracy, a development that challenges the logic of SLB and fights against the logics of NPM and WB.<\/p>\n

<\/span><\/p>\n

The digitization movement challenges the logic of SLB in yet another way because IT systems directed at frontline social work inevitably weakens the autonomy level of the affected professions by determining standard procedures for casework, as well as casework efficiency. <\/span><\/p>\n

\u00a0<\/span><\/p>\n

2. 3. Overall conclusion<\/span><\/b><\/p>\n

In summary, we are able to conclude that developments in the 1990s and on have contributed to the current situation, where many different professions are now involved in the decision-making processes for the provision, production, delivery and management of the welfare services. Simultaneously, a shift has taken place from a mono logic towards multiple logics competing against each other. In part, this development has occurred because of:<\/span><\/p>\n