Gender and the Public Sector: Professionals and Managerial Change

By Jim Barry; Mike Dent et al. | Go to book overview

9

Hard nosed or pink and fluffy?

An examination of how middle managers in health care use the competing metaphors of business and care to achieve desired outcomes

Ann Young

Introduction

It is striking when listening to health care managers describing their work how they move frequently between metaphors of caring and those associated with a business-oriented approach. They talk of caring, of sharing, of the values of service, of being 'pink and fluffy'. In contrast, they clearly appreciate the pressures on them to respond to business expectations, to be efficient, to argue finances, to 'blacken their hearts' in the way they manage others.

This separation of health care work into a caring component and a business orientation has always existed but has become a critical issue in Europe in the last 15 years. Over this period, various global and demographic changes have destabilised European economies with a knock-on effect on the funding of welfare systems in general and a political willingness to introduce into many health care systems new variations on the central control versus competitive market models.

However, a change in rhetoric does not necessarily lead to new values and hoped-for results. As Lowe (1993) pointed out, policy should be judged by its actual impact. This sentiment was echoed by Baldock (1993:24), who argued that the delivery of welfare relied on relationships between organisational forms and outcomes and that the organisation was 'the mechanism by which political commitments and intentions are turned into welfare outcomes'. It is the organisational process of translating strategy into action that is the focus of this chapter.

The aim of this chapter is to examine the effects of a contractual and managerialist approach to health care on middle managers' perceptions of power. Three contrasting groups of middle managers were interviewed: National Health Service (NHS) nurse managers, NHS finance managers with an accounting background and nurse managers from private hospitals. It was thought that the first two groups would illustrate how the introduction of general management and managed markets into the NHS had affected the

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Gender and the Public Sector: Professionals and Managerial Change
Table of contents

Table of contents

  • Title Page v
  • Contents vii
  • Acknowledgements xvi
  • Introduction 1
  • Part I - Contexts and Networks 13
  • 1 - New Labour, Governance and the Politics of Diversity 15
  • Notes 25
  • 2 - Gendered States, Critical Engagements 27
  • 3 - Managing Transformation? 44
  • 4 - Gender, Welfare Regimes and the Medical Profession in France and Greece 65
  • Notes 80
  • Part II - Managing Professional Work 83
  • 5 - Identifying the Professional 'Man'Ager 85
  • 6 - Women's Positioning in a Bureaucratic Environment 104
  • 7 - Plural Frames of Work in Public Sector Organisations 120
  • Note 133
  • 8 - On the Front Line 136
  • 9 - Hard Nosed or Pink and Fluffy? 154
  • References 168
  • 10 - Ministering Angels and the Virtuous Profession 170
  • References 184
  • Part III - Identity and Biography 187
  • 11 - Gendered Narratives of the Management of Residential Care Homes 189
  • 12 - The Problematic Professional 205
  • References 216
  • Index 218
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