Academic journal article Nordic Journal of Working Life Studies

What Is a Good Workplace? Tracing the Logics of NPM among Managers and Professionals in Swedish Elderly Care

Academic journal article Nordic Journal of Working Life Studies

What Is a Good Workplace? Tracing the Logics of NPM among Managers and Professionals in Swedish Elderly Care

Article excerpt

Introduction

New public management (NPM) has been pivotal to the Swedish elderly care system for approximately two decades (Kamp and Hvid 2012). NPM, which is characterized by its emphasis on managerialism and marketization, is arguably a necessary response to healthcare delivery problems such as efficiency and quality (Bergmark 2008; Kamp and Hvid 2012). Among the most fundamental concerns of a welfare state is to provide high-quality care and rehabilitation for its ageing population. Still, care for elderly people follows various paths across societies. Some countries invest more than others, and different caring regimes are found even between welfare states (Anttonen and Sipilä 1996). In Sweden, elderly care is offered and available to all, regardless of socioeconomic status; it is considered generous, publicly financed elderly care of high quality. There are disagreements about the significance, distribution, and direction of neoliberal ideas in NPM in the public sector, including in elderly care (Dahl 2012; Pollitt 2002). As Dahl (2012: 283) puts it, however, consensus holds that 'neo-liberalism has been a transnational discourse that has recently changed public organizational cultures and redrawn the boundaries between the private and the public in various ways.' According to Dahl (2012), neoliberalism has been 'translated, mediated and adapted' in various national and local contexts. In Sweden and its Nordic context, the particular institutional context of the woman-friendly welfare state might, due to the prevalence of universalism and rule of law, constitute either an exceptional or a hostile environment for this trend (Dahl 2012: 284).

The dramatic changes undergone by elderly care are assumed to have disrupted and changed the culture as well as the professional ethos and identities in care work (Clarke and Newman 1997; Dahl 2012). However, principles previously applied in elderly care workplaces may have counteracted NPM principles or new developments may have arisen, running parallel to or entangled with NPM. Thus, both losses of meaning/identity and endeavors to construct new meaning/identity are possible (Kamp and Hvid 2012). Still, little is known about how neoliberalism and its ideology function in Nordic welfare regimes or at the workplace level in elderly care (Dahl 2012). Accordingly, this article explores the discourses of NPM and work in Swedish elderly care by focusing on how a good workplace is represented by professionals and managers. Elderly care is regarded as a relational field of work whose central components are said to be emotions and caring dispositions, such as empathy, communication abilities, common sense, problem-solving abilities, and ability to read people (Fejes 2012; Vabø 2006)-that is, caring about others and their needs (Skeggs 1997). The historical background of the elderly care sector is that it used to be informal; established in the 1950s, it was based on expected femininity, such as housewifely skills and virtues (Dahl 2000). These femalecoded traits and behaviors have long been part of the organizational culture and ideals of elderly care.

Many authors report that employees in elderly care experience time pressure, emotional pressure, work overload, stress, and loss of autonomy (Hayes et al. 2006; Josefsson 2012; Josefsson et al. 2007; Theobald and Szebehely 2013; Trydegård 2005). The rationale of effectiveness that NPM embraces may undermine the possibility of meeting elderly people's needs (Kamp 2012). Research finds that autonomy and the possibility of exercising care disposition are crucial-constituting core values-for doing satisfactory care work. The meaning of care work and the identity of care workers are therefore challenged by NPM rationales with its focus on efficiency. However, care work is also characterized by specific techniques and practical tasks, such as evidence-based practices, long emphasized as standard procedures and criteria for good-quality care and rehabilitation (Grol and Grimshaw 2003). …

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