Résumés
Résumé
On assiste de plus en plus, dans le secteur de la gouvernance des activités professionnelles, au recrutement délibéré de professionnel·le·s pour pourvoir des postes de direction ou de gestion « hybrides ». Il reste à savoir si, du point de vue de l’organisation du travail des expert·e·s, ces « hybrides » servent les intérêts de leur profession ou bien ceux du gestionnariat. Cet article s’appuie sur le concept de « pouvoir pastoral » de Michel Foucault pour comprendre dans quelle mesure ces hybrides « guident » la conduite de leurs collègues médecins. À partir de six études, nous retraçons les pratiques pastorales de ces hybrides ainsi que leur incidence sur la formation et la gouvernance des subjectivités de leurs collègues médecins. Notre analyse permet de réinterpréter les dynamiques relationnelles de pouvoir à l’oeuvre dans l’organisation et la gouvernance des professions, et souligne par ailleurs la distinction entre pastoralité et gouvernance en matière de conduites sociales.
Mots-clés :
- professions,
- hybrides,
- pouvoir pastoral,
- gouvernementalité,
- médical
Abstract
The governance of professional work increasingly involves the purposeful enrolment of professional members into ‘hybrid’ leadership or management roles. Questions remain as to whether these ‘hybrids’ serve the interest of their profession or management in the organisation of expert work. Drawing upon Michel Foucault’s elaboration of ‘pastoral power’, this paper considers how hybrids shepherd the conduct of their professional colleagues. Informed by analysis of six studies, the paper traces hybrids’ pastoral practices in constituting and governing their professional colleagues’ subjectivities. Our analysis offers new understanding of the relational dynamics of power in the organisation and governance of professions, and further demonstrates the distinct practices of shepherding and governing social conduct.
Keywords:
- Professions,
- hybrids,
- pastoral power,
- governmentality,
- medical
Resumen
En el sector de la gobernanza de las actividades profesionales, asistimos cada vez más al reclutamiento deliberado de profesionales para ocupar puestos directivos o de gestión « híbridos ». Queda por determinar si, desde la perspectiva de la organización del trabajo de las personas expertas, estos roles « híbridos » sirven los intereses de su profesión o a los de la administración. Este artículo se basa en el concepto de « poder pastoral » de Michel Foucault para comprender en qué medida estos roles híbridos « guían » la conducta de sus colegas del cuerpo médico. A partir de seis estudios, identificamos las prácticas pastorales de este tipo de roles, así como su impacto en la formación y en el gobierno de las subjetividades de estos colegas. Nuestro análisis permite por lo tanto reinterpretar las dinámicas relacionales de poder que actúan en la organización y en la gobernanza de las profesiones, además de poner énfasis en la distinción entre pastoralidad y gobernanza en términos de conductas sociales.
Palabras clave:
- Profesiones,
- híbridos,
- poder pastoral,
- gubernamentalidad,
- médico
Parties annexes
Bibliographie
- Bejerot, E. et Hasselbladh, H. (2011). Professional autonomy and pastoral power : The transformation of quality registers in Swedish health care. Public Administration, 89(4), 1604-1621.
- Bernardi, R. et Exworthy, M. (2020). Clinical managers’ identity at the crossroad of multiple institutional logics in IT innovation : The case study of a health care organization in England. Information Systems Journal, 30(3), 566-595.
- Bresnen, M. Hodgson, D., Bailey, S., Hassard, J. et Hyde, P. (2019). Hybrid managers, career narratives and identity work : a contextual analysis of UK healthcare organizations. Human Relations, 72(8), 1341-1368.
- Burgess, N. et Currie, G. (2013). The knowledge brokering role of the hybrid middle level manager : The case of healthcare. British Journal of Management, 24, S132-S142.
- Coburn, D., Rappolt, S. et Bourgeault, I. (1997). Decline vs. retention of medical power through restratification : an examination of the Ontario case. Sociology of Health and Illness, 19(1), 1-22.
- Cooper, R. (2019). Pastoral power and algorithmic governmentality. Theory, Culture and Society, 37(1), 29-52.
- Corbin, J. et Strauss, A. (2014). Basics of qualitative research. Sage.
- Croft, C., Currie, G. et Lockett, A. (2015). Broken “two‐way windows” ? An exploration of professional hybrids. Public Administration, 93(2), 380-394.
- Currie, G., Tuck, P. et Morrell, K. (2015). How hybrid managers act as “canny customers” to accelerate policy reform : A case study of regulator-regulatee relationships in the UK’s tax agency. Accounting, Auditing & Accountability Journal, 28(8), 1291-1309.
- Dean, M. (2010). Governmentality : Power and rule in modern society. Sage publications.
- Denis, J-L., Ferlie, E. et Van Gestel, N. (2015). Understanding Hybridity in Public Organizations. Public Administration, 93(2), 273-289.
- Denis, J.L. et Germain, S. (2022). Medical Doctors in Health Reforms : A Comparative Study of England and Canada. Policy Press.
- Evetts, J. (2003). The sociological analysis of professionalism : Occupational change in the modern world. International sociology, 18(2), 395-415.
- Exworthy, M. et Halford, S. (1999). Professionals and the new managerialism in the public sector. Open University Press
- Ferlie, E., Dopson, S., Bennett, C. et Fischer, M. (2018). The politics of management knowledge in times of austerity. Oxford University Press.
- Ferlie, E., Fitzgerald, L., McGivern, G., Dopson, S. et Bennett, C. (2013). Making Wicked Problems Governable ? : the case of managed networks in health care. OUP Oxford.
- Ferlie, E., Fitzgerald, L., McGivern, G., Dopson, S. et Exworthy, M. (2010). Networks in health care : a comparative study of their management, impact and performance. Report for the National Institute for Health Research Service Delivery and Organisation Programme. https://njl-admin.nihr.ac.uk/document/download/2027250
- Ferlie, E. et McGivern, G. (2014). Bringing Anglo-Governmentality into Public Management Scholarship : The Case of Evidence-based Medicine in UK Health Care. Journal of Public Administration Research and Theory, 24(1), 59-83.
- Ferlie, E., McGivern, G. et Fitzgerald, L. (2012). A New Mode of Organising in Health Care ? : Governmentality and Networked Cancer Services in the UK. Social Science & Medicine, 74(3), 340-347.
- Fischer, M.D., Dopson, S., Fitzgerald, L., Bennett, C., Ferlie, E., Ledger, J. et McGivern, G. (2016). Knowledge leadership : Mobilizing management research by becoming the knowledge object. Human Relations, 69(7), 1563-1585.
- Foucault, M. (1980). Power/Knowledge. Harvester.
- Foucault, M. (1982). The Subject and Power. Critical Inquiry, 8(4), 777-95.
- Foucault, M. (1991). Discipline and Punish. Penguin.
- Foucault, M. (1994). The Birth of the Clinic. Routledge.
- Foucault, M. (1998). The Will to Knowledge : The history of sexuality, (vol.1). Penguin.
- Foucault, M. (2007). Security, Territory, Population. Palgrave-Macmillan
- Foucault, M. (2011). The Government of the Self and Others. Palgrave-Macmillan.
- Foucault, M. (2012). On the Government of the Living. Palgrave-Macmillan.
- Foucault, M., Ewald, F., Fontana, A. et Senellart, M. (2004). Sécurité, Territoire, Population : Cours au Collège de France (1977-1978). Gallimard : Seuil.
- Fournier, V. (1999). The appeal to “professionalism” as a disciplinary mechanism. The sociological review, 47(2), 280-307.
- Freidson, E. (1985). The reorganization of the medical profession. Medical Care Review, 42(1), 11-35.
- Giacomelli, G. (2020). The role of hybrid professionals in the public sector : a review and research synthesis. Public Management Review, 22(11), 1624-1651.
- Gleeson, D. et Knights, D. (2006). Challenging dualism : Public professionalism in “troubled” times. Sociology, 40(2), 277-295.
- Golder, B. (2009) Foucault and the genealogy of pastoral power. Radical Philosophy Review, 10(7), 157-176.
- Hoang, H. et Perkman, M. (2023). Physician entrepreneurship : A study of early career physicians’ founding motivations and actions. Social Science & Medicine, 339, article 116393.
- Hodgson, D., Bailey, S., Exworthy, M., Bresnen, M., Hassard, J. et Hyde, P (2022). On the character of the new entrepreneurial National Health Service in England : Reforming health care from within ? Public Administration, 100(2), 338-355.
- Howieson, W. B., Bushfield, S. et Martin, G. (2023). Leadership identity construction in a hybrid medical context : ‘Claimed’ but not ‘granted’. European Management Journal, 42(5), 745-756. https://doi.org/10.1016/j.emj.2023.04.012
- Ibarra, H. (1999). Provisional selves : Experimenting with image and identity in professional adaptation. Administrative Science Quarterly, 44(4), 764-791.
- Jones, L. (2018). Pastoral power and the promotion of self‐care. Sociology of Health & Illness, 40(6), 988-1004.
- Jones, L., Armit, K., Haynes, A., Lees, P. et Sciences, H. (2022). Role of medical leaders in integrated care systems : What can be learnt from previous research ? BMJ Leader, 7(2). https://doi.org/10.1136/leader-2022-000655
- Jones, L. et Fulop, N. (2021). The role of professional elites in healthcare governance : Exploring the work of the medical director. Social Science & Medicine, 277, article 113882. https://doi.org/10.1016/j.socscimed.2021.113882
- Kirkpatrick, I., Altanlar, A. et Veronesi, G. (2023). Hybrid professional managers in healthcare : an expanding or thwarted occupational interest ? Public Management Review, 25(5), 859-878.
- Kitchener, M. (2000). The ‘bureaucratization’ of professional roles : The case of clinical directors in UK hospitals. Organization, 7(1), 129-154.
- Larson, M. S. (1979). The rise of professionalism : A sociological analysis (Vol. 233). University of California Press.
- Llewellyn, S. (2001). Two-way windows’ : clinicians as medical managers. Organization Studies, 22(4), 593-623.
- Macdonald, K. M. (1995). The Sociology of the Professions. Sage.
- Martin, G. P. et Learmonth, M. (2012). A critical account of the rise and spread of ‘leadership’ : the case of UK healthcare. Social science & medicine, 74(3), 281-288.
- Martin, G., Bushfield, S., Siebert, S. et Howieson, B. (2021). Changing logics in healthcare and their effects on the identity motives and identity work of doctors. Organization Studies, 42(9), 1477-1499.
- Martin, G.P., Kocman, D., Stephens, T., Peden, C.J. et Pearse, R.M. (2017). Pathways to professionalism ? Quality improvement, care pathways, and the interplay of standardisation and clinical autonomy. Sociology of Health & Illness, 39(8), 1314-1329. https://doi.org/10.1111/1467-9566.12585
- Martin, G. P. et Waring, J. (2018). Realising governmentality : pastoral power, governmental discourse and the (re) constitution of subjectivities. The Sociological Review, 66(6), 1292-1308.
- McGivern, G. (2024). Governmentality in Health Care. Dans Y. Bhatti, T. Farchi, M. Harris et S. Dopson (dir.), The Oxford Handbook of Healthcare Innovation. Oxford University Press.
- McGivern, G. et Ferlie, E. (2007). Playing tick-box games : Interrelating defences in professional appraisal. Human Relations, 60(9), 1361-1385. https://doi.org/10.1177/0018726707082851
- McGivern, G., Currie, G., Ferlie, E., Fitzgerald, L. et Waring, J. (2015). Hybrid manager-professionals’ identity work : the maintenance and hybridization of medical professionalism in managerial contexts. Public Administration, 93(2), 412-432.
- McGivern, G., Dopson, S., Ferlie, E., Bennett, C., Fischer, M., Fitzgerald, L. et Ledger, J. (2016). Epistemic Fit and the Mobilisation of Management Knowledge in Health Care. Dans J. Swan, S. Newell et D. Nicolini (dir.), Mobilizing Knowledge in Healthcare : Challenges for Management and Organization. Oxford University Press.
- McGivern, G., Nzinga, J., Boussebaa, M. et English, M. (2020). Professional Pastoral Work in a Kenyan Clinical Network : Transposing Transnational Evidence-based Governmentality. Dans M. Bevir et J. Waring (dir.), Governing healthcare networks : Developing a decentred perspective on the narratives and situated practices of networks in health care settings (p. 239-266). Palgrave.
- McGivern, G., Nzinga, J. et English, M. (2017). “Pastoral practices” for quality improvement in a Kenyan clinical network. Social Science & Medicine, 195, 115-122.
- Noordegraaf, M. (2007). From “pure” to “hybrid” professionalism : Present-day professionalism in ambiguous public domains. Administration & Society, 39(6), 761-785.
- Noordegraaf, M. (2011). Risky business : How professionals and professional fields (must) deal with organizational issues. Organization studies, 32(10), 1349-1371
- Numerato, D., Salvatore, D. et Fattore, G. (2012). The impact of management on medical professionalism : a review. Sociology of health & illness, 34(4), 626-644.
- Nzinga, J., McGivern, G. et English, M. (2019). Hybrid clinical-managers in Kenyan hospitals : Navigating between professional, official and practical norms. Journal of Health Organization & Management, 33(2), 173-187.
- Reay, T. et Hinings, C. R. (2009). Managing the rivalry of competing institutional logics. Organization studies, 30(6), 629-652.
- Richardson, J. C. et Godfrey, B. S. (2003). Towards ethical practice in the use of archived transcribed interviews. International Journal of Social Research Methodology, 6(4), 347-355.
- Rose, N. (2007). The Politics of Life Itself. Princeton.
- Rose, N. et Miller, P. (1992). Political power beyond the state : Problematics of government. British journal of sociology, 173-205.
- Rosenthal, M. M. (1995). The incompetent doctor : behind closed doors. Open University Press.
- Shih, P., Worth, H., Travaglia, J. et Kelly-Hanku, A. (2017). Pastoral power in HIV prevention : converging rationalities of care in Christian and medical practices in Papua New Guinea. Social Science & Medicine, 193, 51-58.
- Sofritti, F. (2022). Medical hybridity and beyond : professional transitions in Italian outpatient settings. Social theory & health, 20(1), 90-106.
- Spyridonidis, D., Hendy, J. et Barlow, J. (2015). Understanding hybrid roles : The role of identity processes amongst physicians. Public Administration, 93(2), 395-411.
- Stake, R. E. (1995). The art of case study research. Sage.
- Timmermans, S. et Tavory, I. (2012). Theory construction in qualitative research : From grounded theory to abductive analysis. Sociological theory, 30(3), 167-186.
- Wallace, M., Reed, M., O’Reilly, D., Tomlinson, M., Morris, J. et Deem, R. (2023). Developing Public Service Leaders : Elite Orchestration, Change Agency, Leaderism and Neoliberalization. Oxford University Press
- Waring, J. (2007). Adaptive regulation or governmentality: patient safety and the changing regulation of medicine. Sociology of Health & Illness, 29(2), 163-179. https://doi.org/10.1111/j.1467-9566.2007.00527.x
- Waring, J. (2009). Constructing and re-constructing narratives of patient safety. Social Science & Medecine, 69(12), 1722-1731. https://doi.org/10.1016/j.socscimed.2009.09.052
- Waring, J. (2014). Restratification, hybridity and professional elites : questions of power, identity and relational contingency at the points of “professional—organisational intersection”. Sociology Compass, 8(6), 688-704.
- Waring, J. (2024). New development : Clinicians in management—past, present, future ? Public Money & Management, 44(3), 267-270.
- Waring, J. et Bishop, S. (2010). Lean healthcare: Rhetoric, ritual ans resistance. Social Science & Medicine, 71(7), 1332-1340. https://doi.org/10.1016/j.socscimed.2010.06.028
- Waring, J., Bishop, S., Black, G., Clarke, J.M., Fulop, N.J., Hartley, J., Ramsay, A. et Roe, B. (2022). Navigating the micro-politics of major system change: The implementation of Sustainability Transformation Partnerships in the English health and care system. Journal of Health Services Research & Policy, 28(4), 233-243. doi:10.1177/13558196221142237
- Waring, J., Bishop, S., Black, G., Clarke, J. et Roe, B. (2023). What can clinical leaders contribute to the governance of integrated care systems ? BMJ Leader, https://doi.org/10.1136/LEADER-2022-000709
- Waring, J. et Latif, A. (2018). Of shepherds, sheep and sheepdogs ? Governing the adherent self through complementary and competing “pastorates”. Sociology, 52(5), 1069-1086.
- Waring, J. et Martin, G. (2018). Network leadership as pastoral power : The governance of quality improvement communities in the English National Health Service. Dans M. Bevir (dir.), Government} ality after neoliberalism (p. 135-151). Routledge.
- Weller, S., Davidson, E., Edwards, R. et Jamieson, L. (dir.) (2023). Sourcing and Searching for Suitable Data Sets. Dans Big Qual. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-36324-5_3
- Ziebland, S., Grob, R. et Schlesinger, M. (2021). Polyphonic perspectives on health and care : Reflections from two decades of the DIPEx project. Journal of Health Services Research & Policy, 26(2), 133-140.