Professional Organisation and New Public Management—Conflicting Organisation Models in the Public Sector

For a long time, bureaucracy was the main model for organising public authorities. All cases are administered equally and consistently by using a system of rules. In professional organisations like hospitals, courts and schools the professional organisation has also been influential. The professionals like medical doctors, university lecturers and teachers have had a lot of power in these organisations. The professionals have a long education and their work is characterised by a low division of labour. Their work is coordinated through standardisation of skills and knowledge, which the professionals develop through their common education and training. Work is also coordinated by mutual adjustment, often labelled collegiality, in a democratic decision-making process. Peer review is used for auditing and quality assurance. Since the 1980s however, politicians and public administrators have increasingly started to question the power of the professionals. New public management (NPM) was put forward as the new management model with the arguments higher efficiency and cost cutting. The private company competing on a market is seen as an ideal model in NPM. Customers, for example patients, should have the opportunity to choose between different alternatives. As a help to choose, units are compared by key performance indicators and customer satisfaction surveys. The division of labour and coordination are to some extent affected for the professionals by NPM. The line of command and top-down decision-making is emphasised. The collegial decision-making tends to be diminished, which for example has taken place in universities. The professionals also get more administrative tasks. The research results are mixed regarding the main argument for introducing NPM—improved efficiency, saving costs and increasing quality. However, a number of studies indicate increased costs overall, and lower quality, in the Weberian sense of treating cases equally and fairly. Also, several undesirable side effects are reported, such as grade inflation in Sweden. The schools are competing with grades to attract students. Several studies also point out stressful working conditions in organisations using NPM principles.