Introduction

The shift in recent decades towards free-market economics, competition and ‘small government’ policies in Western liberal democracies has led to an ideological and political climate that has favoured a suite of reformist activity characterised in the literature as ‘new public management’ (Pollitt, 1990). New public management (NPM) is not simply a set of new management practices but a form of deep restructuring drawing together the principles of managerialism and marketisation into context-specific priorities for change in the public sector. Underpinning reform directions is the belief in the superiority of private sector management principles, organisational forms and market-based mechanisms in producing value for public money, greater public choice, increased efficiency and increased responsiveness to customers (Hood, 1991, 1995).

Hood (1995) has shown that the policy mix and intensity of NPM reform varies according to national context. Thus, although there are similar general approaches or policy instruments discernable across national contexts, specific outcomes depend on the underlying geopolitical arrangements. Although some countries have pulled back from the implementation of the more radical aspects of NPM policies, we note that at the institutional level of health service agencies the pressures on public sector professionals to pursue competitive and enterprising modes of conduct, and the operational processes that condition them, have persisted. This state of active commercial focus at the institutional level has resulted in part from contests over a diminishing resource base (Flynn, 1998) and from the direct appeals to health professionals for more ‘business-like’ practices.

The purpose of this chapter is to examine the implication of NPM-styled reforms on professional culture and practices in public sector health services using the Australian allied health professions as the case study. The particular focus is on the repertoire of conducts that professionals mobilise in the face of challenges posed by NPM-styled reforms. The chapter addresses this aim by first discussing the impact of NPM-styled reforms on the professions generally before turning the focus to public sector health professions and entrepreneurship specifically. The research context and methodology are then introduced, including an explanation of the research subjects – allied health professions – before the findings are examined.

Health sector reform, the professions and enterprise discourse

A general theme in the NPM literature is the challenge that NPM approaches such as marketisation and managerialism mount to traditional professional practices and interests.