Quality improvement for all seasons: Administrative doctrines after New Public Management

• DOI: http://doi.org/10.1111/faam.12226
• Published date: 01 February 2020
• Author: Dane Pflueger
• Date: 01 February 2020

Received: 24 June 2018 Revised: 23 May2019 Accepted: 25 July 2019

DOI: 10.1111/faam.12226

REVIEW ARTICLE

Quality improvement for all seasons:

Administrative doctrines after New Public

Management

Dane Pflueger

Department of Accounting and Management

Control, HEC Paris,Jouy-en-Josas, France

Correspondence

DanePflueger, Department of Accounting and

ManagementControl, HEC Paris, 1 Rue de la

Libération,78350 Jouy-en-Josas, France.

Email:pflueger@hec.fr

Abstract

This paper systematically analyzes the discourse of quality in pub-

lic policies and reforms of the U.K. National Health Service (NHS)

between 1983 and 2013. It identifies a subtle and cumulative

but highly significant movement in which “quality” is transformed

from a vague and largely undefined promise related to the pursuit

and extension of New Public Management (NPM) doctrines into a

set of catch-all and seemingly apolitical norms for contemplating

and undertaking reform. This finding contributes to debates about

whether and to what extent NPM is “dead,” “comatose,”“very much

alive,” and so forth, showing that quality simultaneously displaces

NPM as the source of catch-all administrative norms, and also rein-

vigorates and embeds them within and as part of medical profes-

sionalism though with new points of emphasis and twists. Pointing to

generalizablemechanisms underlying this transformation, this paper

highlights a growing international quality improvement movement

as offering a new and consequential set of reform doctrines, to bor-

row Hood’s terms, “for all seasons.”

KEYWORDS

discourse, healthcare, New Public Management, professionalism,

quality

1INTRODUCTION

“Theword has no meaning. Use it as much as possible.” Attributed originally to postmodernism, Wilkinson and Willmott

(1994, p. 1) write that this adage might also be extendedto quality. Indeed, they, likeothers (e.g. Pfeffer & Coote, 1991;

Pollitt & Bouckært, 1995) highlight that the meaning and significance of quality has changed significantly throughout

place and time, and with it the fortunes of various and often far-reaching dreams and schemes. This paper seeks to

explore and expand upon this proposition through a sustained investigation of the changing discourse of quality in

public policies and reforms of the U.K. National Health Service (NHS) between 1983 and 2013.

90 c

2019 John Wiley & Sons Ltd wileyonlinelibrary.com/journal/faam FinancialAcc & Man. 2020;36:90–107.

PFLUEGER 91

This investigation illuminates a subtle but significant series of transformations in the discourse of quality,particu-

larly in relation to administrative doctrines described as New Public Management (NPM; Hood, 1991, 1995). It shows

that quality enters healthcare discourse alongside marketsand management—the “marriage of opposites” constituting

the intellectual foundations of NPM (Hood, 1991, p. 5)—as an optimistic, vague, and undefined promise. However,as

a market and vast managerial infrastructure are constructed, quality becomes a problem in and of itself,leading to a

further extension of the ideas and ideals of NPM. The pursuit of quality,alongside the emergence of an international

quality improvement movement,however, transforms quality once again; from a promise or problem, quality becomes

a set of seemingly apolitical and all-purpose doctrines for contemplating and undertaking reform.

These movementsilluminate empirically a new and important chapter in the social and political significance of qual-

ity in healthcare and in public policy.In this chapter, quality has become more than either a victim of NPM (e.g., Chris-

tensen & Lægreid, 2007; Walshe,1991) or a rhetoric legitimizing its pursuit (e.g., Arnaboldi, Lapsley, & Steccolini, 2015;

Bejerot& Hasselbladh, 2011; Ferlie et al., 2016; Kirkpatrick & Lucio, 1995; Pollitt, 1993; Pollitt & Bouckært, 1995; Schi-

avo, 2000; VanDe Bovenkamp et al., 2014). Rather, quality is shown increasingly to be a series of seemingly apolitical

and catch-all doctrines to rival and even replace those provided by NPM—a quality improvement, to borrow Hood’s

(1991) terms “for all seasons.” Moreover,although documented only in the context of the UK NHS, this research points

to the possibility of a generalizable set of mechanisms (including the lack of a theory of quality within economics) by

which the pursuit of NPM leads to the emergence of quality and quality improvement as a foundation for undertaking

reform.

These findings contribute to ongoing debates about the future of NPM and the source and substance of admin-

istrative doctrines and norms (Groot & Budding, 2008). To debates about whether and to what extent NPM is “dead,”

“passé,”“comatose,” “very much alive,” and so forth (Dunleavy,Margetts, Bastow, & Tinkler, 2006; Hood & Peters, 2004;

Jones, 2001; Lapsley, 2008; Levy, 2010; Osborne, 2006; Pollitt, 2007; Savoie, 1995), this paper shows that NPM has

been simultaneously substituted for and reinvented within the administrative principles provided byan international

quality improvement movement. Even as the doctrines and institutions of quality and quality improvement displace

NPM as the foundation for reform, in other words, they nevertheless reinvigorate many its foundational principles

with new points of emphasis or rhetorical twists (Lapsley, 2008; Pollitt, 2007). Quality does so, this paper highlights,

through medical professionalism. Indeed, this movement entails both an acceptance and evenembrace of professional

autonomy and control over quality and also a transformation of the definition of quality to incorporate many of the

central doctrines of NPM. Many authors propose that the continuation of NPM will necessarily entail “the collision

of values between general management and professional cadres” (Lapsley,2008, p. 80; see also Brandsen & Honingh,

2013; Waring & Currie, 2009). This paper shows, by contrast, that it is “through” the professional embraceof quality

that NPM and managerialism in particular live on (Currie, Lockett,Finn, Martin, & Waring, 2012; Røiseland, Pierre, &

Gustavsen, 2015).

Thispaper proceeds as follows. Section 2 describes the distinctive approach to discourse analysis and set of method-

ological tools that are employed to undertake a systematic analysis of quality without over-specificationof what it is

or might become. Section 3 presents the empirical findings of this analysis. It describes three chapters in the history

of the discourse of quality,each identified as a period of time in which it was discussed in a distinctive and consistent,

though not necessarily exclusive,way. Sections 4 and 5 discuss and develop their theoretical significance and also limi-

tations, pointing to the possibility of,and necessity to further explore, a more generalizable trajectory in the movement

of administrative norms beyondNPM.

2RESEARCH APPROACH

This research mobilizes discourse analysis in order to investigate the changing role and significance of both quality

and NPM in public policies and debates. Discourse analysis, as Alvesson and Karreman (2000) highlight, can imply a