Abstract
Health-care work is increasingly practiced within governance frameworks. These ‘softer’ forms of new public management typically seek to shape working practices and cultures around key organising principles such as risk, knowledge and performance. Yet the implementation of these control mechanisms through standards, monitoring and auditing is problematic, with limited evidence of success. This article highlights the important contribution that understandings of the lifeworld can offer in analysing resistance to governance frameworks, through a positive critique of Habermas. Drawing on qualitative data from interviews with health-care professionals, evidence of both opposition and acquiescence to governance frameworks suggests a state of reflexivity as much as ‘colonisation’. The components of the lifeworld – culture, society and personality – thus represent important bastions of resistance, regulating system intervention through standards of perceived truth, legitimacy and authenticity. Habermas's concerns about the continuing sustainability of this struggle against instrumentalism are considered.
Similar content being viewed by others
References
Abbott, A. (1988) The System of Professions: An Essay on the Division of Expert Labor. Chicago, IL: University of Chicago Press.
Alaszewski, A. (2002) The impact of the Bristol Royal Infirmary disaster and inquiry on public services in the UK. Journal of Interprofessional Care 16 (4): 371–378.
Alvesson, M. and Deetz, S. (1999) Critical theory and post-modernism: Approaches to organizational studies. In: S. Clegg and C. Hardy (eds.) Studying Organization: Theory and Method. London: Sage, pp. 185–211.
Arksey, H. and Knight, P. (1999) Interviewing for Social Scientists. London: Sage.
Berger, P. and Luckmann, T. (1966) The Social Construction of Reality. London: Penguin.
Bevan, G. and Hood, C. (2006) Have targets improved performance in the English NHS? BMJ 332: 419–422.
Black, J. (2008) Constructing and contesting legitimacy and accountability in polycentric regulatory regimes. Regulation and Governance 2: 137–164.
BMA . (2007) Emergency medicine: Report of national survey of emergency medicine, http://www.bma.org.uk/ap.nsf/Content/Emergencymedsurvey07findings, accessed 6 December 2007.
Bolton, S. (2004) A simple matter of control? NHS hospital nurses and new management. Journal of Management Studies 41 (2): 317–333.
Bolton, S. and Houlihan, M. (2009) Beyond the control-resistance debate: A fresh look at experiences of work in the new economy. Qualitative Research in Accounting and Management 6 (1): 5–13.
Brown, P. (2008) Legitimacy chasing its own tale: Theorising clinical governance through a critique of instrumental reason. Social Theory and Health 6 (2): 184–199.
Burrell, G. (1994) Modernism, postmodernism and organizational analysis 4: The contribution of Jürgen Habermas. Organization Studies 15 (1): 1–19.
Department of Health. (1997) The New NHS, Modern, Dependable. London: HMSO.
Department of Health. (1998) A First Class Service – Quality in the New NHS. London: Department of Health.
Dingwall, R. and Strangleman, T. (2005) Organizational cultures in public services. In: E. Ferlie, L. Lynn and C. Pollitt (eds.) The Oxford Handbook of Public Sector Management. Oxford, UK: Oxford University Press, pp. 468–490.
Douglas, M. (1992) Risk and Blame: Essays in Cultural Theory. London: Routledge.
Fairtlough, G. (1991) Habermas’ concept of Lifeworld. Systemic Practice and Action Research 4 (6): 547–563.
Ferlie, E., Ashburner, L., Fitzgerald, L. and Pettigrew, A. (1996) The New Public Management in Action. Oxford, UK: Oxford University Press.
Ferlie, E. and Steane, P. (2002) Changing developments in NPM. International Journal of Public Administration 25 (12): 1459–1469.
Flynn, R. (2002) Clinical governance and governmentality. Health, Risk and Society 4 (2): 155–170.
Habermas, J. (1976) Legitimation Crisis. Boston, MA: Beacon.
Habermas, J. (1987) Theory of Communicative Action. Volume Two: Lifeworld and System: A Critique of Functionalist Reason. Cambridge, MA: Polity.
Halford, S. and Leonard, P. (2006) Place space and time: Contextualising workplace subjectivities. Organization Studies 27 (5): 657–676.
Harrison, S. (2002) New labour, modernisation and the medical labour process. Journal of Social Policy 31: 465–485.
Hood, C. (2002) The risk game and the blame game. Government and Opposition 37 (1): 15–37.
Hood, C. and Peters, G. (2004) The middle aging of new public management: Into the age of paradox? Journal of Public Administration Research and Theory 14 (3): 267–282.
Klein, R. (2006) The New Politics of the NHS: From Creation to Reinvention. Oxford, UK: Radcliffe.
Lam, A. (2000) Tacit knowledge, organizational learning and societal institutions – An integrated framework. Organization Studies 21: 487–513.
Law, A. and Mooney, G. (2007) Beyond new labour: Work and resistance in the ‘new’ welfare state. In: G. Mooney and A. Law (eds.) New Labour/Hard Labour? Restructuring and Resistance Inside the Welfare Industry. Bristol, UK: Policy Press, pp. 263–286.
Luhmann, N. (1993) Risk: A Sociological Theory. New York: Aldine de Gruyter.
Lukács, G. (1971) History and Class Consciousness: Studies in Marxist Dialectics. London: Merlin.
Mason, J. (2002) Qualitative Researching. London: Sage.
McDonough, P. (2006) Habitus and the practice of public service. Work Employment and Society 20 (4): 629–647.
McLoughlin, I., Badham, R. and Palmer, G. (2005) Cultures of ambiguity: Design, emergence and ambivalence in the introduction of normative control. Work Employment and Society 19 (1): 67–89.
Nettleton, S., Burrows, R. and Watt, I. (2008) Regulating medical bodies? The consequences of the ‘modernisation’ of the NHS and the disembodiment of clinical knowledge. Sociology of Health and Illness 30 (3): 333–348.
Neuman, W. (2000) Social Research Methods: Qualitative and Quantitative Approaches. Boston, MA: Allyn and Bacon.
O'Neill, J. (1995) The Poverty of Post-Modernity. London: Routledge.
Power, M. (1990) Modernism, post-modernism and organisation. In: J. Hassard and D. Pym (eds.) The Theory and Philosophy of Organisations: Critical Issues and Key Perspectives. London: Routledge, pp. 109–124.
Power, M. (2000) The audit society – Second thoughts. International Journal of Auditing 4: 111–119.
Scally, G. and Donaldson, L. (1998) Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal 317: 61–65.
Scambler, G. and Britten, N. (2001) System, lifeworld and doctor-patient interaction. In: G. Scambler (ed.) Habermas, Critical Theory and Health. London: Routledge, pp. 45–67.
Scambler, G. and Kelleher, D. (2006) New social and health movements: Issues of representation and change. Critical Public Health 16 (3): 219–231.
Schön, D. (1983) The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books.
Schutz, A. (1972) The Phenomenology of the Social World. London: Heinemann.
Sennett, R. (2008) The Craftsman. London: Allen Lane.
Sheaff, R. and Pilgrim, D. (2006) Can learning organizations survive in the newer NHS? Implementation Science 1 (27), doi:10.1186/1748-5908-1-27.
Smith, J., Walshe, K. and Hunter, D. (2001) The ‘redisorganisation’ of the NHS. British Medical Journal 323: 1262–1263.
Strathern, M. (2000) The tyranny of transparency. British Educational Research Journal 26: 309–321.
Thomas, M. (2002) The evidence base for clinical governance. Journal of Evaluation in Clinical Practice 8 (2): 251–254.
Vann, J. (2004) Resistance to change and the language of public organizations: A look at ‘clashing grammars’ in Large-Scale Information Technology Projects. Public Organization Review 4 (1): 47–73.
Vaughan, D. (2005) Organizational rituals of risk and error. In: B. Hutter and M. Power (eds.) Organizational Encounters with Risk. Cambridge, UK: Cambridge University Press, pp. 33–66.
Waring, J. (2005) Beyond blame: The cultural barriers to medical incident reporting. Social Science and Medicine 60 (9): 1927–1935.
Waring, J. (2007) Adaptive regulation or governmentality: Patient safety and the changing regulation of medicine. Sociology of Health and Illness 29 (2): 163–179.
Acknowledgements
The author is grateful to Tim Strangleman, Sarah Vickerstaff and the anonymous reviewers for their constructive comments on earlier drafts.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Brown, P. The concept of lifeworld as a tool in analysing health-care work: Exploring professionals’ resistance to governance through subjectivity, norms and experiential knowledge. Soc Theory Health 9, 147–165 (2011). https://doi.org/10.1057/sth.2011.3
Published:
Issue Date:
DOI: https://doi.org/10.1057/sth.2011.3