Enterprise discourse, professional identity and the organizational control of hospital clinicians

Recent reform of the healthcare sector in New Zealand involved the corporatization of public hospitals, and the contractualization of social relations between and within institutions. Various attempts were made to incorporate hospital clinicians within some system of organizational control in order to make them accountable for the resources consumed as a consequence of their treatment decisions. This paper considers how the general intention of government to control, curtail or influence the professional autonomy of hospital clinicians was played out in the context of a single New Zealand hospital. It considers the possibility that power effects of discourses associated with such neo-liberal programmes of reform could influence the subjectivity of hospital clinicians, aligning their clinical behaviour with the broader goals of the governmental programme. It explores how individuals manoeuvre in relation to these discourses of management and enterprise, whether in acceptance, resistance or compromise. The resulting outcomes are complex and varied, as individuals negotiate dominant discourses in the construction of identity and self.