Programme de la conférence

The academic debate on roles of public professionals such as medical doctors, teachers and police officers in tackling societal issues has generic overtones. It tends to draw on (empirical) work in large countries and identifies the bigger issues and bigger patterns in service delivery. In this paper, we provide a more grounded perspective on professional work, in distinctive contexts, specifically those of small islands. We do so to get a grip on the reality and variety of how public professionals respond to sudden shifts, surprises and sentiments, or societal turbulence, in service situations that are characterized by vulnerable operational capacities and challenging authorizing environments. Small island contexts serve as critical cases: their characteristics, including geographic isolation, limited resources and closed social networks, affect professional acts and behaviors, whilst these acts and behaviors are important to tackle turbulent challenges related to safety, security, public health and migration. We analyze professional navigation tactics, which are adaptive acts that public professionals employ to render services in turbulent times. Empirically, we focus on police officers and social workers in Aruba, a constituent island country in the Dutch Kingdom, located in the Southern Caribbean Sea. Our findings shed light on grounded professional acts and highlight how professional navigation does not occur in isolation in small island contexts, within multi-level or layered governance arrangements. Instead, ‘networked navigation’ emerges in such landscapes. We conclude that the conditions for dealing with turbulence are highly turbulent themselves, and that vital connections between professionals and their surroundings, including clients, colleagues and institutions, are pivotal. At the end, we discuss findings and sketch academic and practical implications.

Bernando Zacka’s book When the State Meets the Street (2017) develops a theory of street-level bureaucrats’ practice that emphasizes the limits of bureaucratic logics and need for individual moral reasoning. Hard and fast rules run out when practitioners reason about adequate solutions to their challenges. But is there nevertheless a public role that delivers standards of responsible reasoning beyond bureaucratic rules? This article claims that the kinds of cases Zacka draws on can and should be reinterpreted with a perspective of professionalism. This perspective sees street-level reasoning as guided by a mission-based role that integrates a broad range of concerns. By systematically investigating five key aspects of frontline practice—knowledge, discretion, principles, deliberation, and responsibility—the article explains why a professional theory is relevant for both analytical and normative purposes. Although the organizational context of street-level practice is multidimensional and unpredictable, a perspective of professionalism clarifies the potential for making sense of experiences and judgments as a form of role-based reasoning that undergirds shared and justifiable practice.

Aging populations worldwide have led to increasing political interest in the organization and financing of elder care. One of the most prominent policy trends in this area has been various forms of marketization, in which services remain publicly funded and regulated but delivered by a mix of public and private providers that compete for public contracts and financial reimbursement. As a result, a substantial body of literature on the marketization of elder care services has emerged, describing different models for structuring provider competition, and public-private contracting. However, since each country has tended to develop its own policy solutions in this regard —creating forms of quasi-markets for elder care services that vary in their specific organization—cross-national comparisons of their functioning and effects have proven challenging.

Sweden was among the early adopters of marketization policies in elder care in the early 1990s, introducing competitive tendering and allowing for-profit organizations to compete for service contracts. However, criticism of this model grew, particularly as it became evident that the market was increasingly dominated by large corporations, while non-profit organizations and smaller firms found it hard to compete. In response, a new marketization model based on accreditation and consumer choice was introduced in 2009. In practice, these two models -competitive tendering and vouchers for users- have come to operate in parallel, as Swedish municipalities are free to choose which system to use. The voucher model has since become wide-spread, particularly in the area of home-based care services.The Swedish case, therefore, provides a valuable opportunity to compare two distinct approaches to marketization within the same sector.

The aim of this paper is to contrast two different models of marketization employed in Swedish home-based elder care and evaluate their effects in terms of market structure, quality and cost developments, accountability mechanisms, and user influence. The empirical contribution of the study is a detailed analytical description of how two types of quasi-market models have been applied within the Scandinavian context of publicly funded elder care. The theoretical contribution lies in the structured comparison of two forms of privatization within the same welfare area, which makes it possible to identify the different dynamics within them which structure the private /public interaction.