Why do public professionals resist policy changes? In this book Lars Tummers argues that we can use the concept of policy alienation – a “general cognitive state of psychological disconnection from a policy” that professionals can feel – to understand why. Case studies cover the implementation of new health policies in the Netherlands and discuss the factors that influence whether policies are resisted. Julián López-Murcia finds the policy alienation concept to be a significant contribution to debates regarding the organization of public services.
Policy Alienation and the Power of Professionals Confronting New Policies. Lars Tummers. Edward Elgar. April 2013.
“Professors, We Need You!” was the title used by Nicholas Kristof in one of his columns in The New York Times about the marginalisation of academics from public debates. For Kristof, doctoral programmes “have fostered a culture that glorifies arcane unintelligibility while disdaining impact and audience”. By contrast, this book on why public professionals resist policy changes is very explicit (maybe too explicit) in its aim to catch the attention of practitioners. Written by Lars Tummers, assistant professor in Public Management and Public Policy at Erasmus University Rotterdam, the book’s strategy includes a cover with a red boxing glove breaking a kind of labyrinth, reading guidelines for practitioners in the introduction, and particular advice for them in the conclusions. However, academic readers should not be deterred by this approach; this work not only contributes to tackling the intellectual hegemony of public choice theories regarding organisational change in the public sector but can also be used in the debates on the application of business-like values in higher education.
Tummers explains that the context of his research is characterised by what he sees as the increasing impact of New Public Management ideas around the world. Public professionals are supposed to enjoy significant levels of discretion at work; however, since the 1980s the use of the private sector’s management approaches and techniques by governments has seriously affected their autonomy, as Tummers explains. Equity and autonomy have been dominated by efficiency and client choice. One physician cited in the book writes, “tensions arise when physicians want to work accurately, and managers tell them that they have to do fifteen re-examinations a week”. Regarding schoolteachers, Ball (also cited in the book) states that the intense use of performance indicators not simply changes what they do, but also who they are.
On the other hand, the organisational change literature is still dominated by public choice theories. At the core of these theories, there is the assumption that civil servants are just seeking to protect their own interests, rather than the public interest. In his classic bookBureaucracy and Representative Government, Niskanen states that a bureaucrat only seeks to maximise her budget and influence. Moreover, the hegemony of these ideas has influenced not only the shape and structure of an important part of the policies implemented around the world, but it has also atrophied the body of research that opposes them, as Piore explains.
In such an environment, Tummers’ book focuses on why public professionals who interact directly with clients on a regular basis resist policy changes. The main cause, for the author, is what he calls “policy alienation”: a “general cognitive state of psychological disconnection from a policy”. This has two dimensions: powerlessness, defined as a “person’s lack of control over events in their life”; and meaninglessness, related to the “inability to comprehend the relationship of one’s contribution to a larger purpose”. In turn, powerlessness has three sub-dimensions: strategic, tactical and operational. The strategic sub-dimension is related to the professionals’ perceived influence on the content of the policy; the tactical is about the professionals’ perceived influence on the way the policy is operationalized within their organisation; while the operational is related to their perceived degree of discretion during actual policy implementation. The meaninglessness dimension also has two sub-dimensions: societal and client meaninglessness. The former concerns the professionals’ perceptions of the “added value of the policy to socially relevant goals”, and the latter is related to “the perceptions of the professionals concerning the added value of their own implementation of the policy for their own clients” (e.g. students, patients, etc.).
Using this model, Tummers analyses two cases of the implementation of new health policies in the Netherlands. The model was tested in a survey of 780 midwives implementing a policy focused on using ultrasounds to check the health of the unborn child. Another test was conducted using a survey of 1319 health care professionals implementing Diagnosis Related Groups. In both cases, policy alienation had strong influence in resistance to change (caused by factors associated with NPM, the degree of professionalism and professional orientation, and other factors). The strategic and tactical powerlessness dimensions had the lowest influence in both cases. In the case of the midwives, operational powerlessness, and societal and client meaninglessness were especially influential. But the most important factor in explaining willingness of midwives to implement policies was their perception about the added value of the policy to mothers and children, while health care professionals implementing DRG were more unwilling if they did not perceive the benefits of the policy for society. Tummers also examined whether the dimensions of policy alienation were still influential on resistance to change when other explaining variables (e.g. personality characteristics) were included. Again, the two most important factors were societal and client meaninglessness.
In the organizational change literature, some authors are more focused on searching for better conditions to develop episodic changes (led by policy makers or managers, see Kotter and Schlesinger; Moore) and others emphasise the need to improve continuous organizational change (led by public servants or workers, see Campbell; Lipsky).” In general, this book seeks to talk directly to public managers rather than to public professionals.
However, there are different ways to read this book depending on what the reader stands for. From my own perspective, the book’s most interesting academic contribution is that it enlarges the still incipient evidence against public choice assumptions. Using a solid research model with large-scale surveys, Tummers finds that the main cause of resistance to new policies by midwives and health care professionals was a psychological disconnection with the policy. This disconnection was not mainly associated with their own interests, influence or budget, but rather with their perception about what was better for their patients or their society. Tummers’ “policy alienation” concept is not only a significant academic contribution, but can also be used as a powerful instrument in a number of important debates regarding the organization of public services.
Julián Daniel López-Murcia is a research fellow at the Facultad de Ciencias Jurídicas, Pontificia Universidad Javeriana (Colombia). His key research interests are in the areas of utilities regulation, public-sector reform, and social rights. He holds an MSc in Regulation from the London School of Economics, and is currently a DPhil (PhD) candidate in Politics at Harris Manchester College, University of Oxford. Julián also tweets @JulianLopezM. Read more reviews by Julián.
Editor's note: This review was originally published in The London School of Economics Review of Books, and has been reposted with permission. It is available under Creative Commons and the original page can be found here. Like what you read? Subscribe to the SFRB's free daily email notice so you can be up-to-date on our latest articles. Scroll up this page to the sign-up field on your right.