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The paper seeks to explore how universal welfare arrangements based on needs testing may change and assume different institutional forms. Drawing attention to Norwegian home care, the paper explores how established interpretations of needs and associated notions of equity among needs have been challenged by shifting modes of governance.

The study draws on policy documents, interviews and observation from three different case studies undertaken at different points in time representing different eras of governance. From this perspective, the study examines the role of professionals taking part in needs assessment.

The studies indicate that routines for needs assessment in home care are contingent on shifting logics of governance. A shift in policy of needs testing may be described as a shift from a personal situated approach encouraging “creative justice” towards a detached and impartial approach better equipped to ensure “proportional justice”. The latter approach has become more dominant as heightened attention has been paid to citizens' rights. It is, however, questionable to what extent it will improve the preconditions for treating citizens with equal concern and respect.

The case study approach underlying the study is incapable of providing generalised conclusions about the development in all Norwegian municipalities.

Universalism is often talked about as a stable feature of the Nordic welfare system. Drawing attention to the underlying and elusive notions of needs, the study makes explicit some unstable aspects of universalism.

This paper seeks to explore various types of quasi‐market governance in domiciliary elderly care with an interest in both the institutional variety of these governance arrangements and their assumable consequences, against the twofold background of the EU care policy agenda and the Nordic experience.

Based on evidence from four Western European countries, the paper examines how recent reforms have changed the provision of domiciliary care, including the shape of vertical and horizontal governance arrangements. Moreover, summarizing results of previous research and drawing on theoretical reflections rooted both in economics and sociology, the paper discusses the wider impact of these reforms.

The analysis points to country‐specific limitations of the quasi‐market approach regarding issues such as the work‐life balance of carers and the access to adequate services.

By combining different scientific approaches and exploring several institutional contexts, the paper offers new insights both in problems of quasi‐market governance and their cultural colouring.

This paper seeks to draw attention to the historical and institutional context of Norwegian home care and to the way in which care agencies have been pressed to reconcile competing demands caused by conflicting policy aims and administrative values. The paper also aims to explore how ideas of contractual management have been interpreted and put into practice in this field of tension.

The study draws on policy documents, historical and social research reports, and personal interviews with managers and home care staff from three different case studies representing different eras of management ideas. From this micro perspective the study examines professional work as the intersection between new public management and the health care state.

The findings demonstrate how contractual management is highly influenced by competing drivers of change. Reforms, stressing cost reduction, do not act as a unidirectional reform programme. Instead, they are infused with administrative arguments linked to previous reform ideas aiming to create legitimacy both from “above” and from “below”. The dynamic of change often has unintended consequences which in turn prompt further reform efforts.

The paper provides insights into the complexity of change following on from New Public Management (NPM). More specifically, change is characterised by tensions originating in competing normative drivers as well as the co‐existence of old and new forms of organising.

This paper sets out to explore health professionals' views and experiences regarding the work culture that exists in their hospital units, and further how patients influence these experiences.

The paper employs a qualitative approach involving individual interviews with 60 health professionals in Canada employed in what is conceptualised as “open” (emergency room and maternity care) and “closed” (intensive care, head and neck surgery) units.

The paper finds that the influence of the hospital unit outweighs the influence of professional boundaries but for some groups more than for others. Health professionals in more open units tend to be less satisfied with their work, have more difficult relations with patients, and experience tensions with co‐workers and management. Those in closed units tend to be more satisfied with their work, have relatively better relations with patients and co‐workers, and tend to have more cooperative relations with management. The different structural conditions of work in open and closed units are also clearly important.

The sample for the study was self‐selected from one hospital, which may limit the generalisability of some of the findings.

The insights garnered from the study may help professionals and managers to develop unit‐specific policies to create a more positive workplace culture.

There is a growing body of research on professional culture and oganisational culture that often does not clearly delineate how the two exist concurrently. The paper explicitly investigates this issue by examining work culture across various health professional groups and also across hospital units, and further how patients figure in these experiences.

The new “agenda of choice” in public services emphasises service users' needs and agency. The ideals of consumerism and user involvement have set new challenges for professionals. This paper aims to explore the effects of consumerism and user involvement at the level of day‐to‐day service delivery, looking at the encounters between professionals and service users.

The paper applies an ethnographic approach. Observation data were collected at two Finnish drug treatment institutions: a needle exchange and health counselling service, and a specialised maternity clinic for pregnant women. Data from each institution consist of seven to 12 months of participant observation notes, which were subsequently systematically coded and analysed comparing the two institutions.

The promotion of new ideals does not automatically result in the empowerment of service users or the erosion of professional power. The two institutions differ greatly: institutional context and gender shape the everyday realisation of the new ideals. In both institutions, however, professionals have adopted new practices and rethought their role. The cultivation of service users' choice and agency can become valuable professional capital, a new kind of “know how” that can also be used by the professionals to justify the importance of their work.

The paper provides a nuanced and contextualised insight into “how” the ideals of consumerism and user involvement are translated into everyday encounters between service providers and users.

Based on a case study of Norway, the purpose of this paper is twofold: to present recent trends in the development of the multi‐level governance of the care services for the elderly and people with mental illness towards what we call the cooperative turn; and to discuss the implications of this trend for universalism in service provision.

The paper is a study of documents and the recent research literature.

A shift towards the cooperative turn can be identified as a change from command‐and‐control instruments to soft regulation mechanisms. Regulations and economic means are increasingly complemented by informational means. Soft versions of the steering instruments are used to target the results and processes of local policies. Hard instruments do not disappear, and a mixture of all the abovementioned instruments governs the two policy fields. This has implications for universalism defined as territorial uniformity, accessibility and coverage as user groups are competing for scarce resources, professionals are gaining autonomy in decision making and users are involved in service provision.

The originality of this paper is the discussion of the development of multi‐level governance towards a cooperative turn and the implications of this for universalism in service provision.

This paper aims to attempt to explore current transformations in hospital governance by tracing the evolution of medical autonomy in the Belgian hospital sector in the second half of the twentieth century.

Using published secondary sources and archive data the paper developed a historical approach to the relationship between profession and organisation, asking qualitative questions of the characteristics of professional power and knowledge.

Since World War II, two important evolutions have occurred: first, the hospital evolved into an organisational entity that is described as a “professional bureaucracy”; second, at the sectoral level the hospital adopted a position that is characterised as a “divisional structure”. Both evolutions are linked by the processes of rationalisation and bureaucratisation. The findings do not support the thesis of an overall loss of autonomy but bring into focus the transformation of medical autonomy. New forms of professional power and knowledge are emerging with the processing (bureaucracy) and pre‐processing (rationalisation) of information on medical work as key elements.

The paper explores the evolution of the medical profession's autonomy in the second half of the twentieth century. It highlights reflexivity in the changing relationship between professions and organisations and how physicians are becoming “managers of expertise” who are important for both the hospital organisation and the state.

In 2016, New Zealand's Ministry of Health introduced the System Level Measures Framework which marked a departure from health targets and pay-for-performance incentives towards an approach based on local, collaborative approaches to health system improvement. This exemplifies an attempt to “overwrite” New Public Management (NPM) institutional practices with New Public Governance (NPG). We aim to trace this process of overwriting so as to understand how attempts to change institutional practices were facilitated, blocked, translated and edited.

We develop a conceptual framework for understanding and tracing institutional change towards NPG which emphasises the importance of discursive strategies in policy attempts to overwrite NPM with NPG. To analyse the New Zealand case, we drew on policy documents and interviews conducted in 2017–18 with twelve national key informants and fifty interviewees closely involved in local development and/or implementation of the SLMF.

Policy sponsors of collaborative approaches to health system improvement first attempted formal institutional change, arguing that adopting collaborative, quality improvement (NPG) approaches would supplement existing performance management (NPM) practices, to create a superior synthesis. When this formal approach was blocked, they adopted an approach based on informal persuasion of local organisational actors that quality improvement should supplant performance improvement. This approach was edited and translated by local actors, and the success of local implementation varied considerably.

This article offers a novel conceptualisation of public management institutional change, which can help explain why it is difficult to completely erase NPM practices in health.

This paper explores the rhetorical practices that are used in the introduction of a New Public Governance policy framework.