Keynote speak by Professor Kerstin Sahlin at OBHC14

Keynote speak at OBHC14 by Professor Kerstin Sahlin

Today Kerstin Sahlin Professor of Public Management at the Department of Business Studies at Uppsala University gave her keynote speak at #OBHC14. With the title ‘Institutional Ambiguity - Transformations, transpositions and translations’, Sahlin elaborated on the field of transformations of health care organization and governance.

Through what she argued as being a Scandinavian version of institutional theory she explained how the importance of organizational practices and the use of language in local organizational contexts, influences what can be grasped as institutional complexity.

Sahlin explained how reforms came to Scandinavia in early 90’s and ever since has influenced everything form professional dominants to more political control. It hasn’t always been linked to the traditional forms, and despite reforms often take on much clarity we often find results of more institutional complexity. The story of New Public Management (NPM) is therefore also known as extremely broad and loose defined. And, as Sahlin stressed, what is interesting is how NPM is based on OECD data, data that afterwards is picked up by OECD again and then taken into reforms. In this process research play an important role.

Sahlin introduced the more or less 100 participants to her conception of transposed individual techniques. She explained how following individual ideas and models, and the circulation of the same, opens new inceptions. The circulation is undertaken by actors as transnational networks, communities, the media, and research. It results in amongst others the advance of supply. Like that, we see international organizations spreading ideas while in the same time help put ideas to politics. As so we cannot just remake a concept, it is not an open process but a socially restricted one. Editing modes for the field of health care organization therefore also call for a need to include more demand driven features, and the acknowledgement and awareness of the fact, that professional ideas always are present in healthcare, and always can pop up when least expected.

As an always important point, Sahlin took up for discussion the issue of distrust. She introduced it as a concept which we must keep in mind to understand organization, and in general to capitalize the characteristics of our society. Distrust, she explained, causes the understanding, that you shouldn’t trust anyone so you have to control them. Also through empirical investigations we see this in school systems, in health systems and everywhere else.

So why look into the understanding of institutional complexity? Sahlin argues that we stand in front of a institutional shift towards more sticky organisations, organisations that remains even when new reforms come and challenge the organisation. If we find today’s organization as multi-institutionalism, how can we then analyse it? It is difficult to understand as soon as we leave the personal level. The fact is that it is extremely difficult in modern organizations. We see more competing institutions and the first task when facing problems in society is always: we need to form an organization.

Complexity and ambiguity makes in the same time more and less space in organizations argues Sahlin, and afterwards she raises her normative concluding thought:  Are the current and recent transformations irreversible?

Download the presentation with much more details here:sahlin_copenhagen_obhc14.pdf