Mapping The Governance Of Care and Professional Development: A European Comparative Study

This article investigates the care sector through the lens of the sociology of professions. We introduce a dynamic approach that systematically links changes in the nursing professions and society at large with new modes of governance in healthcare. The aim is to explore institutional conditions that contribute to the development of an integrated professionalism and efficient health human resource management in the care sector. A novel contribution is the cross-sector and profession-centred approach that connects professional developments in nursing in hospital, primary and long-term care with governance arrangements. A comparative case study design is applied that focuses on western European countries using England, Finland, and Germany for an in-depth analysis. In terms of methods, we draw on public statistics, document analysis and other secondary sources. Three emergent patterns can be identified: (1) ‘constrained professional development’ was observed in the German corporatist and federalist/fragmented system with overall high density and quality of healthcare services and concentration in the middle-range professions with a lack of upward institutional pathways; (2) ‘elitist professional development’ was found in the more centralised governance in England and characterised by a growing expansion in the high-status segments, but overall weak development in the middle-level and lower segments; and (3) ‘integrated professional development’ emerges in the context of decentralist and universal governance arrangements in Finland, that foster expansions in both high-status segments and low and unqualified segments of nursing. In summary, the findings highlight connections between professional development and governance. This suggest that interventions on the (meso/micro) level of professions, in order to achieve transformative potential, must be connected and backed-up by (macro-level) health and social policy interventions.