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The public sector is facing turbulent times and this also challenges the health professions who are expected to serve both the interests of the citizens and the cost-containment and austerity policies of governments. This article seeks to explore the changing role of the health professions. I introduce an approach on 'citizen professionals' as active players in the policy process and mediators between the state/policymakers and the citizens/patients. The aim is to highlight a transformative potential of professionalism and the connectedness with other sets of governance, like management. Empirical material from a German case study and a comparative European study serve to illustrate the arguments, drawing on policy analysis and secondary sources. The results bring the complexity of transformations and new emergent forms of professionalism into view that cannot be understood in traditional categories of conflict, exclusion and jurisdiction. Exploring the potential of the health professions to creatively respond to new challenges may reveal new opportunities for innovating healthcare policy beyond market and management. ; O setor público enfrenta tempos atribulados, constituindo isto igualmente um desafio para as profissões de saúde, de quem se espera que sirvam tanto os interesses dos cidadãos quanto as políticas de contenção de custos e de austeridade dos governos. Este artigo procura explorar o papel em mudança das profissões de saúde. Introduzo uma abordagem aos profissionais cidadãos como agentes ativos no processo de produção de políticas e como mediadores entre o Estado/produtores de políticas e os cidadãos/utentes. O objetivo é salientar um potencial de profissionalismo transformador e a interligação com outras instâncias de governança, como a gestão. Elaborado a partir da análise de produção de políticas e de fontes secundárias, os argumentos aduzidos são ilustrados com base em material empírico relativo a um estudo de caso alemão e a um estudo comparativo europeu. Os resultados fazem sobressair a ...

PurposeThe purpose of this paper is to present information on gender studies and feminist approaches in Germany and cross‐national perspectives on the challenges and chances of changing science systems.Design/methodology/approachThe paper is report on an international conference in Germany "Re‐visioning the future. Perspectives in gender studies". It discusses selected topics – race, class, gender and gender and professions – to highlight the need for and benefit of an international debate on gender studies.FindingsInternational and comparative research into gender expands the scope of gender studies both internationally and in one country.Originality/valueThe paper adds new geopolitical perspectives to a debate on gender studies and equal opportunities in academia that is shaped by Anglo American research.

What part does gender play in professionalism? How does gender translate into hierarchies in professions? This paper attempts to deal with these questions and to move towards an embedded approach that can account for paradoxes of gender and professions. It focuses on the notion of context and the hypothesis that gender is both stable and variable. Using empirical material from a multi‐method study of the German dental profession, three main issues are considered: the impact of different structuring modes and diverse actors on gender relations, the relation of gender difference and hierarchy, and differentiation between women as a group. Gender becomes manifest on the symbolic level as well as in structural arrangements. However, its impact on each of these levels varies. Most striking is the empirical proof that gender does not lead to the construction of hierarchies under all conditions. Female symbolism can also favour women. Professionalisation theories help to reconstruct these processes.

PurposeThis article aims to provide an overview on key trends in public sector policy and professional development and how they intersect with gender and diversity. It seeks to explore new configurations in the relationship between gender and the professions and to develop a matrix for the collection of articles presented in this volume.Design/methodology/approachThe authors link social policy and governance approaches to the study of professions, using the health professions and academics as case studies. Material from a number of studies carried out by the authors together with published secondary sources provide the basis of our analysis; this is followed by an introduction of the scope and structure of this thematic issue.FindingsThe findings underline the significance of public policy as key to better understand gender and diversity in professional groups. The outline of major trends in public sector professions brings into focus both the persistence of gender inequality and the emergence of new lines of gendered divisions in the professions.Practical implicationsThe research presented here highlights a need for new models of public sector management and professional development that are more sensitive to equality and diversity.Originality/valueThis article focuses on the "making" of inequality at the interface of public policy and professional action. It introduces a context sensitive approach that moves beyond equal opportunity policies and managerial accounts and highlights new directions in research and policy.

An authoritative, state-of-the-art collection that brings together key experts to provide an overview of the field. This new paperback edition includes 3 new chapters on human resources and health, end-of-life care and complementary and alternative medicine as well as thorough updates to the introduction and conclusion

Zusammenfassung
Der Gesundheitssektor steht im Zentrum wohlfahrtsstaatlicher Neuorientierungen. Dieser Beitrag erweitert die New Governance Debatte und rückt das Management der Arbeitskräfte als Innovationspotenzial der Gesundheitsversorgung in den Blick. Wir diskutieren ,skill-mix' Modelle und analysieren die Beschäftigungsstrukturen der Ärzteschaft und Pflege in einem 10-Jahres-Zeitraum. Methodisch greifen wir auf Konzepte des Arbeitsmarktmonitoring und öffentliche Datenquellen zurück. Die Ergebnisse weisen auf neue Ungleichheiten zwischen Pflegekräften und Ärzteschaft sowie privaten und öffentlichen Trägern hin, die Frauen und Männer unterschiedlich treffen. Weiter Zeigt sich die Regulierungsstruktur der Gesundheitsversorgung als wesentliche Blockade für ein innovatives Arbeitskräftemanagement.

PurposeRecent scholarship reveals the imagery of the professional as the "ideal citizen". The linkage between professionalism and citizenship is here approached from the perspective of democratic social justice in order to examine the persistence of gendered inequalities in the health care system. The paper aims to examine the ideas framing professionalism, both in sociological theory and historically, asking what gendered hierarchies mean in modern health care systems, and why and how they persist in the conditions of liberal democracy.Design/methodology/approachThe question is approached through both sociological literature and an analysis of historical framings of professionalism; the Finnish health care system is employed as a case. The reason for keeping the discussion close to a specific case is that different professional fields, countries and historic contexts differ from each other in democratically relevant respects.FindingsTraditional sociological theory assumed that professional privilege was based on essentially neutral expertise that benefits democracy only if protected from bureaucracy and politics. The recent theoretical turn reframes professional knowledge as socially defined, but the destabilisation of professional knowledge claims is not without problems. The paper refers to the persisting tensions between changing governance and gendered hierarchies in health care and argues for new approaches that suggest ways through which professional expertise can be democratically represented in politics.Originality/valueThe interdisciplinary framework uses political theory on social justice to examine how health care politics frame professionalism.

PurposeThis study seeks to examine the reconfiguration of professional groups in welfare service work through the lens of gendered inequalities in order to develop an inclusive research horizon that extends to the middle grade of care workers.Design/methodology/approachThe research design positions workforce change within a wider social and cultural context by highlighting occupational, educational and unionist orders from the viewpoint of Finnish practical nurses.FindingsA weakening anchorage in the welfare state and a differentiation of the patterns of recruitment, employment and industrial relations create segmentation, particular forms of exclusion, and identity instabilities. The article identifies the special vulnerability of the practical nurses institutionally embedded "in‐between" the upper and lower grades, the social and health sector, and the union traditions.Research limitations/implicationsThe national policy agenda on workforce change mainly follows the sectoral split and focuses on the established health professions. The unionist agenda of practical nurses in turn reflects interprofessional relationships and tribalism.Practical implicationsThis analysis of welfare service work provides insight into social and cultural transformations related to workforce change in a segmented and culturally diverse labour force and offers reflections on the changing nature of craft unionism.Originality/valueThis article argues for the added value of historicised, gender and culture sensitive analysis of the tensions between policy aims, educational, occupational and unionist orders for understanding reconfiguration through inequality‐producing processes.

This chapter compares transformations in professional self-regulation in the UK and Germany through the lens of governance. We introduce an expanded concept of governance that includes national configurations of state–;profession relationships and places selfregulation in the context of other forms of governance. The analysis shows that a general trend towards network governance plays out differently. In the UK, a plural structure of network governance and stakeholder arrangements is emerging in the context of stateled change. In Germany, partnership governance between sickness funds and medical associations shape the transformations and act as a barrier towards the entry of new players.