Bringing anglo-governmentality into public management scholarship: The case of evidence-based medicine in UK health care

Abstract

The field of public administration and management exhibits a limited number of favored themes and theories, including influential New Public Management and Network Governance accounts of contemporary government. Can additional social science-based perspectives enrich its theoretical base, in particular, analyzing a long-term shift to indirect governance evident in the field? We suggest that a variant of Foucauldian analysis is helpful, namely "Anglo- governmentality." Having reviewed the literatures, we apply this Anglo-governmentality perspective to two case studies of "post hierarchical" UK health care settings: first, the National Institute for Health and Clinical Excellence (NICE), responsible for producing evidence-based guidelines nationally, and the second, a local network tasked with enacting such guidelines into practice. Compared with the Network Governance narrative, the Anglo-governmentality perspective distinctively highlights (a) a power-knowledge nexus giving strong technical advice; (b) pervasive grey sciences, which produce such evidence-based guidelines; (c) the "subjectification" of local governing agents, herein analyzed using Foucauldian concepts of the "technology of the self" and "pastoral power"; and (d) the continuing indirect steering role of the advanced neoliberal health care State. We add to Anglo-governmentality literature by highlighting hybrid "grey sciences," which include clinical elements and energetic self-directed clinical-managerial hybrids as local governing agents. These findings suggest that the state and segments of the medical profession form a loose ensemble and that professionals retain scope for colonizing these new arenas. We finally suggest that Anglo-governmentality theory warrants further exploration within knowledge-based public organizations. © 2013 © The Author 2013. Published by Oxford University Press on behalf of the Journal of Public Administration Research and Theory, Inc. All rights reserved.