Drivers and enablers of change in healthcare: How professions matter.

Governments around the world are under pressure to make services more cost-effective and at the same time improve public safety and the quality of care. Policy makers are pursuing strategies of marketisation and managerialism coupled with consumer involvement. These policies attempt tighter control over care providers by taking away their power. This paper argues for a more dynamic approach regarding the role of the professional in changing healthcare systems. With a focus on the medical profession as the dominant player in healthcare, modernisation processes in the German health system serve as a case study to explore how professional groups matter in the changing governance of healthcare. The case study also highlights the overlapping interests of professionals and institutions. The approach described in this paper moves beyond performance and managerial regimes and brings into view a broader range of driving forces and 'enabling players'. The paper argues that a greater variety of professional groups may create more sustainable 'motion' in power structures than the new managerialist regimes. [ABSTRACT FROM AUTHOR]