Re-connecting histories: modernity, managerialism and development
The Authors
Sadhvi Dar, University of Cambridge, Cambridge, UK
Abstract
Purpose – The aim of the paper is to connect the field of health management to other related academic discourses (critical management studies and critical development studies) that can contribute to a more interdisciplinary approach to understanding health organizations and management.
Design/methodology/approach – The paper's design is theoretical critique that blends post-structural, critical management and critical development approaches into a focused discussion of modernity and its relevance to contemporary health management issues.
Findings – Modernity proliferates through a variety of rhetorical tropes that go unnoticed or remain invisible. Through a brief analysis of historical definitions of management and development, the findings suggest that health management could also be critiqued as a cultural and social construction, enriching anthropological studies as well as informing practical critiques of health projects in the development sector.
Research limitations/implications – The conceptualisation of health-management as a cultural construct of modernity opens up the prospect for some rich empirical studies into what management practices support the scientific-rational claims on which it rests.
Practical implications – The critique informs a re-appraisal of health management practices that are often taken for granted and ritualistic parts of organizational life. Such a re-evaluation could lead to the implementation of more nuanced and appropriate health practices.
Originality/value – Connecting management and development discourses in this way has not been done before and its relevance to health management remains under-researched. This paper highlights the way these discourses can enrich the study of health organizations and create a truly interdisciplinary understanding of health.
Article Type:
Conceptual paper
Keyword(s):
Critical management; Health services sector; Management technique; Cross-functional integration.
Journal:
Journal of Health Organization and Management
Volume:
22
Number:
2
Year:
2008
pp:
93-110
Copyright ©
Emerald Group Publishing Limited
ISSN:
1477-7266
Introduction
This paper connects histories of management and development organizations through a critique of modernity and its consequences for each sector. Development organizations are diverse and multi-faceted, taking various forms, structures and activities. A significant role of development organizations remains the commitment to health issues in countries and communities that are living in some of the most adverse environments. For example, these organizations range from large monoliths such as, World Health Organization and UNDP; through to International Non-Governmental Organizations (NGOs) such as, Medecins Sans Frontieres and Family Health International to a host of smaller grassroots organizations dedicated to alleviating poverty through implementing community-based health projects. Health remains a critical aspect of development work, yet there has been little attention paid to how development organizations uncritically assimilate development-management ideas (Cooke, 2003a, b, 2004), leading to an unreflexive and, at times, inappropriate health development sector. As such, this paper makes a valuable contribution to connecting the study of health management to a critique of modernity by illuminating the relation between critical management and critical development studies. Both these fields I argue are legitimated through their appeal to modernist assumptions – assumptions that are absorbed uncritically and lead to tensions between what is promised by development projects and what can be delivered. There is, to this extent, a very practical implication to this theoretical critique, and it is one that will be elaborated on throughout the main discussion.
In particular, the focus of this paper is on management practices – the most mundane activities carried out in health organizations that often are a taken-for-granted part of organizational life. These practices could include auditing, monitoring and evaluation and reporting. Through following this analysis of management practices, the health academic can begin to engage with an interdisciplinary critique of health projects in the development sector whilst connecting seemingly neutral technologies, rituals and organizational pursuits to the social construction of these projects.
The prime aim of this paper then, is to introduce health academics to a managerial critique of development organizations, leading to what I hope, could be a critique of health through a development-management lens. What this paper hopes to illuminate is the way health management is also a social construction that relies on modernist assumptions to remain a legitimate idea within the development sector. In order to connect health academics to development-management ideas, it is imperative to first introduce the development context and the relevance of management practices.
Management practices and the development context
Development organizations exist in an ambiguous space, with little structural, accounting and organizational patterns in place (Ebrahim, 2003). Workers (and organizations) therefore, negotiate a sense of legitimacy through an ongoing re-definition of what development means (what it ought to be about) through a number of management practices.
Management practices and the rhetorical devices employed in them can shed light on the rise of managerialism as a cross-cultural strategy for economic progress during our modernist epoch. For example, relating this to health issues, health-management as a concept may exist as a single sectoral category, however, rendering health-management as a set of practices (i.e. including reporting) allows us to look beyond a normative definition of health organizations and actually explore how a variety of actions and a diversity of organizational forms make up a richness of approaches in the field. These diverse practices contribute to nuanced micro-definitions of health-development that form at the grassroots of every organization. Locating health in such a fractured and changing discursive field, allows us to question the very existence of any singular strategy for health-development and also to question whether a sole strategy can ever be singled out as applicable world-wide.
This paper outlines a critique of modernity by connecting two seemingly exclusive ideas – that of development and management. Firstly, the paper discusses development as a loose architecture of practices that are held together by rhetorical devices. For example, such rhetorical devices could include the employment of modernist ideals in health-development to legitimate ways of framing reality. Broadly, defining development is proposed as an impossible task and the section focuses instead on setting out an overview of how development has been represented in academic literature in more recent years. Modernist definitions of development are countered by “post-modernist” contestations.
Secondly, I discuss managerialism and how, as an ideology (rather than management which I define as a set of practices), it has its own particular logic and way of perceiving the world. This logic includes assumptions and myths about what an organization is and what it should be. For example, managerialism assumes that organizations do and should have a cohesive identity, a set of accountability structures, and strategies for success. In this way, I argue that the practice of management has been elevated to an ideology of control, progress and order that has been absorbed by mainstream development ideas for growth and stability that have huge implications for what health projects are legitimated or remain silenced.
Thirdly, and in conclusion, development and managerialism are discussed in terms of their interconnectedness. Since development as an idea is inherently fragmented and disputed, managerial ideas inserted into development practices allow development being accepted as a legitimate and homogeneous set of practices. I argue that it is this strategy of bringing the ideology of management (control, progress, order) closer to ways development projects play out in the field that has brought about a subtle conflation of two enormously powerful ideas relevant to the way many aspects of the world are run today.
Development: meanings and definitions
Development is a contested and changing idea, with definitions that are often contradictory yet concurrent, defying the existence of a single modernist/managerial approach to organizing activities in the field. But simply acknowledging diverse approaches to development is not enough, unpacking development to portray it as a collection of politically loaded concepts with their own logics and ways of conceptualizing poverty and human security allows a more complex story to unfold. This section outlines a brief historical exploration of definitions and meanings and how development as a practice has been moulded by current agendas for building a managerialized world.
Development today is an object of academic study as well as a political and economic international policy. Yet it is difficult to pin it down as a single set of practices or rules that denote it a unique status. There are many different practices in the field and shadowing this diversity – a fragmentary and ruptured group of contributions from academics on the nature of development work and development theory. These disparate views of development offer a variety of historical accounts that are illustrative of the different ways development has been rooted in particular political origins. Histories of development are embedded in the quest to define or redefine the origins of human security and how it should be protected or enhanced. The idea of protecting human security is certainly relevant to ideas of health and it is not an altogether contemporary agenda, for example, many theorists, philanthropists, and students of culture have cited such ideas as far back as the medieval Christian crusades that offered rice bowl Christianity (Cowen and Shenton, 1996) and also in colonial strategies of pursuing Northern imperialism in Southern countries (Said, 1979; Bell, 1994; Corbridge, 2000; Cooke and Kothari, 2001). Through a distinctly post-world war dialect, one that is heavily reliant on scientific-objective methodologies and ways of understanding the world we live in, human security has come to be understood as a utopian project in a modern epoch (Gray, 2003). In this way, historical accounts defining development are accented by current political and ideological debates, adapting to changing norms and ways of perceiving the world according to which particular geographical region and historical moment development is thought to be reflective of. Development, in this way health-development, can be conceptualized as a fractured set of practices on which modernist interpretations of human security are grafted. Such critical and “postmodernist” perspectives have clustered under the banner of critical development studies or post-development, I introduce some of its protagonists below.
Critical development studies and Arturo Escobar
Arturo Escobar made a seminal contribution to the field of critical development studies with the publication of Encountering Development in 1995. In his work he defines development as a distinctly post-war discourse that has become a powerful instrument in normalizing the world (Escobar, 1995, p. 26). The birth of this new discourse, he posits, was supported by the geo-political and socio-economic outcomes of the Second World War, where a decline in the colonial order led to the proliferation of alternative methods for exerting control over the “third world” and inventing the category of “underdeveloped”. This “making” of the Third World legitimated the self-professed developed countries to intervene in and implement economic and social programmes. Escobar perceives development as a construction that is embedded in modernist ideals that gained credence with the emergence of a free-market economy and global banking institutions. He cites specific historical conditions between 1945 and 1955 as being the defining moments in which “the architecture of the discursive formation (was) laid down” for development (Escobar, p. 42). Since its construction it has “remained unchanged” (Escobar, p. 42), but at the same time has premised some structural changes in the discourse leading it to be so successful in adapting to new contexts.
Escobar focuses on constructing a grander narrative encompassing institutions of development (and power) and the wider discursive realm these institutions exist in. Despite Escobar's post-structuralist sentiments (for example, his reliance on many Foucauldian concepts for furthering his thesis), he essentially develops a structuralist argument, and this is exemplified by his definition of development as a structured and unchanging discourse. Escobar's seminal work though excellent in discussing the broader discursive context development exists within, does not fully counterbalance this with a careful analysis of smaller, more micro-processes that may be useful in explaining development logic (and power) as conceptually fractured and fragile. Escobar sees little change in what development set out to achieve just after the Second World War, and what it is today. His argument is that the organizing principles of any discourse have enduring qualities that resist challenges and essentially remain static. Changes therefore only occur at the level of legitimation and myth-making, not at any deeper level that would involve a change in practices and relations of power.
By tying development to a specifically anti-communist strategy applied by the United States, Escobar overlooks changes that were and have been worked towards at the level of organizations. He also arguably supports a normative definition of power, leaving more anthropological understandings of power left unacknowledged. Power (or empowerment) is readily accepted and promoted in Escobar's polemic as the common utopian goal any society striving to be modern hopes to foster amongst its civilians. Yet this precept for critiquing development fails to recognize how empowerment itself is a Eurocentric utopian ideal that does not necessarily apply to all societies universally. In this way, the many disparate and contradictory interpretations of power that exist in different regions, cultures, and historical moments remain invisible in Escobar's thesis on poverty.
Science and development-management
Despite overlooking micro-processes of construction, Escobar does discuss the relevance of modernity and management practices in relation to the rise of science as a legitimating metaphor. Escobar cites the rhetoric of science and technology as being fundamental in legitimating the role of the expert, and a view of development as objective, rational and politically neutral. Driven by a new social science where economics, demographics and statistics played (and do still play) a crucial role in setting up hypothesis and means to test the truth-value of these hypotheses, development became a sector, an occupational category led by expert knowledge. In presenting the path to development as progressive, sequential and pre-defined, development or modernization theories eclipsed their racist and Euro-centric roots. The rise of science and technology during this period was the impetus for the professionalization and institutionalization of development (Escobar, 1995, pp. 44-47). Processes of professionalization brought the third world under the gaze of expert knowledge and Western science, which were and continue to be considered neutral and apolitical.
The expert or consultant, Escobar suggests, becomes a key author of reports and documents that feeds into the organizational practices of those doing the developing. This textual and tangible form of expert knowledge undermines local forms of knowledge (that can be non-textual, non-standardized, and more culturally embedded) and therefore presents the expert or professional as the key agent who can ensure social and economical improvement (see Escobar, 1995, pp. 106-13). This bureaucratization of knowledge Escobar describes as “the institutional production of social reality” (Escobar, 1995, p. 108). It is this process of translating experience into text that “the organization's perception and ordering of events is preordained by its discursive scheme” (Escobar, 1995). Here, Escobar ties the non-local practices of institutions to textual practices that in turn create an organizing scheme that fixes subjects in a web of subjectifying practices. Institutional norms proliferate through textual practices, such as the pervasive use of labels (e.g. “target groups”, “tribals”, “community”, “peasants”) and eclipse actual relations of power. The textually mediated discourse substitutes actual relations and practices of the “beneficiaries” and buries these in a matrix that organizes the institution's representation (Escobar, 1995, p. 109).
The practices connected to such bureaucratization and documentary processes are far from harmless, impotent organizational routines. Documentary practices, like reporting, are loaded representations that are both cultural artefacts of a modernist episteme and organizational technologies that disseminate and help to create an institutional and normalizing version of a single “social reality” and a specific strategy for addressing a host of development issues – including health issues, for example.
Cowen and Shenton: inventing development
Cowen and Shenton's (1996) significant contribution maps out the philosophical roots of development back to eighteenth and nineteenth century European theories of trusteeship and strategies for imperialism. In their analysis, they identify all developmental theories as originating in modernist European debate of whether development is an “immanent process” or “intentional practice” (Cowen and Shenton, 1996, p. 28). To elaborate, in understanding development as an immanent process, developers assume that there is a natural, pre-defined, cycle of events. This interpretation assumes that progress is inherent in all societies and generations. Understanding development as an intentional practice however, assumes a different logic: that societies themselves must decide how best to progress and improve. That progression is not a natural state of being and that it needs to be informed, worked towards, and managed. As such Escobar's critique of development, though radically opposed to the hegemonic institutional foundations of development practice, supports the idea of development being an intentional process and so excludes stories of progress that fall in the “immanent” category outlined by Cowen and Shenton.
Arguing that the debate between immanent and intentional has long been forgotten, Cowen and Shenton suggest that an uncritical mainstream interpretation of development has been forged. They point to the way how, in recent educational textbooks, development is presented as a strategy resulting from an informed choice (i.e. that development is a result of a decision, economic or political, made by interested parties) – in short – an intentional practice. Thus, Southern nations are represented by mainstream theory as having a choice: to develop or not to develop. The classic debate about the status of development – that is whether it is spontaneous or a planned practice is eclipsed. By ignoring the possibility that countries and communities find ways to progress and are always improving in some way or the other makes managerialism (which includes practices of planning, monitoring, design, and reporting) all the more obvious as a strategy for improvement. Choice and decision-making have to be organized in some way, or at least there needs to be an interested and able party to make such decisions. It is this conviction that Cowen and Shenton refer to as the theory of trusteeship in nineteenth century politics that they propose legitimated European imperialism. Today, it is institutions like the World Health Organization, the World Bank Organization, and international NGOs that make the same claim of holding the rights of trusteeship to help Southern countries alleviate poverty, tending to colonial relations between the North and South. However these imperial roots of development are hidden by development being presented as a post-war strategy, which has a history of no more than 60 years.
Trusteeship and managerialism in the development sector
The theory of trusteeship has three main implications for how poverty and methods of dealing with human security are conceptualized. These implications are also inherent in managerial ideas of control and progress. Firstly, the logic of trusteeship implies an external locus of control for initiating change and progress. Development is not something, which occurs internally and during a specific historical moment, it is a transformation of one region into a superior order as a result of those who are entrusted with the future of society (Cowen and Shenton, in Corbridge, 2000, p. 34). Thus, and this is the second point, development is instilled with an overbearing sense of design. Development must be planned in order for it to be successful, and the rules for planning and designing development endeavours must be taken on by those who are thought of as having the capacity to lead such projects. In this way western traditions of managerialism are grafted on ideas of development; planning, bureaucracy, and systemization all become processes that share logics delineating from development and managerialism. This leads us to the third and final point. Through an emphasis on design and control, development has become synonymous with linear-economic ways for steering such progress. Progress is endless as are the technological advances and methods that will lead us to a prescribed utopian goal.
Technology conceptualizes human improvement as limitless and perceives the goal of social perfectibility as obtainable for every society. What exactly the perfect society is (or what Utopia is) is determined by the particular historical, geographical and social context from which such thought arises. In doing all this, the theory of trusteeship equates underdevelopment with corruption, disorder, and chaos and mismanagement with similar negative connotations. By emphasizing these negative aspects of life in Southern countries, development is successful in legitimating its own projects in external locations. It is through its own internal assessment criteria that development and organizations identify the underdeveloped and how best to tackle the poverty problem. A problem that has been constructed using its own unique logic, whilst all along presenting itself as a thoroughly modern and scientific project.
Modernity itself therefore remains a distant and utopian goal. It is never truly realized, for if it was then there would no poverty to alleviate and development practitioners and managers would be out of a job. But certainly, if poverty eradication is the fundamental goal of development organizations, then working towards redundancy is the only strategy that practitioners and academics should be employing.
Despite Cowen and Shenton's persuasive discussion on how debates about development need to be anchored in in-depth understandings of its pre-war colonialist philosophy, development as a discourse is presented as a homogenous and unique set of ideas. This is problematic when attempting to incorporate and highlight local knowledge and practices as compelling, critical, and valued perspectives. Invariably, local knowledge and culture is presented as assimilating modernity and all its practices without resistance, mutations or debate. Managerialism is presented as totally saturating every aspect of organizational life in the field, regardless of context, space and time. That is, development-management discourse is represented as a solid and indestructible force that is absorbed by every social structure it touches. But is the story of development and its colonial history quite so straightforward?
The contribution of Morag Bell: development as semblance
Morag Bell (1994) suggests a different history of development and the tales it tells of progress and transformation. She proposes that histories of colonialism and development go to great lengths to present the world as segregated blocks that are consistent and unified in their political and social agendas (Bell, 1994, p. 175). This, she argues, is much more than a simple generalization, it is instead a way of slipping into stereotypes set up by colonial powers to give the impression that the Third World is a homogenized force that can be harnessed or colonized depending on their design. This solidified image of the Third World and indeed of the colonial powers themselves has propagated a view of the world as divided into neat blocks that steer their own political and economic agendas according to some grand design. If we begin to dig deeper however, a different image of the Third World and colonial powers emerges: one that is a “protracted, painstaking and fiercely contested process” (Bell, 1994). By acknowledging the history of development being rooted in a colonial history fraught with conflict, the relationship between North and South becomes less obviously one of power per se and more of an issue of identity and image management: of imposing an identity on non-European cultures through a complex web of representation and ways of knowing. In pursuing a homogenized image of the Third World or indeed of the colonial powers, a specific reality is constructed that legitimates power and design as central issues for the realization of the European utopian project, as described by western philosophical movements of the eighteenth and nineteenth centuries.
Secondary to this point, acknowledging a contested history also problematizes the argument regarding colonial intention:
… while Europe would appear to be dominant, in practice colonialism was not the planned, deliberate process implied by much of development theory. Control over non-Western peoples and their environments was slow to evolve and persistently contested Bell (1994, p. 175).
Bell moves away from Cowen et al.'s thesis that development's roots are in an immanent or intentional matrix. Instead, she proposes that development has been constructed in a way that it is given the semblance of a single homogenous strategy and that in fact, it is far from such a structured and resilient discursive architecture. By underplaying resistance, conflict, and heterogeneity, the European project to civilize was given greater legitimacy. But, as Bell states:
Britain's acquisition of … territories was hardly achieved with the skills of scientific management and planning (Bell, 1994, p. 179).
She cites several instances of how the British Empire was contested and challenged by the colonies themselves and also by the British “at home”. Further conflicts are outlined between the “settlers” and the central British administration, drawing out how colonialism as a utopian ideal was never a solid and consistent collection of ideas – but instead was an inherently contradictory and contested discursive domain. It was nevertheless, the semblance of a unified and solid empire that gave the impression to those “at home” that the conquest was a triumph and should continue and that scientific planning and design were the tools to this success.
Today, poverty is still viewed in deprivationist terms while forms of development are imbued with a positive image. This justifies the ongoing use of dualist categories when discussing the world in terms of rich/poor, North/South, core/periphery, developed/developing (Bell, 1994, p. 184). This dualism feeds other attempts to homogenize recent changes in international politics that stand outside this dualism. Such stories of dissent have been the boom and bust of the “tiger economies”, the liberalization of India and its rejection of international aid post-tsunami, and the Chinese threat to American economic hegemony. These have all challenged the image of a homogenous and downtrodden Third World. Concurrently, and in contradiction to these disparate and diverse regional issues, major social movements have sought to construct a unity between and across national boundaries. In academia there has been a rediscovery of gender as a basis for a common class and cultural struggle. In policy-making circles HIV/AIDS has been re-branded as a threat to all life regardless of social or economic background, and in other development sectors, such as the environment, there have been enormous efforts to stress mutual interests and the “common crisis”. This is not to say that the HIV/AIDS epidemic and global warming do not exist, far from it, but the point that is often overlooked is that these crises are diverse, unpredictable, and varied: formal interventions that seek to “better” people of the Third World are contested and do not go unchallenged.
Bell's contribution, though focussed and most illuminating on how macro definitions of development are a semblance of reality, rather than a true representation of it, does exclude a more in-depth micro-analysis of how these definitions come into play. Ferguson's, 2003 (1990) Foucauldian study of Lesotho does justice to these more subtle processes of construction and ties his ethnography to the bureaucratization of development projects worldwide.
Ferguson: development practices as instrument-effects
Ferguson (1990), though often overlooked in many critical development texts, makes an enormous contribution in terms of explicitly analyzing micro-processes of construction in development NGOs. By tying managerial practices in NGOs to how textual artefacts, including reports, are constructed and dispersed through organized ventures, his work echoes Bell's (1994) contention that development is spontaneous and uninformed, and as such always in process of constructing itself as a whole and unique sector.
Ferguson's work features in Escobar's analyses of reporting and bureaucracy in development organizations, but it is somewhat misapplied when Escobar asserts that development texts are written with specific intentions to subordinate and overturn local or “indigenous” knowledge. It is perhaps Ferguson's emphasis on the concept of “instrument-effects” (Foucault, 1977) rather than on that of the expert that leads his own analysis of textual artefacts to being more subtle than an intentional action based on an actor's own agenda. Instead, he proposes textual artefacts are micro-processes that are part of a bigger machine (Ferguson, 1990, p. 255). Such instrument-effects are part of a broader yet unspoken logic: they are processes that are simultaneously the instruments of and the effect of what “turns out” to be an exercise of power (Ferguson, 1990). In this way, Ferguson's understanding of power and institutional practices is more complicated. Though he acknowledges the expert's role in homogenizing developmental practice Ferguson, 1990, p. 258), he pays far greater attention to the complex relationship between intention and unintended consequences. Highlighting how the expert's intentions are never to damage human security or perpetuate unequal relations of power, Ferguson looks at the resultant system these practices construct and how the application of development logic to real situations has dangerous and abusive repercussions.
It is development's own logic and the proliferation of this logic through bureaucratic processes that leads to a certain reality being constructed which denotes a semblance of reality. Logic becomes an experience that is constructed as a reality in reports. This process of reification escapes criticism by the way practices such as the writing of project plans and reports paint development projects as neutral, rational, and technical. It is through the reports own logic and employment of rhetoric that experiences described in reports seems above scrutiny and appear as scientific fact (Ferguson, 1990, p. 256).
Critical development studies: some conclusions
Development cannot be pinned down as a single set of values and ideas, it defies definition because of its fractured and disjointed histories. As a discourse it is changing, adapting, and contested. Its semblance of reality is constructed through processes that are buried under the mundane and ritualistic practices associated with planning, design, bureaucracy and documentation.
By acknowledging development as a contested discourse, we can begin to incorporate alternative views, practices and representations that help to remove the crude stereotypes that persist even today in planning and managing health projects worldwide. Identities of those “patients” or “clients” in developing countries are never stable or homogeneous either. It is through examining the discourse of development organizations that we can begin to understand such conflicts as being played out in a variety of practices and strategies to defend or create identities.
Critical development studies does have a clear interest in discussing managerial practices and some of its main protagonists have incorporated lengthy discussions on the role of bureaucracy, of scientific-management and the impact of modernist utopian ideas on the way development proliferates and reproduces itself as a neutral and logical strategy of transformation. Nevertheless, such development texts work largely in isolation from critical management studies – a field of management studies that explicitly critiques managerialism for its modernist, colonial, masculine and capitalist roots. Critical management studies has an established number of contributors who take a post-colonialist perspective when discussing relations of power between the developed and developing nations (Prasad and Prasad, 1997; Prasad, 2003). Nevertheless, the following section sidesteps this huge volume of literature in favour of outlining critical management perspectives that critique the modernist philosophical roots of managerialism, and its elevation to ideology worldwide. Such contributions focus analyses on processes – a focus that is shared in this thesis as well, looking at reporting in NGOs as one significant process that leads to subject-positions opening up in organizations.
Managerialism: modernity and its discontents
Since the “textual turn” (Parker, 1992) in the social sciences, words, and how we employ them, are understood to be the foundation of how we imbue the world with meaning and experience reality (Derrida, 2001; Foucault, 1977; Edelman, 1985). Overturning taken-for-granted ideas and myths about managerialism and management is a relatively new endeavour that has been explored by academics in the business school, and most notably by contributions from critical management studies. Although its roots can be found in the writings of structuralist labour process academics (Braverman, 1974), its arrival as a discipline in its own right can be identified in the early 1990s. Critical management studies or CMS has gained popularity through applying largely post-structuralist, post-modern critiques that attempt to overthrow the classic management principles of organizing (e.g. efficiency, rationality, objectivity). These critical voices have also turned against the rising tide of globalization and the issues associated with it, such as, the utilization of technology, the need for homogenization across regions and cultures and the unyielding desire to forge a unified world market economy.
In parallel to these critical contributions, mainstream management has picked up on the growing dissent targeted at hierarchical forms of management and the promise of managerialism making work meaningful, ordered and stable. Such critique has been tackled within mainstream management by endorsing “softer” managerial methods that have come to be known as new wave management. Such methods promote practices that are inclusive, participatory, democratic and empowering. Methods that are promoted in such “softer” management theories include, total quality management, self-management, human relations management and organizational learning. CMS theorists have engaged with such organizational changes and applied Foucauldian critiques of disciplinary power to render such changes as rhetorical (see Townley, 1993, 1993b). But apart from pointing out this reality/rhetoric gap CMS has also sought to analyse managerialism as an ideology, and in doing so, has explained how managerialism is very much a part of a believed reality, and as such a social construction.
Although it is difficult to label CMS as located in a specific theoretical space, we can at least make the generalization that the CMS agenda is essentially to look beyond structural changes and towards understanding subjectivities (Grey, 1996, 1999; Parker, 2002a, b; Grey and Willmott, 2005). CMS, since its arrival in the B-school, has undoubtedly shed light on the social construction of managerialism and its subsequent elevation to an ideology worldwide. This section on managerialism follows some of the crucial arguments set out by CMS over the past decade or so, that seek to draw out the social construction of management. This, it is hoped, will resonate with health academics in terms of how health organizations construct an idea of health that is in fact legitimated through a myriad of practices, activities and rituals. In particular, managerialism and its entanglements with modernity are discussed, highlighting similarities and differences with development ideas discussed in the previous section.
Why be against management?
Parker (2002a) is against management. He justifies this position by stating that it is management that creates a yearning to be better, wiser, more efficient human beings and it continues to be a significant part of life by the fact that this ideal is never quite satiated. It is not Utopian ideals that Parker is against in general, but more specifically, that western market managerialism has become the vehicle through which these utopian goals are worked towards and that it is this type of management that is considered to be the one and only strategy for progress and transformation worldwide. Management, it is suggested, has gained such unquestionable status through three legitimating assumptions (Parker, 2002a, p. 2). First, social progress is assumed to be equivalent to our ability to increase control over the natural world. Management is a key element of a particular progressive scientific attitude that encourages humans to increase their control over their immediate and distant environment by technological advances. Recall Escobar's (1995) assertion that sustainability is an organizing metaphor constructed out of a conflation of management and environment. Second, it assumes that humans are intrinsically chaotic and a source of disorder in organizing the world. This assumption justifies management's role in exerting control over human beings: control fosters a better future. Here, recall Cowen and Shenton's (1996) thesis that modernity is based on the precept that control and order bring about progress. And third, management justifies its existence by inserting its own methods of practice in stories of success and progress. These stories set up traditional societies as cruel and autocratic, highlighting management as democratic and transparent. And here, Bell's (1994) and Ferguson's (1990) analyses of development as semblance through proliferation of representations can be seen as being relevant.
While Parker critiques managerialism in particular, the three assumptions that are set out in his work can be seen as having a direct connection to the disparate works in critical development through a common critique of modernity and in particular the critique of Saint-Simon's philosophy. Therefore, drawing on such arguments in critical management studies can illuminate critiques of development-management further by connecting these literatures through a post-modern perspective that highlights organizational practices as instrument-effects of modern forms of organizing development.
Encountering modernity in management
Management is inseparable from modernity, and embraces all the challenges modernity sets out to tackle (disorder, autocracy, degeneration) as its own. It is this fight against disorder and degeneration that legitimates management as:
… ordering, producing a pattern which will transcend space and persist into the future, (and) is the activity which defends us against being open-mouthed and hollow-eyed victims (Parker 2002, pp. 4-5).
There is a spatial and time-contingent foundation to such a definition of management. It does not seem to matter where you are in the world or at what time in history you come from, the management-modernity definition of organization allows us to transcend such diversity and work towards a single goal through a single strategy. This notion of management being synonymous with modernity resonates with development ideas of progress being linked to a desire for complete planning, designing, documenting and bureaucratization. Underpinning these ideals of modernity is the western myth that:
… as the rest of the world absorbs science and becomes modern, it is bound to become secular, enlightened and peaceful (Gray, 2003, p. 118).
There is in this way, a promise of global transformation underlining development-managerial ideals. The force for this transformation, and with it the justification for management to be adopted worldwide, relies on a belief in the market economy, in liberalization and open competition in private, public and non-governmental sectors alike.
These ideals are ideals that form the foundation of modernity and can be located in eighteenth and nineteenth century Utopian thought. The works of positivists, like Saint-Simon in particular, have been extremely influential in drawing together ideas of management and market liberalism: a relation that is today cemented, and can be evidenced through the practices of institutions such as the World Bank, the IMF, and the European Bank.
For Saint-Simonians laissez-faire was the most dangerous and destructive of all strategies. Markets, industrialization, and human interests had to be controlled to create the right environment for social progress and transformation to flourish – a contention shared by managerial and development ideas alike (see Cowen and Shenton, 1996). Today that conviction continues and is embedded in the globalization model for free trade and international security. The logic of a successful and wealthy market economy is so intrinsic to how management proliferates, Parker proclaims in his polemic:
… the market is now king, and management its representative on earth (Parker, 2002a, pp. 184-5).
Managerialism and the market are treated as if they have no connection to history and exist in a culturally neutral space. It is this lack of diversity, this unified story of glory and success that wipes out any alternative ways of organizing and exchange. More seriously, it sidelines dissent or anomalies that fail to embrace this model and labels them as unimportant or minor hindrances that should be ignored or swallowed up in the march to a better pre-defined future.
Practices of oppression and the techniques of management
Managerialism does not admit of alternatives. But this does not mean that such alternatives do not exist. As Grey (1996) points out, these alternatives or disparate histories of management are available but have been marginalized. By including and recognizing these forgotten histories, a more complex picture of management practice and managerialism emerges. What also emerges is a better understanding of what we mean by managerialism. Through a review of Simone Weil's work on the organization of production, Grey highlights the over-arching themes that critiques of managerialism encapsulate. He points towards a focused analysis of processes in organizations as highlighting legitimating mechanisms that prop up managerial assumptions and safeguard its status in society as it proliferates as a practice.
Following Weil's contributions, Grey re-asserts the importance of the concept of oppression in managerial practice and more specifically in the degradation of labour. Locating this degradation in oppression rather than exploitation (as Marxists would have it), he follows Weil's argument that capitalism's conception of labour as a means to an end in a long line of production is what makes it an oppressive regime (Grey, 1996, p. 597). It is this understanding of oppression – that humans are constructed as means to achieve some abstract end – that is at the heart of Weil's critique. It is also this conception of oppression that highlights scientific management as an oppressive practice adopted by America and the Soviet Union. This critique of scientific management and the bureaucracy associated with it, is in itself no novel contribution. But what Weil did contribute was to show that:
… techniques of management … led to oppression irrespective of the political context in which they were deployed … (Grey, 1996, p. 600).
In making this analysis, management's status as neutral and “scientific” is overturned and the assumption that it can be put to good or bad ends problematized. Oppression is “inherent within managerial practice irrespective of the intentions behind its deployment and the socio-economic formation within which it is deployed” (Grey, 1996, italics in original).
Today, this critique may, at first, seem inapplicable. Management practices have seemed to evolve beyond crude methods of scientific management, and development-management in particular appears more seductive as it incorporates notions of empowerment, participation, autonomy, emancipation and ethics. Grey makes the case that although organizational forms have changed, management as a practice and rhetoric is still imbued with the language of science:
… the linkage of science and management in which each is understood as neutral is an important element in the constitution of “managerialism” (Grey, 1996, p. 601).
It is this political neutrality that blurs the ideological status of management and makes it all the more applicable to a diversity of fields, disciplines and cultures. So that, “new” management practices and organizational forms such as, business ethics and corporate social responsibility, can be rendered:
… merely an extension of managerialization into the ethical domain (Grey, 1996).
This is a significant point, as in identifying this relation between the philosophical underpinnings of managerialism (science, neutrality) and representations of management (Taylorist/new wave), what becomes of interest is not “who manages” but rather “the social construction of manageability” (Grey, p. 602, emphasis in original).
Moreover, the participatory methods employed by development-management appear to be based on the same principles of control as its non-developmental counterpart. Here, the modernist preoccupation with control is of central importance. Like eighteenth and nineteenth century utopians, modern managers are also interested in preserving sources of control. Contemporary forms of management “redefine the meanings of emancipation and autonomy” through shifting the locus of control from hierarchies to employees, or even beneficiaries and stakeholders. But control, nevertheless, is the guiding principle in constructing notions of manageability and its associated promises of progress.
Discovering plurality in organizational analyses
Fournier's (2002) work is directly relevant to development activities and practices because she explicitly identifies grassroots movements as disruptions and challenges to the dominant vision of utopia. These movements are in themselves fragile, disjointed and fragmented. But it is this elusive characteristic of grassroots movements that defends them against the colonization from some engineered “third way”. Such movements in development could be smaller community-based organizations who remain outside the funding structures of formalized international development. These visions of utopia put forward by Fournier offer “escapability” from forces that appear natural, inevitable and real. In particular, such movements challenge the notion that there are no alternatives to the forces of capitalism and neo-liberalism. Moreover, grassroots movements make explicit that inequalities and persecution are products of decisions made by the powerful and not foregone conclusions or the by-product of some “invisible hand of the market”.
In re-defining reality as incomplete, as pluralistic (not in the sense of it being relativisitic, but rather it being “undecidable” (Derrida, in Fournier)) the mechanisms of choice, decision-making, and volition become increasingly relevant to harnessing alternative ways of organizing and defining organization itself. Organization is infused with the modern desire to design and the preoccupation to control. What Fournier makes available to organizational theorists, is a way of perceiving organizations beyond whole, unified, and stable entities and towards conceptualizing organizations as in flux, spontaneous and sometimes, ineffective. It is this counterintuitive concept of an organization that Fournier wants to promote and acknowledge in her argument. And she concludes:
… shouldn't we ensure that grassroots movements remain ineffective at running states; that they remain small, spontaneous, disjointed, and do not congeal into the formation of another “unified vision of a better future”, another truth, policed by another leader? (Fournier, 2002, p. 209).
It is the re-conceptualization of organization, not management that prises open a space from which to seek out alternatives to the dominant way of perceiving the world around us. Management comes loaded with an ideology of managerialism: that everything can be managed and should be managed, that everything can be controlled, and that it should be controlled; that managerial vision and practices are the only means by which progress is secured and the agenda of development solidified as a unified strategy.
In analyzing organizations, we begin to understand alternative routes to collective action, to patterning our social lives and to giving our reality a certain meaning or value. Through acknowledging the heterogeneity of organizational practices in development, the perceived invisible force of market managerialism becomes less threatening, and potentially fragile. This inherent fragility has huge implications for how health is managed in development projects and raises questions of the scientific-rational premise from which health propagates a single truth of medical science. If we are to talk about discourse then we must accept the contested and fragile nature of reality. In doing so, we can begin to work towards representing visions of hope and presenting a choice to those who perceive as they have no right to one.
Critical management and critical development studies
I have attempted to show how critical development and critical management literatures have a common interest in developing a critique of managerial ideas being embedded in values associated with modernity. Both literatures are concerned with and concerned about ideas of control, stability, neutrality and objectivity as being dominant values that imbue reality with a particular design and way of seeing the world. I have also attempted to show how these arguments have implications for health-management issues and for health-related development projects that uncritically assimilate managerial ideals.
Both development and management literatures are also interested in finding alternatives, of overturning a determinist argument that certain discourses are inescapable, that the marginal will remain marginal and that power lies only in the hands of a few. A way out of this structural argument is the theorization of practices as integral to sustaining unequal power relations and also to highlight the concept of organization as inherently plural, undecidable and spontaneous. In this way, managerial (or modernist) values have been challenged and humans noted as contributing to resistances, contestations and micro-definitions of work, development and even health.
It is stability and order that make the foundations of a strong and successful world economy, of democratic nations, of efficient organizations. And if individuals are autonomous and able to decide for themselves, they would surely all choose to come together and carve out a bigger and better future for all of themselves. By organizing better and managing better, we can all do just that.
This common precept that guides management and development practices today has been identified by Cooke (2003a) where he states that although both literatures are fragmented, the two literatures are common in that they both recognize that:
… managerialist representations of management as a neutral, technical means-to-an-end set of activities and knowledge conceal its status as a product of broader social (at every level from the global to the personal) power relations, and in particular, its role in sustaining these (Cooke, 2003a, p. 48).
In this way my argument echoes Cooke's assertions. The managerial gaze (in the Foucauldian sense) on development projects brings about various assumptions about how development should be organized. And along with these assumptions there are a variety of politically loaded ideologies that become grafted onto seemingly neutral managerial practices. Cooke (2003a, 2004) explicates how management-development as a seemingly new and improved form of management denies its ties to colonial administration.
The irony lies in the fact that development administration has been re-named and re-branded as development-management. As such, the very term development-management reveals the field's pre-occupation with portraying itself as a thoroughly modern project, concealing its ideological roots in colonial administrative practices. The result is a form of management that maintains an image of technocratic neutrality, whilst being embedded in a web of practices initiated to sustain imperial power (Cooke, 2003a, p. 59).
Conclusions
In presenting development and management as intertwined, this paper has sought to unravel a more complicated and pluralistic reality. Ideas of development and management embrace the potential for perfection, and in doing so, they extend a particular Utopian vision. But there are alternatives to this grand narrative of change. As this paper has repeatedly illustrated, there are contradictions between rhetoric and reality. I have also attempted to outline how it is almost impossible to compare rhetoric to a single reality. Instead there is a semblance of reality that is recalled and represented as concrete and unique. And without invoking the anthropological/relativist argument out of the bag, quite simply, the version of reality that is dominant and promoted is often one that serves to keep certain individuals in power. What is more revealing, and what I advocate as an insightful focus of study, is to identify fissures and resistances to this dominant narrative, and seek to understand how these alternatives proliferate through organizational practices and construct subject-positions. Undoubtedly, this theoretical critique can give medical anthropologists a path into analyzing managerialism as a cultural preoccupation, which has implications to how health is constructed in development projects.
For health practitioners, these critical insights into development-management make clearer the potential interconnectedness of managerial discourse and the construction of health. As development-management has been shown to be constructed through a variety of appeals to a modernist ideology, health-management too can be thought of as a social construction that is made real through its appeal to modernist preoccupations of control, stability and science. This is not to say that health is not a science, but rather that the management of health is a political venture which has very specific ways of proliferating (e.g. through audit systems, monitoring and evaluation, reporting and so on). These proliferations are ideologically bound to a managerial episteme that goes unchallenged and unquestioned. In the development sector, where medical resources are stretched, treatment is hampered by unsustainable drug pricing and primary health care units are often insufficient, a modernist critique of health-management is imperative. Through making the connection between development and management clearer, it is hoped that the same can be done for health-management and development projects too.
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Further Reading
von Hayek, F. (1960), The Constitution of Liberty, Routledge Kegan Paul, London, .