Journal of Health Organization and Management

Purpose – This paper seeks to draw attention to the historical and institutional context of Norwegian home care and to the way in which care agencies have been pressed to reconcile competing demands caused by conflicting policy aims and administrative values. The paper also aims to explore how ideas of contractual management have been interpreted and put into practice in this field of tension.

Design/methodology/approach – The study draws on policy documents, historical and social research reports, and personal interviews with managers and home care staff from three different case studies representing different eras of management ideas. From this micro perspective the study examines professional work as the intersection between new public management and the health care state.

Findings – The findings demonstrate how contractual management is highly influenced by competing drivers of change. Reforms, stressing cost reduction, do not act as a unidirectional reform programme. Instead, they are infused with administrative arguments linked to previous reform ideas aiming to create legitimacy both from “above” and from “below”. The dynamic of change often has unintended consequences which in turn prompt further reform efforts.

Originality/value – The paper provides insights into the complexity of change following on from New Public Management (NPM). More specifically, change is characterised by tensions originating in competing normative drivers as well as the co-existence of old and new forms of organising.