Webs of Knowledge and Circuits of Communication: Constructing Rationalized Agency in Swedish Health Care

Abstract

In this article we analyse an institutional transformation of Swedish health care that is underway. We combine the recent work from the ‘Governmentality’-tradition with contributions by John Meyer and associates. The latter is used to explain how these changes are rendered as necessary and natural. The main part of our analysis concerns how the institutional construction of rationalized agency is instrumented. To accomplish that, Dean’s (1999) categories technologies of agency and technologies of performance are used to conceptualize some of the means and principles mobilized in the ongoing institutional transformation of Swedish health care. Firstly, we display the emergence of a complex landscape of new actors, arenas and new practices that regulate and coordinate medical practice. Secondly, various attempts to imbue agency into the patients are analysed as an example of a technology of agency put to use. The conclusions present a more comprehensive picture of governing through new forms of agency. Technologies of agency are closely intertwined with appeals to common goods, the formation of new arenas and forms of expertise.