Audit experienced as an iron cage

In this section, I will expand the analyses of the two previous exemplars by examining how adherent responses to EHR and SPA portray these audit techniques as an iron cage. Generally, the term iron cage¹³ denotes increased rationalisation of social life.

The concept is originally outlined by Weber (1991) in his description of workers

“trapped” in the rules of bureaucracy. There, the iron cage confines individuals in systems based purely on efficiency, rational calculation and control. According to Aas (2005, 72), Weber’s notions on bureaucracy as an iron cage present modern institutions

13 The original German term is “stahlhartes Gehäuse”, which was transformed into “iron cage”

by Parsons in his English translation of Weber’s seminal book The Protestant Ethic and the Spirit of Capitalism (1958).

as depersonalised, calculable, predictable and adhering to rules. The identity of the persons performing does not matter, but the answers lie in the technology or the rule.

Audit as an iron cage lies at the heart of developments described by Taylor and White (2000, 4) who note that increasing new public management (NPM) is exposing professional practice to scrutiny, characterized by a greater degree of anxiety about its goals and outcomes. My use of the concept is influenced by the way Wastell et al. (2010) describe performance management as an iron cage which strongly frames professional practice by reducing professional discretion. So, by increasing regulation, I see iron cage audit as something that makes practitioners adhere to its remits and subsumes their expertise to “formal calculative regimes”, as Dean (1999, 169) puts it.

Building on exemplar 1, I identify the first adherent response to iron cage audit as code‑led rationalisation of practice, in which practitioners reduce non-coded interventions from their daily agenda. There are no codes in the EHR for home visits and extensive case conferences, which means that they are not included in resource allocation of the clinics. Consequently, these forms of work are often dismissed by practitioners.

Also, practitioners reduce certain types of client receptions on the basis that they are not assigned to be as financially valuable in the code system as other types of receptions.

These reduced receptions include sessions with on-going clients or recurring sessions with the same client. On the other hand, the code for receptions with first-time clients is allocated more resources, so practitioners try to meet as many new clients as possible, implying that under high demand for services, frequent receptions with old clients must be reduced. This way, supportive orientation is preferred at the expense of more therapeutic orientation which would mean longer and more frequent sessions with the same clients, but also fewer coded interventions. The preference for coded interventions ensures that the interventions assigned with codes have the primary position, namely receptions are as short as possible, and are repeated as rarely as possible. This response to EHR, called “code-led rationalisation of practice”, is presented in Figure 1 (on page 44).

Its two main dimensions are marked in bold font in the side circles, and finally, their key impacts on practice are indicated in the small circles below.

The other adherent response to iron cage audit, carried out by SPA, is called deployment of effectiveness rhetoric, which signifies adapting expressions of SPA to the ways of talking about daily work (Figure 2). Effectiveness rhetoric is accomplished in two ways:

first, by adapting expressions of progress that are frequently mentioned in SPA. When tendering was going on, there were a growing number of utterances implying clients’

advancements and how these successful rehabilitation processes should be documented.

Second, expressions of economic efficiency are reflected in practitioners’ talk. These utterances emphasise the unit’s potential for competitiveness in providing quality service at an economical price, which is specifically stated in SPA. Figure 2 presents the response to SPA called “deployment of effectiveness rhetoric”. This response consists of two ways of adapting the expressions of SPA in professional talk, which are presented in bold font in the side circles. The actual utterances of the meeting talk mirroring the SPA contents are demonstrated in small circles.

Figure 1. Adherent responses: exemplar 1.

Code-led rationalisation of

practice

Reduction of non-coded interventions

Preference for coded interventions

Receptions with ongoing

clients

Short individual

visits

Infrequent receptions Frequent

receptions Home visiting

Receptions with

first-timers

Extensive case conferences

When audit techniques are experienced as an iron cage, the main function of adherent responses is to give priority to practices that are operationalised by codes and products. Whereas the EHR studied includes existent codes on interventions, SPA states the ordered interventions as products. As “the bars” of an iron cage, both codes and products require practitioners to conceive their work through the classification in which tasks are assigned a certain financial value. Some parts of practice become effectively operationalised, while other parts remain ignored. It is the hierarchy of priced interventions that defines those forms of work which are supported by the audit techniques. This classification signals practitioners about the most salient aspects of their performance. Consequently, practitioners tend to choose those activities and modes of talk that are most likely to improve their performance. This happens simply by preferring some tasks and expressions to others.

Figure 2. Adherent responses: exemplar 2.

Deployment of

With codes and products, caseloads become a primary measure for practice.

Caseloads relate to clients’ progress through services: when clients are successfully treated or rehabilitated, service can be offered to new people in the queue (Treatment Guarantee 2005). This idea of moving clients to another service is inherent for example in SPA’s service products which are of fixed-duration, and in the high financial value of a first-time visit code in EHR. Efficient management of caseloads is partly introduced to ensure universal rights and improved access to services, and thus practitioners can quite easily adhere to such intentions. Making practitioners to assume increasing budgetary responsibilities is a mode of regulating them by allowing managerial control to function – through the construction of “appropriate” professional conduct and work identities (Fournier 1999, 282). In this case, practitioners are required to translate their actions into codes and products which will offer an intelligible description on their “expertise actions” from the point of view of management (Miller & Rose 2008, 108–110). Being a financially productive worker presupposes an alignment between an individual practitioner’s conduct and institutional logic based on managerial and contractual principles. As Lipsky (1980, 50, 51) has noted, “Behaviour in organisations tends to drift toward compatibility with the ways the organisation is evaluated”.

3.2 Resistive responses: Subtle opposition and