Quality matters: re-formatting the boundaries of care in Czech social care policy

This thesis deals with knowledge about the mechanics and effects of quality reforms in public service as advanced by critical policy studies. Critical policy studies have identified managerialism and marketization of public services as key conditions in introducing quality reforms. The argument has been built in opposition to proponents of quality who argue that marketization, when introduced to services, enhances their quality. In contrast, critical studies have shown that quality reforms have restructured organizational contexts of public services where quality acted mainly as a rhetorical figure, and where improvements remain dubious. The real effects of quality reforms, they argue, are increased control over practitioners’ labour process and de-professionalization.

This thesis is a case study of a recent Czech social care reform. The Czech case is a case of a quality reform without marketization and managerialism, yet with a similar outcome in the form of managerialised care. As such, the Czech case offers an opportunity to further our knowledge about the mechanics of quality reforms provided we make a methodological step outside the analytics of managerialism. The thesis undertakes this methodological shift by drawing on Actor Network Theory. The question this thesis asks is how could managerialised care be achieved without either marketization or managerialism? Methodologically, the thesis argues that mapping social alliances among policy actors is necessary but in itself not sufficient to explain the outcome.

The thesis traces the Czech quality reform from its inception as a policy project at the Ministry of Labour and Social Affairs to its circulation in social care sector. The Czech case shows how articulating quality service in quality standards re-organised care by extending (both conceptually and practically) its boundaries. Care traditionally understood as interactional bodywork was extended horizontally to include practices and forms outside the practitioner-client interaction (such as support planning), and it was extended vertically shifting the agency in care from an equipped practitioner to an equipped service.

The contribution of the thesis is twofold. It shows that quality has gained a life in its own outside the managerialist causation model and may not necessarily follow in the footsteps of marketization and managerialism. Mainly, the thesis shows that quality is a complex shibboleth able to re-format the content of practitioner work rather than merely re-structure organizational contexts of public service provision.