ILPC 2026

The struggle between bureaucracy and professionalism has been described in all times. The basis of the struggle is the opposing logics behind these two. Bureaucracy is focusing on administrative hierarchies of formal authority, subordination and control, while professionalism is focused on professional autonomy. Since professionals became part of organizations the professional autonomy has decreased. The bureaucratic order has successively emerged as power, especially when administrators renamed themselves managers. Managerialism is both evasive and direct in its attempts to control professionalism. Especially in public healthcare, with the strongest profession of them all – the doctor, this struggle is very evident in the day-to-day work. Theory provides two archetypical explanations of outcomes of these control attempts: managerialism will have no influence on professional work (e.g., decoupling) or managerialism will intervene in professional work imposing bureaucratic control (e.g., colonization, resistance). However, these two explanations mainly describe how one of these conflicting logics “wins” over the other, but they fail to describe cooperative or interactive explanations. In this article we will focus on such an interactive order and how different techniques influence the negotiated order that emerges. One technique that we will especially highlight is one that has received limited attention in organizational research: co-optation. Co-optation means absorbing new elements as a means of averting threats to stability or existence, and the absorbing part could be an organization, or as in our case professionals. Since co-optation means real influence for the co-opted party, the strategy tends to lead to unintended consequences where both parties are influenced in unforeseen ways. This paper illustrates co-optation processes through a qualitative study of out care units of child and adolescent psychiatric care (CAP) in Sweden. These units are organized in multi-professional teams including psychiatrist, psychologists, social welfare counselors and nurses, and lead by a unit manager. The study shows that professionals co-opt managerial logics and managerial techniques and drives their professional interests. Psychiatrists co-opt budget and resource arguments in avoiding patients that are high-risk in terms of medical failure, but also enable a strict focus on psychiatric patients and refinements in patient treatments. Furthermore, the co-optation of organizational, formal routines and rules (in the name of evidence-based medicine) regarding treatment means a risk transfer from the professional to the organization. Co-optation can explain unintended consequences of managerial reforms since it regards professionals as active, interpreting, strategic actors who use reforms in their interests and thereby co-optation can describe how a negotiated order between managerialism and professionalism appears. A negotiated order that goes beyond nothing happens (de-coupling) or professional values are destroyed by managerialism (colonization). It is possible to view co-optation practices as a form of resistance, but it is a very subtle resistance. Professionals do not need to openly resist the administrative reforms since they co-opt them.