An inquiry into the influence of power dynamics on the operation of knowledge workers and the actualisation of competency-based approaches

The NHS, like many organisations, relies on knowledge workers (‘professionals’ and other staff) and has introduced competency-based arrangements (the Knowledge and Skills Framework (KSF)), covering over one million NHS workers, to support their development and service improvement. However, its conceptual compatibility as a rational managerialist control-based approach is open to question, given the need for freedom, autonomy and self-management. The answer to why this has come about is embedded in power relations and their effects emanating from political and managerial domains manifested in New Public Management (NPM). A feature of NPM is wide-scale assimilation of ‘tried and tested’ private sector managerialist practices into the public sphere. Competency-based approaches exemplify this phenomenon which includes ‘targetry’, ‘Lean’, ‘business-process engineering’ and ‘quality improvement’ initiatives, which, together with imposed ‘market disciplines’, have transformed the organisation, management and delivery of public services. This study refutes the assumption that competency-based approaches (and other managerialist measures) can be unproblematically applied and lead inexorably to performance improvements. Previous research into the KSF from a rational managerialist orientation highlights difficulties with its implementation and recommends ‘more and superior’ managerialist actions. This study indicates such recommendations, while necessary, are insufficient to deal with human, cultural and social complexities material to the maximisation of (knowledge) worker contribution. Through qualitative semi-structured interviews and the use of Foucauldian perspectives on power and subjectivity, a gap is identified between rational managerialist beliefs, intent and rhetoric and the ‘realities’ of lived experience. This investigation moves beyond rational managerialism to identify human and relational conditions necessary to enhance knowledge worker development and performance.