title: Trust and managerialism: exploring discourses of care.
abstract: OBJECTIVE
  This paper reports a study that explored the relationship between trust and managerialism through an analysis of professional discourse.
  
  
  BACKGROUND
  Managerialism is a distinct set of discourses and practices related to managerial effectiveness, flexibility and consumer responsiveness that have come to characterize debates over the provision of health and welfare services across the developed world. At the same time, trust has attracted increasing academic and political interest. Managerial discourses are critical of healthcare professions and the way they operate. Professional opinions are challenged as representing the interests of professions rather than service users; as a consequence trust is contested. However, where practitioners are both professionals and managers, the boundaries between these discourses become blurred. Moreover, paradoxical development occurs where increasing autonomy for practitioners is accompanied by a strengthening of managerial controls over their activity.
  
  
  METHODS
  Discourse analysis was used to explore the text from two genres, academic literature and interviews (n = 17), in the context of community residential services for people with learning disabilities. The study was conducted in 2001.
  
  
  RESULTS
  Two broad themes were identified, each with a number of sub-themes. The first focuses on the relationship between managerialism and trust located around the management of expectations. The second, 'the politics of care', explores the way professional and managerial discourse articulate to produce complementary and contradictory positions.
  
  
  CONCLUSIONS
  The colonization of professional activity by managerial discourse has produced a context where professional activity is defined by a series of managerial imperatives; trust, which was once the product of intimate social activity is now shaped through techniques based on distrust such as audits and quality monitoring. Nevertheless, the persistence of tensions between trust and managerialism suggest an ongoing struggle for professional autonomy in the face of increasing managerial controls.
authors.affiliation: Faculty of Health and Social Work, School of Applied Psychological Studies, University of Plymouth, Plymouth, UK. anthony.gilbert@plymouth.ac.uk
authors.forename: Tony P
authors.initials: TP
authors.lastname: Gilbert
mesh_terms: D001291:Attitude of Health Personnel; D017048:Health Care Costs; D006285:Health Planning / Q000379:methods; D006298:Health Services Administration / Q000191:economics / Q000592:standards*; D006801:Humans; D007802:Language; D009936:Organizational Innovation; D011364:Professional Practice / Q000458:organization & administration; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012941:Social Responsibility; D035502:Trust / Q000523:psychology*