A Health(y) Image in the Post-Managerialist Age

Concomitant with the intensification of private provision of public services, government purchasers are managing third party service providers’ performance through accountability demands. As the excesses of New Public Management (NPM) are superseded by a post-NPM ethos, these purchasers are encouraged to soften those demands and ‘partner’ with providers. However, we argue that post-NPM reforms ignore the role of organisational identity in structuring accountability processes. Organisational identity can be described through image-laden metaphors. This paper explores how negative and positive organisational metaphors affected government purchasers’ demands for accountability from primary health care providers. Notwithstanding standard contractual arrangements, it found that purchasers’ demands for accountability vary according to the providers’ organisational images. Further, these government purchasers used sense-breaking and negative images to force change in providers’ identity