Protective or connective professionalism ... - Oxford Academic

Protective or connective professionalism?How connected professionals can (still)

act as autonomous and authoritative expertsMirko Noordegraaf*

Utrecht University School of Governance,The Netherlands

*Corresponding author. Email: [email protected] 8 February 2020; revised version accepted 9 October 2020

A B S T R A C T

Traditionally, professionals such as medical doctors, lawyers, and academics are protected. Theywork within well-defined jurisdictions, belong to specialized segments, have been granted autonomy,and have discretionary spaces. In this way, they can be socialized, trained, and supervised, case-related considerations and decisions can be substantive (instead of commercial), and decisions canbe taken independently. Ideally, these decisions are authoritative and accepted, both by clients aswell as society (stakeholders) who trust professional services. This ideal-typical but also ‘ideal’ imag-ery always had its flaws; nowadays, shortcomings are increasingly clear. ‘Protective professionalism’is becoming outdated. Due to heterogeneity and fragmentation within professional fields, the inter-weaving of professional fields, and dependencies of professional actions on outside worlds, professio-nals can no longer isolate themselves from others and outsiders. At first sight, this leads to a ‘de-cline’, ‘withering away’, or ‘hollowing out’ of professionalism. Or it leads to attempts to ‘reinstall’,‘reinvent’, or ‘return to’ professional values and spaces. In this article, we avoid such ‘all or nothing’perspectives on changing professionalism and explore the ‘reconfiguration’ of professionalism.Professional identities and actions can be adapted and might become ‘hybrid’, ‘organized’, and ‘con-nected’. Professional and organizational logics might be interrelated; professionals might see organi-zational (or organizing) duties as belonging to their work; and professional fields might open up tooutside worlds. We particularly explore connective professionalism, arguing that we need more funda-mental reflections and redefinitions of what professionalism means and what professionals are. Wefocus on the question of how professional action can be related to others and outsiders and remain‘knowledgeable’, ‘autonomous’, and ‘authoritative’ at the same time. This can no longer be a matterof expertise, autonomy, and authority as fixed and closed entities. These crucial dimensions of pro-fessional action become relational and processual. They have to be enacted on a continuous basis,backed by mechanisms that make professionalism knowledgeable, independent, and authoritative inthe eyes of others.

K E Y W O R D S professionals; professional spaces; connective professionalism; expertise; autonomy;authority

VC The Author(s) 2020. Published by Oxford University Press.This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. Forcommercial re-use, please contact [email protected]

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I N T R O D U C T I O NTraditionally, professionals such as medical doctors,lawyers, accountants, and academics as well as theirprofessionalism are protected (Wilensky 1964;Larsson 1977; Freidson 1994, 2001; Noordegraaf2007; Evetts 2013; Kirkpatrick, Ackroyd and Walker2015). Institutionally, professionals belong to well-organized professions, and they work within well-defined jurisdictions. Occupationally, their work isregulated by occupational (instead of organizational)standards. They also belong to specialized segmentswithin their respective professional fields. Judicially,they have been granted autonomy to treat cases in-dependently. Practically, they have discretionaryspaces to make case-specific trade-offs.

These protective ‘devices’ imply that professionalscan be trained, socialized, and supervised by peers;that case-related considerations and decisions aresubstantive (instead of, e.g. financial or commercial);and that professionals can take decisions in ways thatare profitable for clients. Ideally, these decisions areconvincing and accepted, both by the clients serveddirectly as well as stakeholders and society at large.Ideally, professionals and their professionalism aretrusted.

These protective mechanisms and their profitableeffects have always raised questions (Illich 1975),but they have come under increasing pressures. Theprotective ‘shields’ are increasingly weakened and/ortaken away. This is not merely a matter of ‘manage-rial hegemony’, backed by the rise of business-likemanagement, output control, management systems,and market logics (Freidson 2001). It is a matter ofbroader societal changes that also affect organiza-tions, managers, and systems (Noordegraaf 2011,2015a, 2019; Faulconbridge and Muzio 2012;Kirkpatrick and Noordegraaf 2015).

Academically, this has led to contrasting, ‘black orwhite’ responses. On the one hand, experts highlightthe ‘fall of professionalism’; on the other hand,experts stress a ‘return to professionalism’. In this ar-ticle, we take another route: we stress the ‘reconfigu-ration of professionalism’. We focus on the rise ofnew forms of professionalism, especially connectiveprofessionalism (cf. Noordegraaf, Van der Steen andVan Twist 2014; Noordegraaf 2015a). This impliesthat professional work remains ‘professional’, but innew ways and forms, related to societal conditions,

demands, and expectations. Instead of ‘detaching’professional work from outside environments andsocietal circumstances, it is ‘connected’ to clients,stakeholders, influences, in such a way that profes-sional identities can be upheld, professional decisionscan be taken, and legitimacy can be (re)gained. Howthis is and can be done, has to be analysed and callsfor research outlooks.

We start by discussing the ideal type (and ideal)of protective professionalism. We then discuss pres-sures on professionalism, professional work, and pro-fessionals. Next, we explore academic responses, andwe highlight the importance of the ‘reconfiguration’of professionalism, leading to notions such as ‘hy-brid’, ‘organizing’, and ‘connective’ professionalism.We focus on the latter, which we portray as a rela-tional view upon professional action. We analysethree crucial dimensions of connective professional-ism: how can professionals be connected and remainexperts, autonomous, and authoritative? We elabo-rate this in terms of ‘relational expertise’, ‘relationalautonomy’ and ‘relational authority’. We provideillustrations and present key components of a re-search perspective that fit our explorations. Finally,we draw conclusions.

P R O T E C T I V E S H I E L D S I N A N D A R O U N D

P R O F E S S I O N A L I S MTraditionally, professionalism is seen as a special wayof regulating work (Wilensky 1964; Abbott 1988;Freidson 1994, 2001; Timmermans 2005a). When agroup of workers within an occupational field man-ages to define and develop its own field, backed bythe state and linked to universities, they can form aprofession. The occupational field goes beyond terri-tory and association, but already generates imagesand feelings of occupational belonging. People whowork within the medical field, for example, will de-velop medical identities and loyalties. Within an oc-cupational field, there will be more formalizedprofessions, which are identifiable associations withmembers, operating within a certain jurisdiction. Inthe medical field, to continue the example, there willbe multiple medical professions, first and foremosttied to territory, that is, countries. Nation states ac-knowledge professional associations and legitimatetheir exertion of jurisdictional control.

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The profession, in turn, consists of specialized seg-ments (Bucher and Strauss 1961), with distinctiveprofessional standards, both technical and ethical.These segments, in turn, consist of professionals whodo the real work. They are granted autonomy to act,both as members of a collective association, as wellas individually. A medical doctor, for instance, is enti-tled to make decisions independently of political, or-ganizational, or financial considerations. His/herprofessional work relates to treating cases and clients,and for this, the professional has discretionary space.This means he/she can translate standards to thespecific situation (case, client) at hand, in order todeliver high-quality services.

All of these features act as ‘protective shields’,which detach professionals and professional workfrom the world, whilst at the same time serving theworld. Taken together, these shields determine whatis protected (professions, work, autonomous action),how this is done (by way of legal, cultural, and sym-bolic technologies), who is protecting (the state, uni-versities, and associations), and why this is done (toguard social utility). Professionals can then deter-mine which ways of working are effective, they cantreat clients and cases optimally, and they are ac-cepted by clients, stakeholders, and society at large,which means they have legitimacy. This constitutesthe key dimensions of professionalism: expertise, au-tonomy, and authority. Professionals treat clientswell, and therefore society, by relying on state-of-the-art knowledge, standards, and skills (expertise);by translating knowledge and standards to the needsand features of the case at hand (autonomy); and bycomplying with and updating standards and codes(authority). This protective logic is summarized inFig. 1.

P R E S S U R E S O N ( P R O T E C T E D )

P R O F E S S I O N A L I S MThis idealized (but often also ‘ideal’) imagery alwayshad its flaws. The fact that professionals come to-gether to determine what professionalism means,does not mean that all professionals act ‘profession-ally’. On the contrary, professionals can make mis-takes, show misconduct, mistreat clients, go againstclient preferences, and serve their own interests(Sutcliffe 2004; Rowley and Waring 2011; Currie

et al. 2009). Moreover, there might be issues orproblems related to determining what is ‘effective’and professional acts might not be seen as legitimateby outsiders (Martin 2008). In fact, professional au-tonomy can also be seen as ‘a form of professionallyimmunized accountability’ (cf. Timmermans 2005a:498). In addition, even legitimate professional actionmight harm instead of help society (Illich 1975). Inshort, the protective shields that were discussedabove appear to be fragile. Professionalism is not im-mune to outside pressures.

Societal pressuresNowadays, the shortcomings of protective profes-sionalism are increasingly clear. In fact, protectiveprofessionalism and protected professionals arebecoming outdated. Due to heterogeneity andfragmentation within professional fields, interdepen-dencies between professional fields, and dependen-cies of professional actions on outside worlds,professionals can no longer detach or isolate them-selves from others and outsiders (Noordegraaf, Vander Steen and Van Twist 2014). The protectiveshields are breaking down, against the background ofchanging interactions between professions, states,markets, and social life.

First, the breaking down of protective shields isrelated to financial–economic pressures. In many ser-vice sectors, including healthcare and education, ris-ing costs have to be controlled. Irrespective of howthis is done—by way of budget cuts, rationing, effi-ciency gains, marketization, competition, and thelike—it will have effects on professional work. Inone way or the other, an organizational logic willcome to the fore, quality has to be combined with ef-ficiency, acts and decisions will have to be registeredand traced, and decisions might be turned into cost–benefit trade-offs, at least partly (Kirkpatrick,Ackroyd and Walker 2015; Noordegraaf 2015b).This generates the ‘anti-manager’ and ‘anti-system’sentiments, visible in many sectors, in many coun-tries. These sentiments are understandable and use-ful, although they might underestimate theimportance of managers and systems in order tocope with wider economic circumstances. Wheneconomies are vulnerable, when societies face fiscalstress, and when public means are limited, acts anddecisions—with financial implications—will have to

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be restrained (Noordegraaf 2015a). The relevantquestion is not whether this needs to be done, buthow.

Secondly, there are socio-cultural pressures. Incase of many cases and clients that/who are in needof professional services, there are changing social andcultural circumstances that call for changing profes-sional action. Cases might be increasingly complex,such as in case of the so-called multiproblems, whichmeans that one professional cannot solve the prob-lem. Both ‘component complexity’ and ‘coordinativecomplexity’ might be strong (cf. Bohle Carbonellet al. 2014). Moreover, even when multiple profes-sionals start to act, the nature of the problem mightbe seen to be framed differently. Instead of treating acase of client (e.g. a patient), professionals might beexpected to prevent problems (e.g. diseases) fromhappening. In a wider sense, service interactionsmight be affected by declining trust, against the back-ground of transitions from ‘high trust’ to ‘low trust’societies (Troman 2000; Gleeson and Knights2006).

Thirdly, there are pressures linked to public andpolitical turmoil. Driven by incidents and insecurities,all kinds of public worries are tied to professionalservices. There might be worries over social integra-tion, or radicalization, or polarization, and this can-not be isolated from professional services such aseducation, social work, policing, public persecution,and law courts. There might also be worries overmore mundane problems and failures, such as medi-cal errors, including complications and unnecessarydeaths, for example, during and after medical opera-tions (Sutcliffe 2004). This means that services haveto be transparent and accountable (Timmermans2005a), and that professionals have to optimize workprocesses, reduce risks, and enhance (collective)learning.

Finally, there are technological pressures. On theone hand, this is a matter of social media and itseffects on exposing incidents and anxieties (seeabove), as well as the rise of boundaryless social net-works, fuelled by Google and Facebook. On theother hand, it is a matter of profound technological

Figure 1. Protective professionalism.


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changes, most specifically the rise of the Internet,digitalization, AI, big data, and algorithms (Susskindand Susskind 2015). Thich is not only exploiting orguiding social behaviour, for example, when Googleor Facebook traces and uses its member data. It isalso a matter of digital influences on professionalwork, for example, when medical decisions are sup-ported by algorithms or when medical doctors arereplaced by computers and robots (Darcy, Louie andRoberts 2016).

ResponsesThese pressures have consequences, not only practi-cally but also academically. In fact, various debateson the future of professionalism can be identified.First and foremost, there is a debate in which the‘fall of professionalism’ is highlighted (Southon andBraithwaite 1998; Broadbent, Dietrich and Roberts2005). According to experts, there will be a ‘decline’,‘withering away’, ‘hollowing out’, and so on, of pro-fessionalism. This implies that ‘the end’ of the pro-fessional era is predicted or announced, and thatformerly professional services are ‘normalized’.

On the other hand, there is a debate on the ‘returnto professionalism’. According to other experts, theremight be a ‘return to’ professional identities, values,and spaces (Freidson 2001). This might mean thatprofessional changes are resisted, that professional-ism is ‘restored’ or ‘reinstalled’, and that professional-ism is ‘rescued’. This is important, it is argued,because professionalism represents certain societalideals—independence, quality, (service) ideology—that enhance societal strength.

In addition to these ‘all of nothing’ or ‘black orwhite’ debates and routes or responses to changes,there is a third type of debate which is less dichoto-mous, going beyond binary approaches on ‘profes-sionalism versus managerialism’. This is the debateon the ‘reconfiguration of professionalism’, in whichprofessional identities and actions are neither wither-ing away nor reinstalled. Professionalism changes interms of form, shape, and meaning, in the light of so-cietal changes. Professionalism might then become‘hybrid’ (instead of ‘pure’) or ‘organizing’ (instead ofset apart from organizational aspects), and even ‘con-nected’ (instead of ‘detached’). Before we focus onconnective professionalism, we briefly summarize theother, less far-reaching forms of reconfiguration.

Hybrid and organizing professionalismIn many papers (such as Byrkjeflot and KraghJespersen 2014; McGivern et al. 2015; Spyridonidis,Hendy and Barlow 2015) as well as special issuesand journals, such as this Journal of Professions andOrganization (JPO) (Carvalho 2014; Blomgren andWaks 2015; Breit, Fossestøl and Andreassen 2018),there is an increasing stress upon the hybridization ofprofessionalism. This means that organizational andmanagerial logics are combined with professionallogics, also in professional work, although ‘combined’sounds too easy—it implies difficult combinations.Bringing together different logics might feel unnatu-ral, which is why it is often called ‘hybrid’ or ‘hybrid-ity’, that is, the unnatural coming together ofcontrasting values and logics (cf. Noordegraaf2015a).

Subsequently, there might be a move beyond hy-bridity. Combining organizational or managerial andprofessional aspects, dimensions or logics might beseen as quite normal—as something that is naturalin case of contemporary professional work, despitethe fact that there will be many tensions, dilemmas,and trade-offs. Dealing with collaborative, account-ability, cost-related, and leadership considerations inprofessional work, among medical doctors, for in-stance, might traditionally not be common, andmight raise challenges, but it might be somethingthat belongs to professional work. In fact, it is seenas contemporary professional work, as is illustratedin the medical profession and the redesign of medicaleducation along the lines of new competency mod-els. This is not so much the development of organi-zational aspects in professional work, but oforganizing aspects. Medical doctors cannot ignorethe fact that they are co-responsible for organizingprofessional services processes (cf. Noordegraaf2015a). By working together, by coordinating, byspeaking about results, by taking the wider contextinto account, and by reworking professional duties(such as also focusing on prevention instead ofmerely curing diseases), the quality of services mightbe enhanced instead of reduced.

The effects are far-reaching, not only practicallybut also analytically. Professionalism is no longersolely linked to ‘the professional’. It is linked to pro-fessional work processes (cf. Noordegraaf 2015a).


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Instead of emphasizing the professional as ‘solo prac-titioner’, professionalism becomes more collectiveand processual. This can be taken one step further—we can go beyond organizing professionalism. In addi-tion to combining organizational and professionalaspects as well as interweaving organizing into pro-fessional practices, professionalism can become con-textual in a wider sense. Apart from ‘organizing’aspects, within organizational settings, professionalacts can be related to the outside world, including ex-ternal influences and pressures. This has rather fun-damental effects on the nature and meaning ofprofessionalism. Professionalism becomes meaning-ful in relation to clients, stakeholders, and actors, inwider service systems and societal settings.

Towards connective professionalism?These rather fundamental effects ‘turn around’ theprimacy of professionalism. Instead of letting profes-sionals determine what is effective, societal actors(might) have strong ideas on ‘effective’ services; in-stead of having professionals make decisions, clientsand stakeholders want to be co-deciders and evenco-producers; instead of letting professionals ‘own’client information, information is shared or ownedby clients, also digitally; instead of using informationon ‘a’ client for ‘a’ client, the information gatheredsays a lot about client populations and might be usedto make decisions; instead of trusting professionalsper se, professionals have to earn trust on the basis ofappearance and acts, instead of their association.

More analytically, this means that the nature ofprofessionalism is affected, even more so than incase of hybrid and organizing professionalism. Thekey dimensions of professionalism that were dis-cussed before are heavily affected. Professional exper-tise is affected, that is, the ‘technical base’ ofprofessionalism (cf. Wilensky 1964). Professional au-tonomy is affected, that is, the shelter againstunwanted outside interference and guarantee for in-dependent acts. Professional authority is affected,that is, the way in which professionals contribute tolegitimate and legitimated societal interventions.

In the remainder of this article, we contribute tothis broader understanding of connective profession-alism, given its potential far-reaching and wide-ranging changes. We argue that a move towards con-nectivity calls for more fundamental reflections and

redefinitions of what professionalism means andwhat professionals are. We especially focus on thequestion of how professional action can be related toothers and outsiders and remain ‘knowledgeable’,‘autonomous’, and ‘authoritative’ at the same time.Before we focus on expertise, autonomy, and author-ity, we elaborate our relational understanding of pro-fessionalism. Next, we provide some illustrations anddevelop an appropriate research perspective.

C O N N E C T I V E P R O F E S S I O N A L I S M A S

R E L A T I O N A LIn an earlier paper, Anteby, Chan and DiBenigno(2016) identified three ‘lenses’ for studying and un-derstanding professionalism: professionalism as ‘be-coming’, ‘doing’, and ‘relating’. The first lens,becoming, refers to ‘processes by which new membersare inducted into established occupational communi-ties as well as the individual transformations that oc-cur among newly inducted members’ (Anteby, Chanand DiBenigno 2016: 190). The second lens, doing,‘focuses on how occupational members perform ac-tivities—like work tasks or practices—that have con-sequences for individual, occupational andorganizational outcomes’ (Anteby, Chan andDiBenigno 2016: 200). The third lens, relating, ‘fo-cuses understanding when and how occupationalgroups collaborate with other groups to performinterdependent work or collectively expand their so-cial influence’ (Anteby, Chan and DiBenigno 2016:213). According to Anteby, Chan and DiBenigno,this third lens leads to three emphases in the litera-ture: ‘collaborating’, that is, ‘collaboration across andwithin occupations’ (Anteby, Chan and DiBenigno2016: 213); ‘co-producing’, that is, situating occupa-tions in relation to a complex web of other entities’(Anteby, Chan and DiBenigno 2016: 213); and ‘bro-kering’, that is, ‘the rise of intermediary occupationalgroups that play an essential role in maintaining thefunctioning of these complex webs of relations . . .’(Anteby, Chan and DiBenigno 2016: 213).

In order to improve our understandings of profes-sionalism and professionals, in relation to external/societal changes, we rely upon a relating perspective,which is even more relational than Anteby, Chanand DiBenigno show (as ‘collaborating, co-producing, brokering’ are rather traditional


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concepts). The rise of ‘connective’ professionalism isnot so much a matter of who professionals are, norhow they act, nor how they collaborate, but how thesurroundings and processes that make up their workare producing professional powers—or the lackthereof.

Justin Waring who invokes ‘relational sociology’(Waring 2014: 696) to understand shifting roles of‘hybrid’ elite professionals argues that such a sociol-ogy ‘draws attention to the relational connectionsand dependencies between elites and the workplace,market and society, including both those in moremanagerial domains and also the wider rank and file’(Waring 2014: 697). This enables us to trace ‘chang-ing forms of status, power and inequality’ (Waring2014: 697). ‘Through analysis of . . . relational con-tingencies, it becomes possible to trace the influenceof different discourses and the corresponding formsof governmentality’ (Waring 2014: 697).

Despite the emphasis on professionals’ self-images, identities, standards, coping, and service ori-entations, it is these relations to cases, clients, andstakeholders as well as the services processes thatthey enact, that constitute connective professional-ism. Both in terms of whether their acts are ‘effective’and ‘optimal’ as well as ‘legitimate’. Effectiveness andlegitimacy are no longer ‘owned’ by professionalsthemselves and or ‘granted to’ them. They have tobe generated, reproduced, coproduced, redesigned,and deserved—as active processes.

This implies that professionalism is neither a staticphenomenon nor a dynamic but manageable process.On the contrary, it is an interactive, living phenome-non, taking shape in real-life processes, situated incomplex service ecologies, with multiple relations tostakeholders. This implies that the key dimensions ofprofessionalism—expertise, autonomy, and author-ity—can no longer be seen as fixed entities. Thesecrucial dimensions of professional practice also be-come relational. They have to be enacted on a con-tinuous basis, backed by certain mechanisms thataccentuate—instead of ‘protect’—key aspects of pro-fessional acts. The key question is, How can connectedprofessionals remain experts, autonomous, and authori-tative in complex webs of relations? Beneath we ex-plore partial answers to this question, first andforemost by exploring the three dimensions sepa-rately. We reconceptualize each of these by turning

from static to dynamic to relational interpretations,backed by literature. Backed by notions that were de-veloped before, we speak of ‘relational expertise’, ‘re-lational autonomy’, and ‘relational authority’. Wecombine these notions to develop a fuller (research)perspective on connective professionalism.

R E L A T I O N A L E X P E R T I S E , A U T O N O M Y ,

A N D A U T H O R I T YExpertise, autonomy, and authority are required toperform tasks well, especially when professionals act.Although they are interrelated, they also representdifferent dimensions of professional service delivery.First and foremost, it is important that services arerendered in knowledgeable ways, that is, that up-to-date knowledge is applied, that cases are treated onthe basis of appropriate expertise, and that professio-nals (and clients) learn from treating cases.Secondly, it is important that services are renderedin autonomous and independent ways, that is, thatthere is leeway to deviate from standards in case-specific situations and that ‘inappropriate’ factors donot affect the decisions taken. Thirdly, it is importantto secure authoritative services, which are seen as le-gitimate, rendered in trustworthy ways, and whichare accepted, even if they go against clients’ interests.

These dimensions, however, cannot be secured intraditional, rather static ways, as was argued above.Cases might have become too complex, (stake-holder) connections to cases have shifted, and casecontexts have become complicated and risky. Insteadof professionals who ‘have’ or ‘own’ expertise, auton-omy, and authority, we should focus on relationalprocesses in which professional expertise, autonomy,and authority are ‘enacted’ and maintained.Professional workers are not only part of profes-sional fields and groups (Fig. 1) but also part ofbroader service processes, which include other profes-sionals and support staff, as well as wider service ecol-ogies in which many other actors are active too,varying from organizational actors via clients andtheir families to wider service surroundings andstakeholders, in an even wider context of public wor-ries and political debates. Beneath we discuss andsummarize each dimension (Table 1), and we com-bine and illustrate them, in order to develop a more


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comprehensive research perspective on connectiveprofessionalism.

ExpertiseBoon, Flood and Webb (2005) argue: ‘The powerand legitimacy of professions is acquired in part fromtheir status as organizations defined by their controlover knowledge. If control over knowledge is lost,what happens to power?’ (Boon, Flood and Webb2005: 474). Instead of stressing the ‘decline’ of (le-gal) professions, they stress the ‘reconfiguration ofprofessionalism and professions’ (Boon, Flood andWebb 2005: 487), against the background of ‘thechanging political economy of higher education andits role in the new capitalism’ (Boon, Flood andWebb 2005: 473). They show how training frame-works and programmes are adapted, with more flexi-bility as well as ‘diversity, differentiation andmobility’ (Boon, Flood and Webb 2005: 475).Likewise, Hilferty, who studied teacher professional-ism, highlights ‘countervailing forces that constrainthe efforts of professionals to exercise authority onthe basis of their knowledge monopolies’ (Hilferty2008: 165). In addition, he argues that ‘for associa-tions, these conditions fundamentally change theframework within which they operate and compelthem to develop a new discourse of professionalismthat is not solely based upon specialist expertise’

(Hilferty 2008: 165). In an even broader sense,others also highlight the increasing importance of‘expert labour’, as well as the increasing difficulty in‘acknowledging expert labour in the traditional pro-fessional model’ (Bellini and Maestripieri 2018: 6).The increasing differentiation and heterogeneitywithin and between professional groups/fieldsshould be taken into account in developing morethorough understandings of contemporaryprofessionalism.

Because cases might be complex, partly becausethey consist of new components such as unpredict-ability and/or novelty, and partly because they com-prise coordinative complexity, it is insufficient tomerely strengthen the ‘technical base’ of professionalwork (cf. Wilensky 1964) and to extend the numberof hours professionals spend on specific tasks. The‘claim of possessing specialized knowledge, compe-tence and skill’, in short ‘expertise’ (cf. Lidskog andLofmarck 2015) has always been a ‘negotiated’ claimbut has to be linked to increasingly ‘uncertain con-texts’ that all the more challenge such claims.

In fact, cases are treated in ‘systems of distributedexpertise’ (cf. Edwards 2011, emphasis added).‘Professionals work in and between work settings andengage with other specialist practitioners and with cli-ents to negotiate interpretations of tasks and ways ofaccomplishing them’ (Edwards 2011: 33). This

Table 1. Ideal-typical differences between protective and connective professionalism

I. Protective professionalismFixed/closed off II. Connective professionalismRelational/open

1. Expertise • Case-oriented• Technical base, knowledge and skills• Clear standards• Training, codes, service ethic

• Complex cases• Interpersonal relations• Distributed expertise• Adaptive expertise, meta-cognitive skills• Learning environments

2. Autonomy • Decisions taken by ‘the’ professional• Independent• Leeway, discretion• No interference

• Decision processes• Interdependent• Shared decision-making• Supportive conditions• (Social) experiences

3. Authority • Professional group• Status and trust, legitimacy• Stable positions

• Professionals in relation to clients and stakeholders• Critical attention• (Media) exposure• Navigating risks, uncertainties, dilemmas


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implies that the ‘core expertise’ of professionals issupplemented by ‘relational expertise’, which ‘makesit possible to work with others to expand understand-ings of the work problem . . .’, and ‘also involves theability to attune one’s responses to the enhanced in-terpretation with those being made by other profes-sionals’ (Edwards 2011: 33). This is also shown bySandefur (2015), who studied the effects of both‘substantive and relational expertise’ of lawyers on liti-gation outcomes. Relational expertise ‘involves theunderstanding of how to navigate the relationships in-volved in getting work done . . .’, which is ‘situationaland contextual’ (Sandefur 2015: 911, emphasisadded). The ‘skill at negotiating the interpersonalenvironments in which professional work takes place’(Sandefur 2015: 924) has multiple effects on cases:presence, personal reputations, confidence, they allinfluence how others—in this case law courts andjudges—act. This resembles our own earlier emphasison the importance of ‘how to be wired in’ when pro-fessional expertise is not automatically decisive, likein case of professional strategists (Noordegraaf, Vander Steen and Van Twist 2014, emphasis added).

In addition, although professionals will have to ac-quire knowledge, they will have to relate their knowl-edge and insights to changing case features(‘component complexity’, cf. Bohle Carbonell et al.2014: 17), as well as changing coordination chal-lenges (‘coordinative complexity’, Carbonell et al.2014: 17). This calls for adaptive expertise, the ‘abilityto quickly get accustomed to change’ (cf. BohleCarbonell et al. 2014: 15), which is situated in rela-tional contexts. Such expertise calls for ‘meta-cogni-tive skills’ (Bohle Carbonell et al. 2014: 15)developed in viable learning environments, the ‘so-cial environment as a place where learning happens’(Bohle Carbonell et al. 2014: 16). It is ‘set apartthrough abilities such as flexibility, ability to inno-vate, continuous learning, seeking out challenges,and creativity’ (Bohle Carbonell et al. 2014: 15).

AutonomyBecause connections to cases (clients and surround-ings) are shifting, it is insufficient to merely guard orstrengthen the autonomy of professionals. Althoughthere needs to be leeway when decisions are made,this leeway does not necessarily reside ‘in’ a profes-sional, as ‘the’ decision-maker, but ‘in-between’

professionals, clients, and others, as the decision pro-cess. This can be linked to ongoing debates on theshortcomings of privileging professionals as autono-mous, ‘atomistic’ agents (Verkerk 2001), of seeingprofessional action as ‘separate’ action, set against‘non-professional’ action (Thomas and Hewitt 2011;Wald and Pierce 2016), and professional schoolingas a way of optimizing ‘individual professionalachievement’.

‘Both the individual and collective aspects of pro-fessional autonomy are rooted in (a) the socially leg-islated powers of professional societies, and (b) thesocial status bestowed on professional by our cultureand social institutions’ (Verkerk 2001: 285).Professionals rely upon memberships, shared stand-ards, education and skills, and licences; medicalschool provides transformative experiences; we, thepublic, (re)produce stereotypes. As Pololi et al.(2009: 112) argue, when they discuss the culture ofacademic medicine, ‘A structure that rewards individ-ual achievement, self-promotion, and being lead au-thor on publications, rather than collaborativeefforts, may seriously impede interdisciplinary andcollaborative work in the biomedical sciences.’

Dove et al. (2017) criticize the ‘dominant, indi-vidualistic understanding of autonomy that featuresin clinical practice and research’, ‘underpinned bythe idea that people are, in their ideal form, indepen-dent, self-interested and rational gain-maximising de-cision-makers’ (Dove et al. 2017: 150). They replacethis by stressing the importance of ‘relational auton-omy’, linked to a so-called ‘relational turn’, arguingthat ‘people’s identities, needs, interests—and indeedautonomy—are always also shaped by their relationsto others’ (Dove et al. 2017: 150). Interdependenceinstead of independence is privileged (see alsoVerkerk 2001: 291); ‘interpersonal relations and so-cial conditions’ (Dove et al. 2017: 154) constituteautonomy; professionals are ‘socially situated’ (Doveet al. 2017: 161). In the medical field, this stimulatespractical mechanisms such as ‘informed consent’,‘shared decision-making’, routes for dealing with‘socio-clinical dilemma’s’, and ‘shared medical infor-mation’ (Dove et al. 2017: 160).

According to MacDonald (2002), ‘an understand-ing of relational autonomy . . . requires a focus onthe importance of supportive social conditions forfostering autonomous actions. On such a view,


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individual autonomy is socially dependent, that is, thecapacity and opportunity for autonomous action isdependent on our particular social relationships andthe power structures in which we are embedded’(MacDonald 2002: 283, emphasis added). It requires‘material security’ and ‘supportive structures, bothpersonal and political’ (MacDonald 2002: 283).‘Autonomy is affected by both “transformative expe-riences” and “socially constructed stereotypes”’(MacDonald 2002: 283).

This implies that maintaining autonomy calls forconnecting professional actions to social experiences,in addition to navigating relations and being wired in,in order to perform expert roles (see the previousparagraph).

AuthorityBecause case contexts are complicated and risky, theauthority of professionals is far from secure.Although many professional fields have societalstanding and status, and although we still trust manyprofessional groups, status and trust figures might bedropping, depending on country context, and‘attacks’ on professional fields/groups might begrowing. The latter phenomenon is fuelled by inci-dents that are publicly exposed, by critiques that arespread by (social) media and by political curbing ofprofessional powers, especially in the Trumpian‘post-truth’ era. In some countries, many professionalgroups experience difficult times, varying from law-yers via academic to journalists. Instead of being‘given’ and ‘having’ authority, they have to re-enactauthority on a continuous basis, in relation to clientsand other stakeholders.

Lidskog and Lofmarck (2015) argue that ‘in con-temporary society, authority is to a large extent con-tested and negotiated . . .. Authority is not given buthas to be earned, and therefore, professional expertsmust take the client’s understanding of a problemmore seriously, both to be able to provide relevantguidance and to be trusted by those whose action itseeks to influence . . .’ (Lidskog and Lofmarck 2015:150). They use the empirical example of professionalforest counselling, who have to deal with climatechange, and show how multiple uncertainties in-crease these challenges: cognitive, strategic, institu-tional, and normative uncertainties. This implies,they show, that professional consultants ‘assume the

role of professional navigators in a landscape popu-lated by risks and uncertainties’ (Lidskog andLofmarck 2015: 157). In that way, they can accepttheir changing ‘epistemic authority’ without‘compromising their professional claim’ (Lidskogand Lofmarck 2015: 160). They must be ‘context-sensitive and receptive’ to others’ ‘experience andinterest’.

According to Timmermans (2005b) who studiedthe ways in which death investigators to determinesuicide ‘forensic investigations do not only constitutethe raw material of suicide statistics but also reflect aprofession’s authority to classify and explain suspi-cious deaths’ (Timmermans 2005b: 313). This is atricky affair, especially when there are charges of in-accuracy. Their authority not only depends upon‘professional standards to classify deaths’(Timmermans 2005b: 314), but also on ‘who consti-tute the audiences of their determination’ and ‘whatimpact these audiences—particularly relatives andpublic health audiences—have on the detection ofsuicide’ (Timmermans 2005b: 314).

In another paper on ‘clinical practice guidelines’,Timmermans (2005a) shows the wider implications.Professionals have to seek new ways of remaining au-thoritative amidst other ‘powers, such as corpora-tions, competitors, payers, consumers and the state’(Timmermans 2005a: 492). They do this by adopt-ing new guidelines and standards, backed by ‘evi-dence-based medicine’, so that the requirements of‘other audiences’—external recognition, performanceevaluation, financial accountability—are met(Timmermans 2005a: 496–497). This turns newguidelines that regulate professional behaviour intothe ‘profession’s heart and its Achilles heel’. ‘The es-tablishment and expansion of a profession’s jurisdic-tion [by way of clinical guidelines] might changeclinical and professional autonomy and open a pro-fession to third-party accountability’ (Timmermans2005a: 496). Especially when cases or issues are un-certain, it is challenging to cope with uncertainty in-ternally, within a professional field, and to makeprofessional acts trustworthy for outside worlds.

In addition to navigating relations and being wiredin, in the fabric of organizational decision-making(expertise), and making connections to social experi-ences, in webs of social relations (autonomy), con-nective professionalism implies navigating risks and


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uncertainties and perform trust in order to beingtaken seriously (authority).

C O N N E C T I V E P R O F E S S I O N A L I S MIn Table 1, the move towards connective profession-alism is summarized, by listing the ideal-typical dif-ferences between protective and connectiveprofessionalism in terms of the three key dimen-sions: ‘expertise’, ‘autonomy’, and ‘authority’. This isdone to define and conceptualize this move, but alsoto make it more operational. The listed dimensionsnot only highlight the differences, but they also en-able us to recognize connective professionalism inmore operational ways. This is especially importantwhen we trace the rise of connective professionalpractices, to which we turn now. After we have dis-cussed various practical examples, we discuss how aconnective professionalism perspective can be usedas a research perspective.

Practical examplesThe summary of connective professionalism, as op-posed to protective professionalism, is ideal-typical,as well as—to some extent—‘ideal’. It represents apreferable image of professionalism, linked tobroader, societal conditions. This means that actualprofessionalism might be at odds with this image,both because real-life situations will not automati-cally resemble an ideal-typical representation, andbecause the ‘ideal’ might be contested. In this respectwe need to be modest and downplay any attempt topropose paradigmatic changes.

At the same time, there are reasons to stress therise of connective professionalism, not only becauseit is academically underscored (Noordegraaf, Vander Steen and Van Twist 2014; Waring 2014) butalso because it is visible in day-to-day professionalpractices. Beneath we provide a few clear examplesof connective professionalism: we focus on judges,medical doctors, and academics, who work in promi-nent professional fields in which professionalism isslowly reconfigured.

Community judgesJudges are a ‘critical case’ as far as the reconfigurationof professionalism is concerned: they are highlytrained, they know the law, they apply legal expertise.

Moreover, they are highly ‘autonomous’, both collec-tively—as the judiciary—and individually—asjudges. At the same time, the effectiveness and legiti-macy of the judiciary and judges are not guaranteed.In fact, in many countries there are debates on grow-ing pressures on law courts and judges (Contini andMohr 2008), including inefficiencies, waste, and le-gitimacy problems.

This means, first of all, that we see redefinitionsof the values that law courts and judges might takeinto account. In addition to traditional legal values,there is a growing emphasis on organizational andsocietal values. When a legal case is treated andjudges work towards a verdict, they are not only sup-posed to offer legal quality, but also timely treatmentand societal effects. Do judges treat cases without toomuch delay? Do they help solving conflicts? (e.g. seealso Eicher and Schedler 2012; De Bock 2014;NSOB 2014; Noordegraaf 2015b). When multiplelegal cases are treated, the same logic applies: dojudges offer legal quality, but also ‘efficiency’ and‘results’, that is, do they reduce the number ofdelayed, untreated, and backlog cases, and are lawcourts seen as legitimate problem solvers?

Secondly, we see contemporary attempts to orga-nize in new ways, aimed at making judges co-responsible for serving the law, serving the organiza-tion, and serving society at the same time. This canbe done by introducing self-managing teams ofjudges, making judges co-responsible for planning,making judges co-responsible for quality improve-ment, and by joint learning.

Thirdly, we see more far-reaching attempts to linkjudges and legal procedures to societal surroundings,for example, by introducing community judges whoact as judicial problem solves, by interacting with cli-ents, agencies, and neighbourhoods. One prime ex-ample is the so-called community court, whichoriginated in Red Hook, NYC (Berman 2004) andspread throughout the USA and other countries. Incommunity courts, autonomy is restricted and re-lated to the outside world, in order to (1) treat everydefendant, victim, and member of the public ‘withdignity and respect’; (2) ‘to be more thoughtfulabout case outcomes’ and to increase ‘the use ofcommunity restitution and social services’, in addi-tion to fines and incarceration; and (3) ‘engage thepublic and to speak more plainly with the public’,


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especially among disadvantaged and poor popula-tions, as one of the founders, Greg Berman explains(Berman 2019: 17).

First and foremost, they do this by distinguishingbetween the courthouse and the courtroom. AsBerman explains (Berman 2019: 22), ‘The businessof the courthouse is more than just holding trials.We wanted to leverage the symbolic power of thecourts in the community and go beyond just whathappens in the courtroom. We have argued that thejudiciary should not take judicial independence forgranted, that they have to earn it at some level, andthey earn it by showing their work to the public.’Although what happens inside the courtroom ismore ‘sacrosanct’, ‘impartial’, and ‘independent’(Berman 2019: 22), judges also change. They aremore approachable, there is more horizontal interac-tion with defendants, victims, and agencies, andsocio-economic contexts of cases are much moretaken into account, backed by less judicial and moresocietal attitudes.

More fundamentally, this implies that judgesknow how to link themselves to societal processes,agencies, and parties in and around the courtroom.In other innovative manifestations, this might evenimply that judges move towards urban areas andneighbourhoods, instead of defendants and/or vic-tims moving towards them. (This can be comparedto ‘The patient will see you now’, Topol 2016, whichstresses reversed relations between professionals andclients.). Furthermore, it implies that judges dealwith dilemmas in new ways, such as the dilemma be-tween being neutral, at a distance, and objective onthe one hand versus being involved and committedon the other hand. Or the dilemma between makingdecisive verdicts, which are legally sound, versusmaking societal interventions which ‘lead to some-thing’, such as the reduction of conflict.

Finally, it implies that judges do not presupposethat they are trusted and seen as legitimate problemsolvers—they have to earn respect and trust, not inthe least by how they perform, inside and outsidethe courtroom, together with their colleagues. Thismight concern particular complex cases: how theyact, whether they realize ‘procedural justice’ (Bermanand Gold 2012; Grootelaar 2018), whether they areable to account for judicial decisions towards non-legal audiences, this affects the legitimacy of court

decisions. It might also concern the way in whichthey deal with multiple cases, whether they deal withthem on time, whether they are able to innovate;this might call for public or political justification.And when judicial organizations or institutions are atstake, judges and colleagues will have to find ways tobe transparent about court developments, withoutlosing trust (Grimmelikhuijsen and Klijn 2015).

Leading medical doctorsMedical doctors are also interesting examples ofchanging professionalism, as they represent one ofthe classic image of professionalism: ‘the doctor’ as‘the professional’, who treats the ‘disease’ of ‘his/herpatients’ as optimally as possible, backed by state-of-the-art knowledge, skills, and techniques. These areapplied with much medical autonomy, in order toprotect medical decision-making against unwanted‘intrusions’ and secure ‘medical’ case treatment.

As in the case of judges, one of the first transi-tions relates to the terms ‘medical’ and ‘medical qual-ity’. Definitions are shifting. In case of medicalprofessionalism, there has been a wide-ranging rec-onceptualization of medical quality, which now com-prises multiple dimensions, including what is oftenseen as managerial dimensions (Richardson 2001):high-quality care is ‘safe, effective, patient-centred,timely, efficient, equitable’ healthcare.

Secondly, as in the case of law courts, there aretransitions in organizational forms and methods. Onthe one hand, hospitals are turned into multi-divisional forms (cf. Mintzberg 1983), with clearsteering, results, and accountability. On the otherhand, all kinds of more professional forms and meth-ods are installed to secure leeway for medical profes-sionals and to bring them ‘in the lead’. Think of dualmanagement, medical managers, self-managingteams, and the like (Llewelyn 2001). This impliesthat medical professionalism increasingly becomes‘hybrid’ (cf. Noordegraaf 2007), as has been shownbefore.

Thirdly, going beyond hybridity, medical doc-tors—as well as nurses—are increasingly connectedto complex case contexts, including multiple profes-sionals, multidisciplinary collaboration, organiza-tional requirements, accountability, multi-morbidity,stakeholder preferences, and public debates. This isdone, among other things, by formalizing new


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medical competencies, changing medical curricu-lums, and stimulating ‘medical leadership’ (Voogt2019). In many Western countries, new competencymodels such as CanMEDS (Frank and Danoff 2007)have been adopted and implemented in order to en-act broader repertoires of contemporary medicaldoctors. This is related to broader, systems-relatedviews upon medical interventions (Frenk et al.2010), in which medical professionals and others col-laborate, and in which medical professionals connecttheir evidence to patient experiences. This might befacilitated by technological processes, which changethe nature of professional acts in relation to casesand contexts. Electronic patient files, for example,enable medical professionals to share information;digital information processing facilitates (multidisci-plinary) diagnostic support; algorithms direct medi-cal decisions in relation to context; online systemsfacilitate professional–client interactions.

More fundamentally, this implies that medicalprofessionals have to attend the right meetings, inaddition to patient interactions: multidisciplinarymeetings, meetings to learn from mistakes, staffmeetings, and public meetings in case of new or‘tricky’ circumstances. In addition, it implies thatthey have to deal with dilemmas, such as the di-lemma between extending treatment on medicalgrounds and patient (or family) preferences, whichmight go against extending treatment. Or dilemmasconcerning how to prioritize treatment, and whetherdemographic conditions or lifestyles should be takeninto account.

Finally, it implies that medical professionals can-not start from ‘secure’ positions of authority buthave to earn a legitimate share or stake in healthinterventions. When patients ‘know it better’ or donot trust medical doctors or turn to alternative medi-cal circuits, medical doctors have to earn trust by be-ing honest—for example, on the ‘trial and error’nature of many medical processes; by being convinc-ing, backed by arguments; by explaining how thingswork or did not work; by being transparent.

Impactful academicsFinally, our own work as academics is changing aswell. Instead of focusing on individual research proj-ects and outputs—and primarily on publications—academics have to work together, not in the least to

establish multidisciplinary programmes and con-sortiums, and they have to be relevant for society.The latter aspect means that academics take societalresponsibility, focus on societal issues, and try tohave an impact. This is happening on a broad, trans-national scale, for example, within the EuropeanUnion which has embraced the so-called ‘OpenScience’ movement (Benedictus, Miedema andFerguson 2016). It is happening nationally, for exam-ple, when policy-makers redirect science strategies,aimed at optimizing ‘impact’ and the so-called ‘im-pact pathways’ (cf. KNAW 2018). In addition, it hap-pens at universities, especially when universityboards formalize their social or societal roles andresponsibilities.

If this happens, academics are stimulated to linkeducation and research to society, that is, to societalpartners, practices, and problems. This has organiza-tional consequences and it changes professional ori-entations. Organizationally, it means thatinteractions between science and society have to bedeveloped and supported. This implies clear organi-zational positioning and profiling, in a strategicsense, as well as modern governance, with facultieslinked to themes linked to support staff and organi-zational structuring aimed at linking education, re-search, and impact. In addition, this implies adequatesupport, with adequate back offices, and organiza-tional teams that are able to combine substance, fi-nance, HR, and facilities.

Professionally, it means that ‘the academic’becomes a relative phenomenon, and that teams ofacademics, who are well supported and well con-nected to partners and practices, become more rele-vant. This has consequences for expertise, skills, andcompetencies. Academic fields and bodies of knowl-edge become interrelated. Academics need to be ableto work on the basis of their expertise, which cannotbe isolated from the expertise of others, both insideand outside academia. They need to be able to relateknowledge (development) to publics, sometimes lit-erally (through the media). They, moreover, need tobe able to do this in the light of politicized publicissues, such as sustainability (plastics, energy transi-tion, climate adaptation, urban innovation, circulareconomy), public health (prevention, vaccination,behaviour, cost control), security (terrorism, radicali-zation, violence, right-wing extremism), and the like.


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In addition, academics need to be able to deal withconsortiums, attracting money, and applications;they need to be able to ‘make deals’ and controlprojects.

In a more fundamental sense, this implies thatacademics are present at the right tables, both insideand outside academia, and that they find new routesfor working with other academics and people outsideuniversities. Merely working on ‘your own work’does not generate valuable and/or valued science.Especially as ‘outsiders’, publics, financers, anddecision-makers expect something else. Next, itimplies that academics deal with new matters andquestions, such as matters of what it means to be ‘in-dependent’. When we work together with outsidepartners, including public, private and non-profitorganizations, organizational agendas, interests, and/or reputations might be at stake. Academics will haveto be able to deal with the dilemmas that flow fromthis, professionally, supported by organizationalinfrastructures. Finally, it implies that they need tomaintain and/or develop trust and legitimacy, espe-cially as the outside world does not automaticallyrely upon scientific facts and scientific ‘truth’. In caseof politicized social/societal issues, the scientificvoice is only one of the many voices heard, insteadof a privileged one.

Connective professionalism as a researchperspective

These examples show how professionalism might bereconfigured and how professional identities and actsbecome part of wider environments in which otherprofessionals, organizational actors, clients, stake-holders, organizations, politicians, and publics arepart of realizing ‘professional’ services. Professionalsthemselves still have special significance and addedvalue because they have distinctive expertise, are ableto withstand pressures, and can be trusted, but thesekey dimensions—expertise, autonomy, and author-ity—are not ‘controlled’, that is, not created, main-tained, and applied by professionals themselves.

In many ways, this is a traditional fact of profes-sional life: professional fields have always been depen-dent upon other actors—as ‘powers’—to become anactor or power themselves. They have always neededback-up by the state, support from universities, and

public consent. Setting standards, moreover, alwayshad something to do with case/client-related featuresand ethical or societal values. But nowadays, profes-sional fields and professional acts have become allthe more dependent upon the ‘outside world’.Traditional protective shields are weakened.

This means that connectivity has acquired special,contemporary meaning: in order to maintain exper-tise, autonomy, and authority, professionals need toacknowledge interdependency, instead of indepen-dence and mere dependency. They need to be awareof the fact that expertise is distributed, that auton-omy is contested, and that there are multiple formsof authority. And, vice versa, they need to make surethat they are experts in relating themselves to others,in using social mechanisms to make ‘their own’ deci-sions, and in acting trustfully so that they respected.As far as professional agency is concerned, thisimplies that professional agents need to be aware ofthe fact that professionalism is not residing ‘in’ pro-fessionals but happens in-between professional action(in occupational domains) and the outside world(and social domains). Connective professionals needto be able to navigate relations and to be wired in, tobe at the right tables, in order to perform expertroles; to understand social experiences in order tomaintain a sense of autonomy; and to navigate risks,including trade-offs and dilemmas, and to performtrust and gain respect, also on a day-to-day basis, inorder to remain authoritative.

‘Relational agency’, Edwards (2011) argues,‘involves a capacity for working with others tostrengthen purposeful responses to complex prob-lems’ (Edwards 2011: 34), to ‘expand the object ofactivity or task worked on’, especially by ‘recognisingthe motives and the resources that others bring tobear . . .’ and ‘aligning one’s own responses to thenewly enhanced interpretations’ (Edwards 2011:34). In other words, professionals engage in ‘genera-tive boundary work’ (Edwards 2011: 39) in ‘bound-ary’ or ‘inter spaces’ (Edwards 2011: 35). Thisstrengthens the fact that professional action happens‘in-between’ (Dove et al. 2017: 162). According toHilferty (2008: 163), focusing on teacher profession-alism, ‘professionalism is a phenomenon that articu-lates the quality and character of teacher’s work’,whereas ‘enacted professionalism is a process thatrelates to the ways in which teachers attempt to


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influence the quality and character of this work’ (em-phasis added). In addition, he argues that ‘for associ-ation executives this process comprises the dynamicways in which they support members, advocate sub-ject interests, and respond to a changing educationalenvironment’ (Hilferty 2008: 163).

In terms of a broader research perspective, thismeans that both contexts and agency count.Professional acts are not performed by ‘professio-nals’, but they are part of service processes, in widerservice ecologies, in which many actors and factorsplay a role. ‘The professional’ who ‘treats a case’ withfull attention, care, and consideration—somethingwhich belongs to the more traditional ideal image ofprofessional work—has always been an ideal-typicalimage and is increasingly unrealistic. Professionalsnot only act, but they also have to interact withmany others and take performative action: how theydo things, how they relate to client experiences, howthey learn, how they deviate from standards, andhow they appear trustworthy, that determineswhether they are seen as ‘professionals’.

Professionalism, in other words, is not so muchmade or produced by professionals themselves andthen secured; it is largely ‘made’ by others/outsiderswhen they interact with professionals. When profes-sionals—in terms of agency—are able to relate (navi-gating relations) and let in (wiring in), when they areable to connect to lived experiences (understandingsocial experiences), and when they make trade-offsand deal with dilemmas (navigating risks) and gener-ate respect (performing trust), they practice connec-tive professionalism. This calls for day-to-day ‘acts,texts and objects’ (cf. Yanow 2000), by way of whichactions are opened-up, such as being visible; enteringinto a wide array of (horizontal) interactions;explaining things; taking client experiences seriously;being sensitive; showing societal understanding; tak-ing moral stances; and accounting for actions anddecisions. How this works exactly, when, where, andwhy, has to be studied. All of the notions mentionedmight act as areas for future theoretical and empiricalelaboration, in order to further understand the orien-tations, contexts, and agency that drive connectiveprofessionalism. Table 2 summarizes a connectiveprofessionalism perspective in terms of ‘key con-cepts’ that can be accentuated in subsequentresearch.

D I S C U S S I O N A N D C O N C L U S I O NInstead of either announcing the ‘withering away’,‘end’ and ‘death’ of professionalism or returning totraditional ideas and classic images of ‘stable’ profes-sionalism and ‘strong’ professionalization, this articlechoses a different perspective. It argues that profes-sionalism is not ‘made’ by professionals themselves,but dependent upon many actors and factors inbroader service processes and wider service ecolo-gies. Professionalism happens ‘in-between’ profes-sional action and cases in context, is ‘enacted’ byprofessionals in relation to the wider environment,and ‘performed’ by day-to-day performances.Connective professionalism rests upon the ability tonavigate relations, get wired in, understand social experi-ences, navigate risks, and gain respect.

This goes beyond ‘hybrid’ and ‘organizing profes-sionalism’, as it highlights a reconfigured image ofprofessionalism in which risks, dilemmas, and ambi-guities are part of professional working lives, and asit relates professional acts to webs of relations andthe wider, outside world. This has implications, bothfor research and practice. In terms of research, weneed more empirically grounded analyses of howand why professional fields are changing and con-necting to outside worlds, in one way or the other.We also need a more empirically grounded analysisof how expertise and authority become more rela-tional, and which mechanisms and conditions helpor hinder this.

In terms of practices, the reconfigured idea ofconnective professionalism can be linked to practicalregulatory mechanisms like schooling, socialization,and supervision, which affect how professionalismevolves. In addition to occupational dynamics, wealso need to reflect upon the organizational dimen-sions of professional work: which organizational andmanagerial settings affect whether and how profes-sionalism becomes more connective. In addition, weneed to reflect upon the contextual dimensions ofprofessional work in organized settings: how condi-tions that surround services affect service delivery;whether and how they affect expertise, autonomy,and authority; how specific acts and performances af-fect whether professionals are seen as authoritativeexperts.

When we take a relational perspective upon pro-fessional work, there are far-reaching consequences


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that go beyond ‘brokerage’, ‘boundary crossing’, andthe like. Instead of focusing on ‘the professional’, wefocus on professional processes; instead of focusingon expert-based decisions, we focus on expert-basedinteractions that change the nature and substance of

expertise; instead of privileging knowledge, we takeexperiences and preferences into account; instead ofisolating treatment from society, we relate treatmentto societal concerns and conditions; instead of as-suming that professionals ‘are’ professional(s), we

Table 2. Connective professionalism as a research perspective: key concepts

ORIENTATION• Interdependency

• Professionals are neither independent nor dependent. They are interdependent, which means they are part ofextensive webs of relations, in which people need each other to perform and reach results.

• In-between• Professionalism does not reside ‘in’ professionals, neither in professional acts, within regulated occupationaldomains. It occurs in-between professionals, clients/cases, and stakeholders, in wider social domains.

CONTEXT• Processes

• Professionalism is not a matter of ‘applying knowledge and skills’, but of securing relational processes inwhich joint action is generated. In this way, professional action can be tied to outside experiences, dilemmas,and stakeholder suspicion.

• Ecologies• Professional acts and interactions happen in wider environments in which many actors and factors play arole. Stakeholders such as Inspectorates affect professional work, and so do incidents and publicly exposedcases.

AGENCY• Navigating relations

• Professionals interact with multiple others, in webs of relations, and they know how to connect to the rightcolleagues, cases, clients, and stakeholders. They know how and when to be visible, how to prioritize relations,and how to build relations.

• Wiring-in• Professionals know how to relate to circumstances and contexts, figuratively and literally. They know crucialparticipants, partners, and stakeholders. They know with whom to interact, when, and how. They are present atthe right ‘tables’, in the right meetings.

• Understanding social experiences• Professionals know how to make judgements, in relation to lived experiences, of both clients and wider stake-holders. They know how to connect evidence to experiences and emotions.

• Navigating risks• Professionals do not ‘make decisions’ related to cases, backed by knowledge, skills, and discretionary spaces.They navigate the complexities, ambiguities, and risks related to treating cases in context. They are aware of anddeal with dilemmas.

• Gaining respect• Professionals are taken seriously, and they are seen as trustworthy. This is related to micro-practices, that is,how professionals generate day-to-day respect, as well as to macro-practices, that is, how they prevent and man-age incidents and how they create public images.


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study professionalism as performative; instead of see-ing professionalism tied to professional work andactions, we situate ‘real’ professionalism in land-scapes that surround professional workers.Professionalism is not only produced byprofessionals.

A C K N O W L E D G E M E N T SThe author thanks anonymous reviewers from JPO for theirvaluable comments upon an earlier version of this article. Healso thanks many colleagues who commented upon the arti-cle, during conference panels when earlier versions of this ar-ticle were presented. No conflicts of interest are reported.

R E F E R E N C E SAbbott, A. (1988) The System of Professions: An Essay on the

Division of Expert Labor. Chicago: University of ChicagoPress.

Anteby, M., Chan, C. K., and DiBenigno, J. (2016) ‘ThreeLenses on Occupations and Professions in Organizations:Becoming, Doing, and Relating’, The Academy ofManagement Annals, 10/1: 183–244.

Bellini, A., and Maestripieri, L. (2018) ‘Professions Within,Between and Beyond. Varieties of Professionalism in aGlobalising World’, Cambio. Rivista Sulle TrasformazioniSociali, 8/16: 5–14.

Benedictus, R., Miedema, F., and Ferguson, M. W. (2016)‘Fewer Numbers, Better Science’, Nature News, 538/7626:453–5.

Berman, G. (2004) ‘Redefining Criminal Courts:Problem-solving and the Meaning of Justice’, AmericanCriminal Law Review, 41: 1313.

Berman, G. (2019) Making Court Innovation Work(Interview with G. Berman), Rechtstreeks, nr 1: 16–25.

Berman, G., and Gold, E. (2012) ‘Procedural Justice from theBench: How Judges Can Improve the Effectiveness ofCriminal Courts’, Judges Journal, 51: 20.

Blomgren, M., and Waks, C. (2015) ‘Coping withContradictions: Hybrid Professionals ManagingInstitutional Complexity’, Journal of Professions andOrganization, 2/1: 78–102.

Bohle Carbonell, K., Stalmeijer, R. E., Konigs, K. D., Segers,M. and Van Merrienboer, J. G (2014) ‘How Experts Dealwith Novel Situations: A Review of Adaptive Expertise’,Educational Research Review, 12: 14–29.

Boon, A., Flood, J., and Webb, J. (2005) ‘PostmodernProfessions? The Fragmentation of Legal Education andthe Legal Profession’, Journal of Law and Society, 32/3:473–92.

Breit, E., Fossestøl, K., and Andreassen, T. A. (2018) ‘FromPure to Hybrid Professionalism in Post-NPM Activation

Reform: The Institutional Work of Frontline Managers’,Journal of Professions and Organization, 5/1: 28–44.

Broadbent, J., Dietrich, M., and Roberts, J. (2005) The End ofthe Professions? The Restructuring of Professional Work.Abingdon: Routledge.

Bucher, R., and Strauss, A. (1961) ‘Professions in Process’,American Journal of Sociology, 66/4: 325–34.

Byrkjeflot, H., and Kragh Jespersen, P. (2014) ‘ThreeConceptualizations of Hybrid Management in Hospitals’,International Journal of Public Sector Management, 27/5: 441–58.

Carvalho, T. (2014) ‘Changing Connections BetweenProfessionalism and Managerialism: A Case Study ofNursing in Portugal’, Journal of Professions andOrganization, 1/2: 176–90.

Contini, F., and Mohr, R. (2008) ‘Reconciling Independenceand Accountability in Judicial Systems’, Utrecht LawReview, 3/2: 26–32.

Currie, G., Humphreys, M., Waring, J., and Rowley, E. (2009)‘Narratives of Professional Regulation and Patient Safety:The Case of Medical Devices in Anaesthetics’, Health, Riskand Society, 11/2: 117–35.

Darcy, A. M., Louie, A. K., and Roberts, L. W. (2016)‘Machine Learning and the Profession of Medicine’,Journal of the American Medical Association, 315/6: 551–2.

De Bock, R. (2014) Voorbij de vrijblijvendheid [BeyondNon-commitment], Rechtstreeks, nr 1.

Dove, E. S., Kelly, S. E., Lucivero, F., Machirori, M., Dheensa,S., and Prainsack, B. (2017) ‘Beyond Individualism: IsThere a Place for Relational Autonomy in Clinical Practiceand Research?’, Clinical Ethics, 12/3: 150–65.

Edwards, A. (2011) ‘Building Common Knowledge at theBoundaries Between Professional Practices: RelationalAgency and Relational Expertise in Systems of DistributedExpertise’, International Journal of Educational Research,50/1: 33–9.

Eicher, A., and Schedler, K. (2012) ‘Management Responsesto Mulitple Rationalities in Courts’, International Journal ofCourt Administration, 4/3: 20–34.

Evetts, J. (2013) ‘Professionalism: Value and Ideology’,Current Sociology, 61/5–6: 778–96.

Faulconbridge, J. R., and Muzio, D. (2012) ‘Professions in aGlobalizing World: Towards a Transnational Sociology ofthe Professions’, International Sociology, 27/1: 136–52.

Frank, J. R., and Danoff, D. (2007) ‘The CanMEDS Initiative:Implementing an Outcomes-based Framework ofPhysician Competencies’, Medical Teacher, 29/7: 642–7.

Frenk, J. Chen, L., Bhutta, Z.A., Cohen, J., Crisp, N., Fineberg,H., et al. (2010) ‘Health Professionals for a New Century:Transforming Education to Strengthen Health Systems inan Interdependent World’, The Lancet, 376/9756:1923–58.

Freidson, E. (1994) Professionalism Reborn: Theory, Prophecy,and Policy. Chicago: University of Chicago Press.


Dow



Freidson, E. (2001) Professionalism, the Third Logic: On thePractice of Knowledge. Chicago: University of ChicagoPress.

Gleeson, D., and Knights, D. (2006) ‘Challenging Dualism:Public Professionalism in “Troubled” Times’, Sociology,40/2: 277–95.

Grimmelikhuijsen, S., and Klijn, A. (2015) ‘The Effects ofJudicial Transparency ’, On Public Trust: Evidence from aField Experiment. Public Administration, 93/4: 995–1011.

Grootelaar, H. A. M. (2018) ‘Interacting with ProceduralJustice in Courts’, Doctoral dissertation, UtrechtUniversity, Utrecht.

Hilferty, F. (2008) ‘Theorising Teacher Professionalism as anEnacted Discourse of Power’, British Journal of Sociology ofEducation, 29/2: 161–73.

Illich, I. (1975) Medical Nemesis: The Expropriation of Health.New York, NY: Pantheon Books.

Kirkpatrick, I., Ackroyd, S., and Walker, R. (2015) The NewManagerialism and Public Service Professions. Hampshire:Palgrave McMillan.

Kirkpatrick, I., and Noordegraaf, M. (2015) ‘HybridProfessionalism: The Re-shaping of Occupational andOrganisational Logics’, in Empson L., Muzio D., BroschakJ., and Hinings B. (eds) The Oxford Handbook onProfessional Service Firms, pp. 92–121. Oxford: OxfordUniversity Press.

KNAW (2018) Maatschappelijke Impact in Kaart [SocietalImpact on the Map]. Amsterdam.

Larsson, M. S. (1977) The Rise of Professionalism: ASociological Analysis. Berkeley: University of CaliforniaPress.

Lidskog, R., and Lofmarck, E. (2015) ‘Managing Uncertainty:Forest Professionals’ Claim and Epistemic Authority in theFace of Societal and Climate Change’, Risk Management,17/3: 145–64.

Llewelyn, S. (2001) ‘Two-way Windows: Clinicians asMedical Managers’, Organization Studies, 22/4: 593–623.

MacDonald, C. (2002) ‘Nurse Autonomy as Relational’,Nursing Ethics, 9/2: 194–201.

Martin, G. P. (2008) ‘Representativeness, Legitimacy andPower in Public Involvement in Health-ServiceManagement’, Social Science & Medicine, 67/11:1757–65.

McGivern, G., Currie, G., Ferlie, E., Fitzgerald, L., and Waring,J. (2015) ‘Hybrid Manager-Professionals Identity Work:The Maintenance and Hybridization of MedicalProfessionalism in Managerial Contexts’, PublicAdministration, 93/2: 412–32.

Mintzberg, H. (1983) Structure in Fives: Designing EffectiveOrganizations. Englewood Cliffs, NJ: Prentice-Hall.

Noordegraaf, M. (2007) ‘From Pure to HybridProfessionalism: Present-Day Professionalism in AmbiguousPublic Domains’, Administration and Society, 39/6: 761–85.

Noordegraaf, M. (2011) ‘Risky Business. How Professionalsand Professionals Fields (Must) Deal with OrganizationalIssues’, Organization Studies, 32/10: 1349–71.

Noordegraaf, M. (2015a) ‘Hybrid Professionalism andBeyond. (New) Forms of Public Professionalism inChanging Organizational and Societal Contexts’, Journal ofProfessions and Organization, 2/2: 187–206.

Noordegraaf, M. (2015b) Public Management: Performance,Professionalism and Politics. Basingstoke: Palgrave.

Noordegraaf, M. (2019) ‘Enterprise, Hybrid Professionalismand the Public Sector’. in M. Saks and D. Muzio (eds)Professions and Professional Service Firms, pp. 93–108.Abingdon: Routledge.

Noordegraaf, M., Van der Steen, M., and Van Twist, M.(2014) ‘Fragmented or Connective Professionalism?Strategies for Professionalizing the Work of Strategists andOther (Organizational) Professionals’, PublicAdministration, 92/1: 21–38.

NSOB (2014) Governance in de rechtspraak [Governing theJudicial System]. The Hague.

Pololi, L., Conrad, P., Knight, S., and Carr, P. (2009) ‘A Studyof the Relational Aspects of the Culture of AcademicMedicine’, Academic Medicine, 84/1: 106–14.

Richardson (2001) ‘Reconceiving Health Care to ImproveQuality’, paper presented at the Tanner Lectures onHuman Values, University of California, Santa Barbara, 29January 2001.

Rowley, E., and Waring, J. (eds) (2011) A Socio-CulturalPerspective on Patient Safety. Farnham: Ashgate.

Sandefur, R. L. (2015) ‘Elements of Professional Expertise:Understanding Relational and Substantive ExpertiseThrough Lawyers’ Impact’, American Sociological Review,80/5: 909–33.

Southon, G., and Braithwaite, J. (1998) ‘The End ofProfessionalism? ’, Social Science & Medicine, 46/1:23–8.

Spyridonidis, D., Hendy, J., and Barlow, J. (2015)‘Understanding Hybrid Roles: The Role of IdentityProcesses Amongst Physicians’, Public Administration,93/2: 395–411.

Susskind, R. E., and Susskind, D. (2015) The Future of theProfessions: How Technology Will Transform the Work ofHuman Experts. Oxford: Oxford University Press.

Sutcliffe, K. M. (2004) ‘Defining and Classifying MedicalError: Lessons for Learning’, BMJ Quality & Safety, 13/1:8–9.

Thomas, P., and Hewitt, J. (2011) ‘ManagerialOrganization and Professional Autonomy: ADiscourse-Based Conceptualization’, OrganizationStudies, 32/10: 1373–93.

Timmermans, S. (2005a) ‘From Autonomy to Accountability:The Role of Clinical Practice Guidelines in ProfessionalPower’, Perspectives in Biology and Medicine, 48/4:490–501.


Dow



Timmermans, S. (2005b) ‘Suicide Determination and theProfessional Authority of Medical Examiners’, AmericanSociological Review, 70/2: 311–33.

Troman, G. (2000) ‘Teacher Stress in the Low-TrustSociety’, British Journal of Sociology of Education, 21/3:331–53.

Verkerk, M. A. (2001) ‘The Care Perspective and Autonomy’,Medicine, Health Care and Philosophy, 4/3: 289–94.

Voogt, J. (2019) Handle with Care: A MultidisciplinaryAnalysis of Frontline Medical Leadership in MedicalResidents. Utrecht: University Medical CenterUtrecht.

Wald, E., and Pearce, E.G. (2016). Being Good Lawyers: ARelational Approach to Law Practice. The GeorgetownJournal of Legal Ethics, 29, 601–48.

Waring, J. (2014) ‘Restratification, Hybridity andProfessional Elites: Questions of Power, Identity andRelational Contingency at the Points of‘Professional-Organisational Intersection’, SociologyCompass, 8/6: 688–704.

Wilensky, H. L. (1964) ‘The Professionalization of Everyone?’, American Journal of Sociology, 70/2: 137–58.

Yanow, D. (2000) ‘Seeing Organizational Learning: ACultural View’, Organization, 7/2: 247–68.


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