A matter of (good) faith? Understanding the interplay of power and the moral agency of managers in healthcare service reconfiguration

Soc Sci Med. 2024 Feb:342:116553. doi: 10.1016/j.socscimed.2023.116553. Epub 2023 Dec 24.


Previous studies of service reconfiguration in healthcare have explored the influence of power on processes and outcomes. However, in these accounts the moral agency of managers is often underemphasised. This paper draws on the theoretical tools provided by the sociology of morality to help deepen understanding of the interaction between power and moral agency in service reconfiguration in healthcare. It presents results from a qualitative study of a pan-organisational service reconfiguration in the NHS in England, involving nineteen in-depth interviews with those leading the change and the analysis of twelve programme documents. We combine concepts of the moral background and epistemic governance to interpret participants' conviction that the service change was 'the right thing to do'. The paper shows how epistemic work carried out by service change regulations shaped the moral background within which participants worked. This, in turn, channelled their moral agency - specifically their commitment to patient care - in a way that also reflected central priorities. The paper adds to sociological understandings of service reconfiguration through considering the interaction of structure, agency and power, while also developing the concept of the moral background to show how power relations can influence moral beliefs.

Keywords: Epistemic governance; Health service reconfiguration; Major systems change; Moral background; Qualitative research; Service change; Sociology of morality.

MeSH terms

  • Delivery of Health Care*
  • England
  • Health Facilities
  • Health Services*
  • Humans
  • Morals