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Short abstract

This paper follows consultancy as the everyday enactment of technocratic expertise in governing wicked societal issues. Drawing on ethnographic research, it shows how consultants perform epistemic work that translates uncertain care challenges into governable and actionable forms.

Long abstract

Contemporary states increasingly face “wicked” societal issues characterised by uncertain and contested knowledge and diffuse responsibility. Yet these issues are often addressed through technocratic governance arrangements that promise technical solutions and clear, actionable interventions. This paper examines how such technocratic expertise is enacted in governance of wicked healthcare issues, arguing that this cannot be understood without attending to the role of consultants as a key expert actor.

The analysis centres on a recurring tension. While actors involved in wicked care challenges frequently acknowledge that externally hired expertise cannot resolve the structural roots of these issues, consultants continue to be mobilised as indispensable intermediaries. Rather than treating this as governance failure, the paper asks how consultancy performs an epistemic function that sustains these technocratic responses to wicked problems. Drawing on an ethnography of Dutch regional healthcare networks addressing “misunderstood behaviour”, combining in-depth interviews, observations, and analysis of reports and grant applications, the paper traces the everyday practices through which consultants translate diffuse care issues into governable forms.

The analysis shows how consultants order uncertainty into actionable problem formats and translate political tensions into project-based interventions, stabilising temporary forms of coordination. In doing so, they render wicked care issues governable in the present by framing them as manageable problems, at the cost of other, more complex, dimensions of the issue. By foregrounding everyday practices, the paper positions consultancy as a central epistemic function within contemporary technocracy; one that both enables and reshapes how states act upon wicked societal issues.