Paper short abstract:

Ethnographies of policies in the NHS in England illustrate how multi-site ethnography expands and deepens an understanding of contemporary governance and supports dialogical policy processes that generate more creative, acceptable and effective policies

Paper long abstract:

Contemporary forms of government work through expert knowledge and activities. In the healthcare field, national policy makers, policy documents, academics, think tanks, management knowledge, regional managers, managerial strategies, educational practices, training materials, and healthcare professionals are brought together to shape the conduct of citizens. Multi-site ethnography, that ‘follows’ policy through space and across time, can capture the diversity of actors, practices and arenas of governing. By observing actual behaviour, anthropologists can show how heterogenous material effects are produced as policies interact with situated agency and local traditions all along the policy chain. Multi-site ethnography of reforms in the English NHS has illuminated key features of contemporary governance: how decisions are hidden in the spaces ‘in between’ and ‘out of reach’; the enrolment of doctors in governing; and the way that management consultants and think tanks circulate policy models that homogenise organisational form. At the same time, ethnographic attention to instances of resistance shows the influence of alternative foundations for action, such as forms of belonging. Anthropology’s slow burn expands and deepens our understanding of contemporary governance and supports dialogical policy processes that generate more creative, acceptable, and effective policy.