This paper explores the professionalization project of paramedics, based on an ethnographic study of UK National Health Service (NHS) ambulance personnel. Drawing on concepts derived from institutional theory and the sociology of professions, we argue that the project is enacted at two levels, namely a formal, structural and senior level reflecting changing legitimation demands made on NHS practitioners and pursued through institutional entrepreneurship, and an informal, agentic, ‘street level’ enacted by the practitioners themselves via ‘institutional work’. Focusing on this latter, front‐line level, our ethnographic data demonstrate that the overall impact of the senior level professionalization project on the working lives of paramedics has been somewhat muted, mostly because it has had limited power over the organizations that employ paramedics. Given the slow progress of the senior level professionalization project, paramedics at street level continue to enact subtle forms of institutional work which serve to maintain ‘blue‐collar professionalism’ – a form originally identified in Donald Metz's ethnography of ambulance work. Our analysis draws attention to the complex and contested nature of professionalization projects, in that their enactment at senior and street levels can be somewhat misaligned and possibly contradictory.

Lean thinking has recently re-emerged as a fashionable management philosophy, especially in public services. A prescriptive or mainstream literature suggests that lean is rapidly diffusing into public sector environments, providing a much-needed rethink of traditional ways of working and stimulating performance improvements. Our study of the introduction of lean in a large UK public sector hospital challenges this argument. Based on a three-year ethnographic study of how employees make sense of lean ‘adoption’, we describe a process in which lean ideas were initially championed, later diluted and ultimately eroded. While initially functioning as a ‘mechanism of hope’ (Brunsson, 2006) around which legitimacy could be generated for tackling longstanding work problems, over time both ‘sellers’ and ‘buyers’ of the concept mobilized lean in ambiguous ways, to the extent that the notion was rendered somewhat meaningless. Ultimately, our analysis rejects current prescriptive or managerialist discourses on lean while offering support for prior positions that would explain such management fashions in terms of the ‘life cycle of a fad’.

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University governance is becoming increasingly autocratic as marketization intensifies. Far from the classical ideal of a professional collegium run according to academic norms, today’s universities feature corporate cultures and senior leadership teams disconnected from both staff and students, and intolerant of dissenting views. This is not a completely new phenomenon. In 1960s America, senior leaders developed a technocratic and managerialist model of the university, in keeping with theories around the ‘convergence’ of socio-economic systems towards a pluralist ‘industrial society’. This administrative-managerial vision was opposed by radical students, triggering punitive responses that reflected how universities’ control measures were at the time mostly aimed at students. Today, their primary target is academics. Informed by Critical Theory and based on an autoethnographic account of a university restructuring programme, we argue that the direction of convergence in universities has not been towards liberal, pluralist, democracy but towards neo-Stalinist organizing principles. Performance measurements – ‘targets and terror’ – are powerful mechanisms for the expansion of managerial power or, in Marcuse’s words, ‘total administration’. Total administration in the contemporary university damages teaching, learning, workplace democracy and freedom of speech on campus, suggesting that the critique of university autocracy by 1960s students and scholars remains highly relevant.

The label ‘extreme’ has traditionally been used to describe out-of-the-ordinary and quasi-deviant leisure subcultures which aim at an escape from commercialized and over-rationalized modernity or for occupations involving high risk, exposure to ‘dirty work’ and a threat to life (such as military, healthcare or policing). In recent years, however, the notion of ‘extreme’ is starting to define more ‘normal’ and mainstream realms of work and organization. Even in occupations not known for intense, dirty or risky work tasks, there is a growing sense in which ‘normal’ workplaces are becoming ‘extreme’, especially in relation to work intensity, long-hours cultures and the normalizing of extreme work behaviours and cultures. This article explores extreme work via a broader discussion of related notions of ‘edgework’ and ‘extreme jobs’ and suggests two main reasons why extremity is moving into everyday organizational domains; the first relates to the acceleration and intensification of work conditions and the second to the hypermediation of, and increased appetite for, extreme storytelling. Definitions of extreme and normal remain socially constructed and widely contested, but as social and organizational realities take on ever more extreme features, we argue that theoretical and scholarly engagement with the extreme is both relevant and timely.