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The present paper argues that recent research on public sector reforms offers few contributions to the body of knowledge on this topic because it adds little to the conclusions drawn during the first generation of research in this area. Although these later studies have often been context-specific and have explored the details of the process of change in some depth, it is rather difficult to compare their results or to make reasoned judgements of the comprehensiveness and centrality of the analysed change. Although most public sector reforms that affect hospitals, schools or social services are initiated and designed by national governments, individual case studies of local administrations often fail to capture the generic traits of nationwide reforms. However, public sector change cannot be approached as if it comprises collections of nominally independent local events. The present paper argues for two new approaches to the study of public sector change: (i) the systematic categorization of the different forms of governmental intervention under study and (ii) analysis of the ways in which these forms of intervention are linked and interact. Based on extensive empirical research, this paper suggests a generic classification of these forms of intervention that can be used in empirical research on comprehensive public sector change. Consequently, five interventions in public sector organizations are suggested, namely political intervention, intervention by laws and regulations, intervention by audit and inspection, intervention by management and intervention by rationalizing professional practice. The model is particularly well suited to the longitudinal analysis of complex public sector reforms. This approach provides a conceptual tool to distinguish between interventions based on different forms of knowledge and to investigate how they are linked to each other vertically and horizontally. We demonstrate the usefulness of the model by analysing two empirical examples of reforms in which a variety of interventions were imposed at the local level, through legislation as well as a spectrum of voluntary measures proposed by government agencies, by national associations for local and regional councils and by other national or regional actors.

Physicians' work schedules are an important determinant of their own wellbeing and that of their patients. This study considers whether allowing physicians control over their work hours ameliorates the effects of demanding work schedules. A questionnaire was completed by hospital physicians regarding their work hours (exposure to long shifts, short inter-shift intervals, weekend duties, night duties, unpaid overtime; and work time control), sleep (quantity and disturbance) and wellbeing (burnout, stress and fatigue). Work time control moderated the negative impact that frequent night working had upon sleep quantity and sleep disturbance. For participants who never worked long shifts, work time control was associated with fewer short sleeps, but this was not the case for those who did work long shifts. Optimizing the balance between schedule flexibility and patient needs could enhance physicians' sleep when working the night shift, thereby reducing their levels of fatigue and enhancing patient care.

In this article we analyse an institutional transformation of Swedish health care that is underway. We combine the recent work from the 'Governmentality'-tradition with contributions by John Meyer and associates. The latter is used to explain how these changes are rendered as necessary and natural. The main part of our analysis concerns how the institutional construction of rationalized agency is instrumented. To accomplish that, Dean's (1999) categories technologies of agency and technologies of performance are used to conceptualize some of the means and principles mobilized in the ongoing institutional transformation of Swedish health care. Firstly, we display the emergence of a complex landscape of new actors, arenas and new practices that regulate and coordinate medical practice. Secondly, various attempts to imbue agency into the patients are analysed as an example of a technology of agency put to use. The conclusions present a more comprehensive picture of governing through new forms of agency. Technologies of agency are closely intertwined with appeals to common goods, the formation of new arenas and forms of expertise.

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