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This article deals with professional responses to and handling of New Public Management reforms in the context of Swedish health care. The focus is on Swedish nurses, and the argument is that the extent to which a profession is heterogeneous and embraces a variety of ordering processes explains differing, and even contradictory, responses within a single profession. The paper shows that the ordering processes within the Swedish nursing profession provided a wide variety of conditions for nurses’ encounter with the reforms. Overall, the transformations brought about by the New Public Management reforms aligned more easily with the process of ordering nurses into administrative leaders than with the process of ordering nurses into experts in caring.

This paper provides an account of the rising clamour for transparency in the Swedish healthcare fi eld. Previous research into accounting, auditing and classifi cation has shown that such visualizing technologies potentially have the capacity to create new objects and ideals in a fi eld ( Miller 1994;Power 1997;Bowker and Star 1999 ). It is thus reasonable to believe that the simultaneous use of various visualizing technologies in a fi eld might transform it. This paper provides an analysis of the early stages of such a transformation process. The carriers that promote transparency are identifi ed and it is shown that the drive for transparency has opened up the fi eld to new actors. It is also shown that the drive for transparency has changed the quality discourse and as a consequence of that, the National Quality Registries are beginning to be opened up to the public.

Strategic communication is today a salient feature of public organisations as they put more efforts into communicating self-presentations to their various stakeholders. This article assumes that strategic communication may pave the way for a legitimacy-reputation dilemma, because organisations in highly institutionalised fields operate under strong isomorphic pressures to behave in line with shared norms and values in order to gain legitimacy. The article contributes to the discussion of the legitimacy-reputation dilemma by adding a sociological institutional perspective to strategic communication theory. Based on a qualitative in-depth study of what are assumed to be the most communicative hospitals in Sweden, the article investigates which strategies are used to balance the tension between legitimacy and reputation. The findings reveal that hospitals avoid unwanted institutional associations by communicating that they are 'special in an ordinary way'.

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