To Örebro University

In this article we analyze public sector change as a profoundly constructed phenomenon – as performative reforms. Public sector reforms, of which policy processes are an integral part, are constituted and realized through long chains of interventions.Communicative–discursive interventions posit and constitute problemsas real and important, while technocratic interventions, such as plans, analyses, and schemes construct new imagined worlds for possible and attractive instrumental solutions. Our empirical results display circular movements of three modes ofchange, making up a continuous policy cycle in the transformation of Swedish health, reiterated on different levels of the system, indifferent scales, and with different actors involved.

The continuity of the reforms is to a large extent the result of a successful institutionalization of the policy cycle and its content. It is stabilized as a set of discourse and social technologies, distributed throughout the entire healthcare system and almost impossibleto question.