LAUSR

ABSTRACT 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 problems as 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 of change, making up a continuous policy cycle in the transformation of Swedish health, reiterated on different levels of the system, in different 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 impossible to question.