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This dynamic does not eliminate discretion; it redistributes it. Decisions are still made, but the criteria by which they are evaluated shift from professional standards to managerial ones. The operative question is no longer “Was this good care?” - or “Was this the right scientific call under uncertainty?” - but “Did this meet the target?” In that shift, judgement is not removed; it is displaced, and its accountability is re-anchored to what the system can measure rather than to what the domain most needs to know.
Management Theory’s Circular Economy
The durability of management theory is sustained less by cumulative explanatory power than by a self-reinforcing citation economy. A small set of elite journals disproportionately cite one another, reproducing shared assumptions, preferred methods, and accepted problem framings. While critical perspectives are periodically acknowledged, they are rarely permitted to alter the field’s core categories or evaluative standards. Recognition substitutes for incorporation.
Empirical research within this ecosystem frequently relies on self-reported measures, cross-sectional designs, and statistical techniques that confer the appearance of rigour without resolving underlying conceptual ambiguities. Findings are typically incremental, context-bound, and weakly replicable. Yet through repeated citation, these results are recontextualised as building blocks of a cumulative literature. Methodological conformity enables publication; publication generates citations; citations are then taken as evidence of theoretical solidity. What circulates is not validated knowledge, but mutual reinforcement.
This epistemic circularity is institutionally stabilised by business school incentive structures. Faculty advancement, funding, and status depend on publication within the same narrow journal hierarchy that defines legitimate knowledge. Research that questions foundational assumptions - rather than extending them - faces elevated barriers to entry. Critique is permitted insofar as it is framed in the field’s authorised vocabularies and methodologies. Challenges that would disrupt the circulation itself are filtered out, ensuring that the system reproduces its own criteria of success.
A Genealogical Perspective
Explaining how management came to occupy its current position of authority requires a genealogical approach. Rather than evaluating management theories in terms of truth or falsity, genealogy asks how they emerged, what historical problems they were intended to address, and which interests they came to organise and stabilise. The focus shifts from epistemic validity to conditions of possibility.
Viewed genealogically, management knowledge appears less as a cumulative science and more as a succession of discursive formations shaped by changing social, economic, and organisational conditions. As enterprises expanded in scale and complexity, older forms of coordination - personal supervision, craft knowledge, informal norms - proved insufficient. New vocabularies were required to render organisations legible, comparable, and governable. Management theory supplied these vocabularies, translating heterogeneous practices into abstract categories such as performance, efficiency, leadership, and control.
This perspective is indebted, in part, to Michel Foucault’s analysis of the entanglement of knowledge and power. Management discourse does not just describe organisational realities; it actively constitutes the objects it claims to analyse, defining what counts as a problem, what can be measured, and what forms of intervention are deemed legitimate. In doing so, it shapes both how organisations are understood and how they are governed.
Seen in this light, the central puzzle is not why management theory falls short of conventional scientific standards, but why such shortcomings have had little effect on its institutional authority. Its durability lies in its practical function: management theory operates less as an explanatory body of knowledge than as a technology of governance. Its value is measured not by its truth claims, but by its capacity to structure action, allocate responsibility, and render organisational life amenable to intervention.
Why Critique Has Not Transformed Management
Management has been criticised for decades - by labour scholars, organisational sociologists, critical theorists, and practitioners themselves. Yet these critiques have rarely shifted the centre of gravity of mainstream practice.
One reason is that management theory is highly assimilative. Critical ideas are not so much rejected as domesticated: they are absorbed, rebranded, and returned as tools. Reflexivity is reframed as leadership development. Power is translated into stakeholder management. Resistance is recoded as change management. In this process, critique survives as language but loses its edge as diagnosis - its political and structural implications are converted into managerial technique.
A second reason is that management’s authority is not primarily epistemic. It does not depend on being true so much as being usable - especially by those with the capacity to act. If managerial discourse helps organisations justify decisions, coordinate action, discipline uncertainty, and perform legitimacy for regulators, investors, and publics, then its weaknesses as knowledge are tolerable. In other words, critique struggles to transform management because management is organised less as a truth-seeking enterprise than as a practical and justificatory technology - one that can incorporate criticism without conceding power.
The Cost of Unscientific Authority
The consequences of this arrangement are no longer abstract. As managerial logic extends into domains once governed by professional norms, the costs of unscientific authority become increasingly legible - and increasingly hard to dismiss as implementation failure.
In healthcare, these costs show up as misaligned incentives, burnout, erosion of trust, and the quiet displacement of clinical judgement by targets, dashboards, and procedural compliance. They also surface in healthcare-adjacent organisations - commissioners, regulators, insurers, digital health firms, and suppliers - where “what counts” is often shaped upstream through metrics, contracts, and reporting regimes that travel faster than evidence. The result is a system that can look controlled on paper while becoming less adaptive on the ward, in the clinic, and across the care pathways.
More broadly, unscientific authority produces organisational fragility: repeated cycles of reform and disappointment; constant restructures that generate motion without learning; and a persistent gap between managerial rhetoric (“transformation”, “efficiency”, “quality”) and lived experience. When success is defined through proxies that are only loosely coupled to real outcomes, organisations optimise what is measurable and narratable, not necessarily what is true or beneficial.
These outcomes are not accidents. They are predictable consequences of a regime in which management knowledge is insulated from rigorous evaluation, largely unaccountable as a profession, and legitimised by its association with science rather than by the disciplined practice of it. Under those conditions, managerial authority can expand even when its claims fail - because it is rewarded for coherence, control, and legitimacy, not for accuracy.
Reframing the Question
The point is not to romanticise pre-managerial forms of organisation or to deny the need for coordination and administration. Large, complex systems require structures of management. The question is on what epistemic and ethical grounds these structures operate.
If management is not a science, it should stop claiming the authority of one. If it is not a profession, it should not displace those that are. And if its knowledge claims cannot withstand empirical scrutiny, they should be treated as provisional frameworks rather than universal truths.
Healthcare, with its moral urgency and epistemic complexity, makes these questions impossible to ignore. It reveals what management discourse often conceals: that governing through abstraction is a choice, not a necessity, and that the legitimacy of that choice depends on standards management has largely abandoned.
Takeaways
Management today governs through a paradox: it wields significant power while resting on fragile knowledge claims. It borrows the prestige of science without accepting the disciplines that make science real - clear hypotheses, the possibility of being wrong, and the willingness to stop when the evidence turns - while displacing professional judgement without assuming professional responsibility. In doing so it converts complex care, work, and risk into legible proxies that travel well in board packs but fracture at the bedside. Naming this is not a call for denunciation or nostalgia; it is a strategic demand for epistemic honesty. If leaders want their interventions to carry the authority of evidence, they should be prepared to state, in advance, what will falsify them; if they want dashboards to substitute for judgement, they should be able to show the outcomes they improve and the harms they do not. We should treat management for what it has become - a dominant coordinating language of modern institutions - and then insist it earns its reach through transparent evaluation, clear accountability, and measurable effects on real outcomes. The danger is not management per se, but the illusion that it is a science or a profession when it is neither; healthcare has already paid the price of that illusion, and whether we learn from it is the choice now.
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1 day, 15 hours ago
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