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The purpose of this paper is to examine, first, how social capital was crafted and transformed from a theoretical concept to an organizational tool for public sector improvement that was adopted by a Danish region and implemented in all regional hospitals. Second, the paper examines the application of social capital in one of these hospitals and, further, in a department of the hospital with the purpose of showing how it was applied by the managerial levels and responded to by the nurses of the department.

A Bourdieusian ethnographic approach was used for understanding the local and subjective understandings of social capital as well as the wider context in which the new tool was crafted.

Social capital as a tool for organizational improvement was constructed in a gray zone between science and consultancy. The paper demonstrates that the application of social capital in practice is connected with paradoxes because the concept is inherently ambiguous and Janus-faced in that its official representation is “soft” and voluntary with a working environment focus yet, it envelopes concealed steering intentions. These contrary working features of the concept produce a pressure on the department management and the nurses.

The explanatory critical framework combined with the ethnographic approach is a useful approach for theorizing and understanding social capital as an example of the emergence and consequences of new managerial tools in public organizations.

It has been argued by researchers from the Anglo‐Saxon nations that the rationality of the market has increasingly infiltrated the medical field. This paper seeks to enquire via policy analysis to what extent these principles have affected the prototypical welfare state of Denmark in relation to Danish hearing health policies.

The paper is based on qualitative methods comprising observations and interviews in two hearing clinics.

The paper shows that rather than a “withdrawal” of the state there has been a process of reform. The data suggest that a distinguishing mark of the consumer role on offer in Denmark is that, along with a free hearing aid, the Danish health consumer enjoys a range of rights and reciprocal responsibilities. The paper concludes that few of the hearing‐impaired patients were able to embrace the consumer ethos, and those who chose not to wear their prescribed hearing aids experienced the added burden of moral reproach.

It makes little sense to analyse abstracted rationalities without proceeding to analyse how they actually function in practice. This paper demonstrates empirically how and to what degree governmentality is embedded in social practice in two public hearing clinics in Denmark.