Shifting the balance of power? Culture change and identity in an English health-care setting

摘要

Purpose - A recurring theme in Government policy documents has been the need to change the culture of the NHS in order to deliver a service "fit for the twenty-first century". However, very little is said about what constitutes "culture" or how this culture change is to be brought about. This paper seeks to focus on an initiative aimed ostensibly at "empowering" staff in an English Primary Care Trust as a means of changing organisational culture. Design/methodology/approach - It presents findings from an ethnographic study which suggests that this attempt at "culture change" is aimed at manipulating the behaviour and values of individual employees and may be interpreted as a process of changing employee identity. Findings - Employees reacted in different ways to the empowerment initiative, with some resisting attempts to shape their identity and others actively engaging in projects to bring their unruly self into line with the ideal self to which they were encouraged to aspire. Originality/value - The challenges presented by the need to respond to conflicting Government policies created tensions between individuals and conflicts of allegiance and identity within individual members of staff. Alternative forms of selfhood did not merely replace existing identities, but interacted with them, often uncomfortably. The irony is that, whilst Government seeks to promote culture change, the frustrations created by its top-down target-driven regime acted to mitigate the transformational and reconstitutive effects of a discourse of empowerment aimed at achieving this change.