McDonald Ruth
National Primary Care R&D Centre, University of Manchester, Manchester, UK.
J Health Organ Manag. 2005;19(3):189-203. doi: 10.1108/14777260510608934.
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.
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 self-hood 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.
政府政策文件中反复出现的一个主题是，需要改变国民医疗服务体系（NHS）的文化，以提供“适合21世纪”的服务。然而，对于什么构成“文化”或如何实现这种文化变革，却很少有相关论述。本文旨在聚焦一项表面上旨在“赋权”英国一家初级医疗信托机构员工的倡议，将其作为改变组织文化的一种手段。
设计/方法/途径：本文呈现了一项人种志研究的结果，该研究表明，这种“文化变革”的尝试旨在操纵员工的行为和价值观，并且可以被解释为一个改变员工身份的过程。
员工对赋权倡议的反应各不相同，一些人抵制塑造他们身份的尝试，而另一些人则积极参与项目，以使他们不羁的自我符合被鼓励追求的理想自我。
原创性/价值：应对相互冲突的政府政策的必要性所带来的挑战，在员工个体之间制造了紧张关系，以及员工个体内部忠诚和身份的冲突。自我认同的替代形式不仅仅取代了现有的身份，而且还与它们相互作用，这种相互作用往往令人感到不适。具有讽刺意味的是，虽然政府试图推动文化变革，但其自上而下的目标驱动体制所产生的挫败感却起到了缓和旨在实现这种变革的赋权话语的变革和重构作用。
