Young A P
East London Business School, University of East London, Dagenham, Essex, UK.
Nurs Ethics. 1997 May;4(3):191-201. doi: 10.1177/096973309700400303.
With the introduction of general management and then of planned markets into the National Health Service (NHS), health care in the UK has gone through a massive amount of change. The effect on those working for the NHS has been 'challenging' and often confusing. This paper aims to clarify what is happening by taking an ideological perspective: what ideologies exist, how they are changing and the strategies being used to ensure their survival. Ideologies are basically about power. The relationship between market, managerial and professional ideologies is analysed using charters, codes of conduct and other associated documents. A tentative conclusion is reached that professional ideologies are able to adjust to the overriding market/consumerist ideology. However, the managerial ideology is having difficulty in gaining any real ground against the professional ideology and is having to move strategically by using audit, not just of finance, but also of clinical judgement, to gain power.
随着国民医疗服务体系（NHS）引入综合管理以及随后的计划市场，英国的医疗保健经历了巨大变革。这对在NHS工作的人员产生了“挑战性”影响，而且常常令人困惑。本文旨在从意识形态角度阐明正在发生的事情：存在哪些意识形态，它们如何变化以及为确保其生存而采用的策略。意识形态本质上关乎权力。运用宪章、行为准则及其他相关文件，分析市场、管理和专业意识形态之间的关系。得出一个初步结论，即专业意识形态能够适应占主导地位的市场/消费主义意识形态。然而，管理意识形态在对抗专业意识形态方面难以取得实质进展，并且不得不通过开展审计（不仅是财务审计，还有临床判断审计）来战略性地获取权力。
