title: Shifting the balance of power? Culture change and identity in an English health-care setting.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Primary Care R&D Centre, University of Manchester, Manchester, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: McDonald
mesh_terms: D015279:Organizational Culture; D009936:Organizational Innovation; D016134:Organizational Policy; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom