The double spiral of change--experiences of privatization in a Swedish hospital.
Privatization is a trend in countries with a public health system. It involves organizational change, a cultural transformation and changes for the employees as well as a more strictly controlled work. The objective of this study is to describe, analyse and interpret how privatization is perceived by the employees of a health care organization in Sweden.


METHODS
In-depth interviews have been performed with physicians, paramedics, secretaries, nurses, assistant nurses and local managers, in all 14 respondents, after a private entrepreneur had taken over the management of a hospital. The interviews were tape-recorded and have been analysed and interpreted following a grounded theory approach.


RESULTS
The transcribed interviews show that trust is a core category and linked with emotions, commitment and security. The analysis shows that employees' experience of privatization within a health care organization differs and is full of nuances and complexities.


CONCLUSIONS
A simultaneous virtuous and a vicious circle of experiences and reactions may describe how employees experience privatization. It can also be concluded that leadership is an important factor in the success of organizational change.
Engström
Agneta Kullén
AK
Nordic School of Public Health, Göteborg, Sweden. agneta.kullen_engstrom@vgregion.se
Axelsson
Runo
R
D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D009936:Organizational Innovation; D010564:Personnel, Hospital; D011332:Privatization; D013222:State Medicine; D013548:Sweden