“Top-down-bottom-up”: a critical discourse analysis on empowerment efforts in a hospital environment

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School of Business | Master's thesis
Degree programme
Management and International Business (MIB)
82 + 2
Change is inevitable and constantly present, even in public sector organizations. There is a continuous drive towards more agile and cost-efficient practices, which can be seen for example in Lean management practices and the New Public Management (NPM) reforms. One aspect of NPM is empowering the employees. Previous research shows that empowering lower-level managers and employees enhance, not only job satisfaction, but innovation and financial performance as well. However, oftentimes efforts towards more empowered practices, as well as NPM reforms in general, seem to fail in regards of not achieving the intended positive outcomes. The purpose of my study is to find out what kind of discourses can be found concerning a change of leadership model, with the aim of empowering lower-level managers and employees. I wanted to see on one hand what kind of discourses were perceived to impede the empowerment effort and on the other hand, what kind of discourses were seen to enhance the empowerment effort. By recognizing these, the practices could be changed so that they would best support the intended change towards more empowered employees, in contrast to, in the worst case, undermining the effort. I did fifteen interviews with managers on different levels in a public hospital. In my analysis, I applied a critical discourse analytical perspective and found five discourses that were seen to impede empowerment efforts. I labeled these discourses Verticalization, Perfunctory participation, Perplexity, Legacy, and Distinction. I further found two discourses that were seen to enhance empowerment, which I labelled Horizontalization and Concretization. Previous studies on empowerment distinguish between structural and psychological empowerment and my findings are related to both of these aspects. By bringing attention to the discourses used and their implications, I want to encourage reflection on how communicational and social practices affect empowerment, and how they could be used to further support empowerment efforts. Recognizing the gaps between the intended change and practices in use, helps to correct actions if needed, and help to reduce felt confusion. As several of the discourses are related to structural aspects, they also highlight the need to have structural support for the intended change. On the other hand, Concretization especially is related to psychological empowerment and by an increased focus on this discourse, the felt competence and impact of employees could be supported, and thereby, the psychological empowerment increased. By accentuating the discourse of Horizontalization I want to initiate a discussion on whether the traditional ‘top-down’-talk is necessary in contemporary organizations, or merely just maintaining inequalities between different levels.
Thesis advisor
Pälli, Pekka
empowerment, change, New Public Management, critical discourse analysis, hierarchy, power, public sector, hospital
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