ABSTRACT

Recent national healthcare reforms have resulted in many changes to healthcare organizations. When social realities are enacted in social interactions, changes also occur in communication through discourses. In public hospitals, middle management groups form one important platform for change talk. This study aimed to identify and understand how change talk emerges in management group meetings. Data were collected from 10 hospital meetings, and change-related interactions were explored by analyzing sensemaking and positioning. In the data, change talk took three forms: collaboration, control and confrontation. These forms consisted of change discourses (change as a possibility, concealed change and enforced change) and simultaneously negotiated positions (expert position, power/powerlessness position and cohesion/opposition position). The findings suggest that middle managers use sensemaking power through discourses. Positioning is also of vital importance in directing change talk because it defines the power relations in the change process.

摘要

最近的国家医疗改革导致医疗机构发生了许多变化。当社会现实在社会互动中得以体现时，通过话语进行的交流也会发生变化。在公立医院，中层管理团队是一个重要的变革对话平台。本研究旨在识别和理解管理小组会议中的变革谈话是如何出现的。从 10 次医院会议中收集数据，并通过分析意义构建和定位来探索与变化相关的交互。在数据中，变革谈话采取了三种形式：协作、控制和对抗。这些形式包括变革话语（作为可能性的变革、隐性变革和强制变革）和同时协商的立场（专家立场、权力/无权立场和凝聚力/反对立场）。研究结果表明，中层管理人员通过话语使用意义建构能力。定位在指导变革讨论中也至关重要，因为它定义了变革过程中的权力关系。