Markets, Moral Economy and Healthcare Provision in England

由于预算压力，患者需求的变化和技术的变化，英国的NHS目前正在进行大规模的结构变革（NHS England 2014, 2017）。这项研究正在研究这种变化对NHS组织文化的规范（或道德）维度的影响。为此，该研究借鉴了道德经济学的理论框架。道德经济方法指出，所有有组织的经济活动都依赖于对诸如好与坏、对与错、适当与不适当等问题的共同道德理解。它还承认，这些理解是适应性的，可以随着经济环境的变化而变化（Sayer, 2007）。因此，该研究正在探索以下问题：在组织或团体（如专业团体）中，有多少共同的道德理解（与责任、公平、尊重等问题有关）；这种理解如何受到服务重构过程的影响；以及一个组织内不同群体的道德理解如何影响国家或地方政策的实施。为了产生这些见解，该研究对一个服务变更的实现进行了深入而深入的研究。该研究还将寻求利用研究结果进一步发展道德经济视角，使其成为一种理论工具，其他研究人员可以将其应用于类似背景（即经历重大变革的组织），以了解组织文化如何受到经济和结构变革的影响。

The NHS in England is current embarking on large scale structural change due to budgetary pressures, shifting patient needs and changes in technology (NHS England 2014, 2017). This research is examining the impact of such change on the normative (or moral) dimension of the culture of NHS organisations. To do this, the research is drawing on a moral economy theoretical framework. A moral economy approach states that all organised economic activities rely on shared moral understandings regarding issues such as what is good and bad, right and wrong, and appropriate and inappropriate. It also acknowledges that these understandings are adaptable and can change in response to changes in the economic environment (Sayer, 2007). The research is therefore exploring issues such as: the extent to which there are shared moral understandings (relating to questions such as duty, fairness, respect etc.) within organisations or groups (such as professional groups); how such understandings are affected by the process of service reconfiguration; and how the moral understandings of different groups within an organisation influence the implementation of national or local policy. The research is drawing on an in-depth, intensive study of the implementation of one service change in order generate these insights. The research will also seek to use the findings from the study to further develop a moral economy perspective into a theoretical tool that can be applied by other researchers to similar contexts (i.e. organisations undergoing a significant level of change) to understand how organisational culture is affected by economic and structural change.