Empowerment in the national health service: does shared governance offer a way forward?

This paper explores definitions of the notion ‘empowerment’, noting that it is both an ambiguous and a contested concept, with antecedents in left-of-centre political ideologies, but appropriated into the language of managerial transformation. Empowerment's origins are considered in the light of efforts to improve the UK's economic performance in relation to its competitors, drawing particularly on Japanese management practice. It distinguishes between employee participation and employee involvement, noting that shared governance in nursing is a form of indirect employee involvement that is profoundly antihierarchical. It examines those factors likely to enable (and disable) the development of empowerment through shared governance. The paper concludes that an instrumental/regulatory approach is likely to fail in highly professionalized organizations such as the NHS, while an expressive/revelatory approach, expressive of professional values, is more likely to succeed.