A literary approach to managerial discourse after the NHS reforms

Abstract

The 1990 NHS and Community Care Act can be seen as the culmination of the importation into the UK National Health Service of 'business' language. This has entailed struggles between the values of new general managers and the traditional professions and unprecedented attention to issues of 'measurement'. A recent study of NHS Trusts involved three yearly rounds of interviews with managers and the administration of questionnaires to the nursing workforce in the same areas. Although the main intentions of the research lay in gauging the job satisfaction of the workforce and describing the managers' approaches to organisational strategy, the way that each group used language soon emerged as an area of interest and as a pointer to the foundational values and epistemologies of each group. An approach to the texts of interviews and questionnaire responses was informed partly by an analysis of discourse, elaborated by Foucault and others and partly by deconstruction, an approach usually associated with literary texts. The approach to analysis is based on the realisation that language is structured in a way that reflects existing power relations and that attention to metaphor and other rhetorical devices can give insight into these discourses. After briefly introducing the policy context and a particular approach to literary texts, this paper offers analysis of how managers talked about measurement and financial constraints.