Discourses, Rhetorical Strategies and Arguments: Conversations in an NHS Trust Hospital Board

Abstract

This article is concerned with the introduction of the agenda of New Public
Management (NPM) within the board of a UK Hospital Trust: West London Hospital
(WLH). We discuss the literature on New Public Management, including its
limitations for analysing the organizational reality of implementing NPM. But we
will also be drawing on discourse theory and the literature on rhetoric. The main
argument in this article is that in order to understand the reality of the NPM paradigm,
we need to study the rhetorical strategies of protagonists involved in the negotiation
of the NPM agenda. Rhetorical strategies are means of making general viewpoints
more convincing, for example, by comparing ‘our’ organization with similar organizations.
Rhetorical strategies show patterns, which reappear in conversations and
arguments made by protagonists. Specifically, we identified three rhetorical strategies
justifying why and what kind of a more ‘rounded picture’ was required: widening the
argument to include national productivity comparisons with other hospitals; widening
the argument away from a narrow focus on finance toward a strategic and political
perspective; and, lastly, widening the argument to look at innovation in the whole
clinical process.