‘A Rounded Picture is What We Need’: Rhetorical Strategies,Arguments,and the Negotiation of Change in a UK Hospital Trust

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.