Clinical Governmentality
A Critical Linguistic Perspective on Clinical Governance in Health Care Organizations
DOI:
https://doi.org/10.1558/japl.v2.i3.299Keywords:
clinical governance, governmentality, mental health, nursing practice, professional identity, narrativeAbstract
The introduction of clinical governance policies in the UK offers an opportunity to explore the links between organizations, politics and language in health care. This paper attempts to theorise the links between symbolic and ideological formations and health care practitioners’ accounts in one mental health care trust as a clinical governance initiative was implemented. Drawing on Fairclough, Foucault and Bourdieu, we attempt to situate the practices, formulations and identities of health care staff in a way that allows us to show the links between policy, professional identity and language. The data suggested that whilst there was widespread acceptance of the clinical governance concept this had resulted in little change in practice with clients. However, the major reconfigurations seemed to have taken place in personal and professional identity and the identities preferred amongst the clients. This had to do with ‘feeling listened to’ whilst the process of implementation was left to ‘grow organically’ and was what they were ‘supposed to be doing anyway’ whilst the clients were increasingly asked to be experts on their own care. The implementation of the policy thus involves reorganising symbolic capital so that adopting clinical governance represented a recapitalisation of the self with new experiences, skills, ideas and practices. This highlights the importance of drawing on critical theories and notions of identity and governmentality in doing applied linguistic analysis in health care institutions.
References
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Lugon, M. (2002) Clinical governance: rhetoric or reality? Clinical Governance Bulletin 3(2): 1–2.
McCarthy, C. (2005) Towards a definition of interiority. Space and Culture 8(5): 112–125.
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Scheuer, J. (2003) Habitus as the principle for social practice. Language in Society 32(2): 143–175.
Schiffrin, D. (1996) Narrative as self-portrait: sociolinguistic constructions of identity. Language in Society 25: 167–203.
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Traynor, M. (1999) Managerialism and Nursing: beyond oppression and profession. London: Routledge.
Barker, J. (1993) Tightening the iron cage: concertive control in self-managing teams. Administrative Science Quarterly 38(3): 408–437
Boje, D. M. and Windsor, R. D. (1993) The resurrection of Taylorism: total quality management’s hidden agenda. Journal of Organisational Change Management 6(4): 58–71.
Bourdieu, P. (1991) Language and Symbolic Power. Cambridge: Polity Press.
Bourdieu, P. (1999) Outline of a Theory of Practice. Cambridge: Polity Press.
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Brown, B. and Crawford, P. (2003) The clinical governance of the soul. Social Science and Medicine 56(1): 67–81.
Casey, C. (1999) ‘Come join our family’ discipline and integration in corporate organisational culture. Human Relations 52(2): 155–178.
Cheek, J. and Porter, S. (1997) Reviewing Foucault: possibilities and problems for nursing. Nursing Inquiry 4(2): 108–119.
Cicourel, A. (1982) Language and belief in a medical setting. In H. Byrnes (ed.) Contemporary Perceptions of Language: interdisciplinary dimensions 48–78. Washington, DC: Georgetown University Press.
Cicourel, A. (1987) The interpenetration of communicative contexts: examples from medical encounters. Social Psychology Quarterly 50(2): 217–226.
Chafe, W. (1971) Directionality and paraphrase. Language 47: 1–26.
Chouliaraki, L. and Fairclough, N. (1999) Discourse in Late Modernity: re-thinking critical discourse analysis. Edinburgh: Edinburgh University Press.
Courpasson, D. (2000) Managerial strategies of domination: power in soft bureaucracies, Organization Studies 21(1): 141–161.
Daudelin, M. (1996) Learning from experience through reflection. Organizational Dynamics 24(3): 36–48.
Dean, M. (1999) Governmentality: power and rule in modern society. London: Sage.
Degeling, P., Maxwell, S., Kennedy, J. and Coyle, B. (2003a) Medicine, management and modernization: a ‘dance macabre’? British Medical Journal 326: 649–652.
Degeling, P., Iedema, R., Winters, M., Maxwell, S. A., Coyle, B. A., Kennedy, J. and Hunter, D. M. (2003b) Accomplishing leadership in the context of health reform. In S. Dopson and A. L. Mark (eds) Leading Health Care Organizations 113–133. Basingstoke: Palgrave Macmillan.
Dent, M. (2003) Managing doctors and saving a hospital: irony, rhetoric and actor networks. Organization 10: 107–127.
Department of Health (1998) A First Class Service: quality in the new NHS. London: Department of Health.
Dietz, J. L. G. (2001) DEMO: towards a discipline of organisation engineering. European Journal of Operational Research 128: 351–363.
Donaldson, L., Halligan, A. and Wall, D. (2003) Improving the child’s experience of healthcare: the implementation of clinical governance. Current Paediatrics 13(4): 298–302.
Drew, P. and Sorjonen, M-L. (1997) Institutional dialogue. In T. A. van Dijk (ed.) Discourse as Social Interaction. Discourse Studies: a multidisciplinary introduction Volume 2, 92–118. London: Sage.
Du Gay, P. (1997) Cultures of Production/Production of Culture. Buckingham: Open University Press.
Dyson, S. and Brown, B. (2005) Social Theory and Applied Health Research. Buckingham: Open University Press.
Edwards, D. (1997) Discourse and Cognition. London: Sage Publications.
Fairclough, N. (1992) Discourse and Social Change. Cambridge: Polity Press.
Fairclough, N. (2003) Analysing Discourse: textual analysis for social research. London: Routledge.
Fairclough, N. and Wodak, R. (1997) Critical discourse analysis. In T. A. van Dijk (ed.) Discourse as Social Interaction 258–284 (vol. 2). London: Sage.
Flynn, R. (1999) Managerialism, professionalism and quasi-markets. In M. Exworthy and S. Halford (eds) Professionals and the new managerialism in the public sector 18–36. Buckingham: Open University Press.
Foucault, M. (1977) Discipline and Punish. The Birth of the Prison. Harmondsworth, Middlesex: Penguin Books.
Foucault, M. (1980) Michel Foucault: power/knowledge. Selected interviews and other writings, 1972/1977. Brighton, Sussex: Harvester Wheatsheaf.
Foucault, M. (1990) The History of Sexuality, vol. 1: an introduction. Harmondsworth, Middlesex: Penguin Books.
Freidson, E. (1994) Professionalism Reborn: theory, prophesy and policy. Cambridge: Polity Press.
Gastaldo, D. and Holmes, D. (1999) Foucault and nursing: a history of the present. Nursing Inquiry 6 (4): 231–240.
Gee, J. P. (1992) The Social Mind: language, ideology and social practice. New York: Bergin and Garvey.
Gee, J. P. (1996) Social Linguistics and Literacies: ideology in discourses (Second edition). London: Taylor & Francis.
Gee, J., Hull, G. and Lankshear, C. (1996) The New Work Order: behind the language of the new capitalism. Sydney: Allen and Unwin.
Gray, A. and Harrison, S. (2004) Governing Medicine: theory and practice. Buckingham: Open University Press.
Grugulis, I. and Wilkinson, A. (2002) Managing culture at British Airways: hype, hope and reality. Long Range Planning 35: 179–194.
Guba, E. G. (1981) Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Communications and Technology Journal 29: 75–92.
Halford, S. and Leonard, P. (1999) New identities? Professionalism, managerialism and the construction of self. In M. Exworthy and S. Halford (eds) Professionals and the New Managerialism in the Public Sector 102–120. Buckingham: Open University Press.
Harrison, S. and Lim, J. N. W. (2003) The frontier of control: doctors and managers in the NHS 1966–1997 Clinical Governance: an international journal 8(1): 13–18.
Hodkinson, P. and Bloomer, M. (2000) Stokingham Sixth Form College: institutional culture and dispositions to learning. British Journal of Sociology of Education 21(2): 187–202.
Holmes, D. (2001) From iron gaze to nursing care: mental health nursing in the era of panopticism. Journal of Psychiatric and Mental Health Nursing 8: 7–15.
Iedema, R., Braithwaite, J., Jorm, C. M., Nugus, P. and Whelan, A. (In press) Clinical governance: complexities and promises. In P. Stanton, E. Willis and S. Young (eds) Health Care Reform and Industrial Change in Australia: lessons, challenges and implications. Basingstoke: Palgrave Macmillan.
Johnstone, B. (2001) Narrative. In D. S. Schiffrin, D. Tannen and H. E. Hamilton (eds) The Handbook of Discourse Analysis 635–649. Oxford: Blackwell.
Jordens, C. and Little, M. (2004) ‘In this scenario, I do this, for these reasons’: narrative, genre and ethical reasoning in the clinic. Social Science & Medicine 58: 1635–1645.
Kmietowicz, Z. (2003) Implementation of clinical governance is patchy, report says. British Medical Journal 327: 641.
Lilley, R. (1999) Making Sense of Clinical Governance: a workbook for NHS doctors, nurses and managers. Oxford: Radcliffe Medical Press.
Lugon, M. (2002) Clinical governance: rhetoric or reality? Clinical Governance Bulletin 3(2): 1–2.
McCarthy, C. (2005) Towards a definition of interiority. Space and Culture 8(5): 112–125.
McKinlay, A. and Taylor, P. (1998) Through the looking glass: Foucault and the politics of production. In A. McKinlay and K. Starkey (eds) Foucault, Management and Organisation Theory 54–67. London: Sage Publications Ltd.
McLaren, P. (1994) Multiculturalism and the post-modern critique: toward a pedagogy of resistance and transformation. In H. Giroux and P. McLaren (eds) Between Borders: pedagogy and the politics of cultural studies 193–222. New York: Routledge.
McSherry, R. and Haddock, J. (1999) Clinical governance. Evidence based health care: its place within clinical governance. British Journal of Nursing 8(2): 113–117.
Macken-Horarik, M. (2003) Appraisal and the special instructiveness of narrative. Text 23(2): 285–312.
Martin, J.R. (2000) Beyond exchange: appraisal systems in English. In S. Hunston and G. Thompson (eds) Evaluation in Text: authorial stance and the construction of discourse 142–175. Oxford: Oxford University Press.
Martin. P. (1998) On the side of the angels? Open college networks as a case of cooperation within a competitive environment. Research in Post Compulsory Education 3(1): 57–70.
Mercer, D., Richman, J. and Mason, T. (2000) Out of the mouths of forensic nurses: a ‘pathology of the monstrous’. Mental Health Care and Learning Disabilities 3(6): 197–200.
Mishler E. (1986) Research Interviewing: context and narrative. Cambridge, Mass.: Harvard University Press.
National Audit Office (2003) Achieving Improvements through Clinical Governance: a progress report on implementation by NHS Trusts. London: National Audit Office.
Nelson, S. and Purkis, M. E. (2004) Mandatory reflection: the Canadian reconstitution of the competent nurse. Nursing Inquiry 11: 247–257.
Pamphilon, B. (1999) The zoom model: a dynamic framework for the analysis of life histories. Qualitative Inquiry 5: 393–410.
Pateman, T. (1980) Language, Truth and Politics: towards a radical theory for communication. London: Jean Stroud.
Pennycook, A. (2001) Critical Applied Linguistics: a critical introduction. Mahwah, NJ: Lawrence Erlbaum Associates.
Pollock, A. (2004) NHS Plc: the privatization of our health care. London: Verso.
Precht, K. (2003) Stance moods in spoken English: evidentiality and affect in British and American conversation. Text 23(2) 239–257.
Rose, N. (1990) Governing the Soul: the shaping of the private self. London: Routledge.
Rose, N. (1996) Inventing Ourselves: psychology, power and personhood. New York: Cambridge University Press.
Ross, J. E. (1993) Total Quality Management: texts, cases and readings. Delray Beach: St Lucie Press.
Scally, G. and Donaldson, L. (1998) Clinical governance and the drive for quality improvement in the new NHS in England. British Medical Journal 317: 61–65.
Scheuer, J. (2003) Habitus as the principle for social practice. Language in Society 32(2): 143–175.
Schiffrin, D. (1996) Narrative as self-portrait: sociolinguistic constructions of identity. Language in Society 25: 167–203.
Schiffrin, D. (1997) The transformation of experience, identity and context. In G. Guy (ed.) Towards a Social Science of Language: social interaction and discourse structures. Amsterdam: Benjamins.
Sheaff, R., Rogers, A., Pickard, S., Marshall, R., Campbell, S., Sibbald, B., Halliwell, S. and Roland, M. (2003) A subtle governance: ‘soft’ medical leadership in English primary care. Sociology of Health & Illness 25(5): 408–428.
Shields, R. (1991) Places on the Margins: alternative geographies of modernity. London: Routledge.
Silverman, D. (1993) Interpreting Qualitative Data: methods for analysing talk, text and interaction. London: Sage.
Soder, R. (2001) The Language of Leadership. San Francisco: Jossey Bass.
Svedberg. (2004) Rhetorical resources for management: the leading words. Educational Management, Administration and Leadership 32(4): 423–438.
Syrett, V., Jones, M. and Sercombe, N. (1997) Implementing community care: the congruence of manager and practitioner cultures. Social Work and Social Sciences Review 7(3): 154–169.
Tallis, R. (2004) Hippocratic Oaths: medicine and its discontents. London: Atlantic Books.
Thompson, J. (1991) Editor’s introduction. In P. Bourdieu (ed.) Language and Symbolic Power. Cambridge: Polity Press.
Thornborrow, J. (2002) Power Talk: language and interaction in institutional discourse. London: Longman.
Thorogood, N. (2000) Sex education as disciplinary technique: policy and practice in England and Wales. Sexualities 3(4): 425–438.
Tilah, M. (1996) The medical model to the management model: power issues for nursing. Nursing Praxis in New Zealand 11(2): 16–22.
Traynor, M. (1999) Managerialism and Nursing: beyond oppression and profession. London: Routledge.
Published
2008-04-11
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Articles
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Equinox Publishing Ltd.
How to Cite
Brown, B., Crawford, P., & Mullany, L. (2008). Clinical Governmentality: A Critical Linguistic Perspective on Clinical Governance in Health Care Organizations. Journal of Applied Linguistics and Professional Practice, 2(3), 299-324. https://doi.org/10.1558/japl.v2.i3.299
