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

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