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

Frank Mueller, John Sillince, Charles Harvey, Chris Howorth

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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.
Original languageEnglish
Pages (from-to)75-93
JournalOrganization Studies
Issue number1
Publication statusPublished - 1 Jan 2004


  • New Public Management
  • professional
  • managerial
  • hospital management
  • discourse
  • rhetorical strategies
  • arguments
  • health care management

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