The Contestation of Archetypes: Negotiating Scripts in a UK Hospital Trust Board*

Abstract

 This paper deals with the aftermath of the creation of a new governance structure in the UK National Health Service. We conceptualize this new governance structure as a 'Trust Hospital Archetype' in order to establish the promises and limitations of an archetype transition framework. We find that the 'reality' of the 'Trust Hospital Archetype' is one involving a high degree of contestation. This is confirmed by evidence drawn from interviews, documents, observation and participant observation. In order to analyse contestation, we distinguish between three interpretive schemes -Ideological-New Public Management, Executive Pragmatism and Medical Professionalism; and we outline five scripts -challenging, critiquing, mediating, cautioning and defending. This diversity casts doubt on the usefulness of simplistic managerialism-professionalism dichotomies prevalent in much of the literature. It also suggests modifications to archetype transition theory, which lends too much weight to the role of dominant interpretive schemes.

Working identities? Antagonistic discursive resources and managerial identity

“…Our findings thus contest suggestions that managers are amoral agents concerned only with the efficient and effective ordering of material and knowledge resources within specific organizational offices (Friedman, 1970;MacIntyre, 1985) and use notions of morality only as rhetorical devices to facilitate policy implementation (Mueller et al, 2003). As Watson (2001: 15) asserts, not only has management a moral dimension, it is 'valued soaked'.…”

Entrepreneurship as an integrating mechanism for disadvantaged persons

“…Extant research also reveals that certain sectors of the economy (e.g. public) tend to model themselves after the business or entrepreneurial sector (Du Gay 1994Gay , 2004Mueller, Harvey, and Howorth 2003;Thomas and Davies 2005), which means that the former fields are dominated or colonized by the latter (Bourdieu 1983(Bourdieu , 1998. Accordingly, to the extent that disadvantaged persons' focal field is dominated by the field of entrepreneurship -for example, some minority groups may have more entrepreneurial role models amongst themselves compared to other groups and therefore have been more exposed to what starting and running a business entails -they should be more motivated to comply with existing entrepreneurial norms, because they are more familiar with them.…”

Implementing a new governance model

“…It also examines the role of external and internal environmental factors such as government policy, the demand for services as well as the organisation's value system in shaping organisations. The primary aim in archetype theory is to understand the nature of organisations through an analysis of the relationship between an organisation's informal value system known as its interpretive scheme, and its more formal structure and systems (Brock, 2006;Brock et al, 2007;Hinings and Greenwood, 1989;Kirkpatrick and Ackroyd, 2003;Mueller et al, 2003;Powell et al, 1999). Archetype theorists believe that an holistic approach needs to be taken in order to understand an organisation, meaning that the values, beliefs and ideologies of the organisation's members, its interpretive scheme, need to be viewed alongside the physical structure and systems of that organisation (Brock, 2006;Brock et al, 2007;Powell et al, 1999).…”