The Contestation of Archetypes: Negotiating<br /> 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.