Abstract:

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.

Author: Brian Brown, Paul Crawford, Louise Mullany