a critical discourse analysis of constructions of power by
TRANSCRIPT
A Critical Discourse Analysis of
Constructions of Power by
Healthcare Leaders
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A Critical Discourse Analysis of
Constructions of Power by
Healthcare Leaders
Student Guide
Introduction
Discourses of distributed leadership within the National Health Service (NHS)
claim that employees at all levels of the organisation have the capacity to lead
changes and improvements (O’Reilly & Read, 2010, 2011). The MSc study aimed
to explore the experiences of clinicians and managers within a healthcare
organisation, focusing on the way in which language constructed the social
realities of the participants. Nine semi-structured interviews were digitally
recorded and transcribed verbatim. This exemplar is intended for students new
to Critical Discourse Analysis (CDA), and the process of moving from text corpus
to the eight sections of text selected for further detailed analysis will be outlined
below. The process of analysis of a section of text using Fairclough’s Textual
Analysis Checklist (Fairclough, 2003) is worked through before attempting to
show how a summary of the analyses across actional, representational, and
identificational layers of meaning gave rise to an interpretation of the way in which
the participants socially constructed power through the langue they used. This
interpretation is then contextualised by the literature to create an opportunity for
conclusions to be drawn. The reader is provided with two additional sections of
text as learning points.
Data Exemplar: A Critical Discourse Analysis of Constructions of
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Power by Healthcare Leaders
The sections of text in this exemplar are taken from semi-structured interviews
with healthcare professionals that worked together in a Task and Finish Group
(TFG). The TFG had an aim to achieve a specific organisational change within
an anticipated time frame for completion. Recruitment to the study was initiated
via face-to-face contact with the group, with an invitation to participate made via
email. Nine group members took part in the study, representing the majority of
the group’s active membership (n = 11). Participant’s position in the organisation
were: Allied Health Professional (n = 3), Consultant Psychiatrist (n = 3), Clinical
Service Manger (n = 3).
Interviews were conducted at the participant’s place of work and lasted between
40 and 70 minutes. Written consent was obtained prior to the interview starting.
The semi-structured schedule offered a template to ensure a degree of
consistency across the interviews whilst allowing for information to be elicited
iteratively as interviews progressed, with flexibility built into the interview schedule.
The aim of the schedule was to open up areas of naturalistic conversation through
exploration of key areas such as experiences of leadership, contribution to the
TFG, and involvement in organisational change. The interviews were carried out
between July and October 2014, digitally recorded and transcribed in full.
The study was approved by the Swansea University College of Health and Human
Science & College of Medicine Research Ethics Committee (27 March, 2014) and
the participating health board’s Research and Development department (IRAS
Ref: 154340).
Analysis: Critical Discourse Analysis
The unit of analysis in CDA is text, both written (e.g., document, media,
communications, policies, novels) and spoken (e.g., meetings, interviews,
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discussions). Text can be understood as consisting of a number of smaller units
or “messages.” Multiple messages are organised into socially connected units
called texts, and a multitude of texts join together in creating the social process
of discourses (Locke, 2004). CDA is a popular approach in a number of social
research disciplines, focusing on the ways in which relationships of dominance,
discrimination, power, and control show themselves in the language we use
(Leitch & Palmer, 2010). A student new to this methodology might assume that the
acronym CDA reflects a shared understanding of method, theory, and ideology.
However, CDA is best understood as a theoretically diverse collection of methods
with interdisciplinary roots. As Lee and Otsuji explain, each “brand” of CDA has
its own theoretical position: Teun van Dijk focuses on the cognitive dimension of
discourse and social practice, Ruth Wodak focuses on the political and historical
analysis of context, whilst Normal Fairclough focuses on the dialectical
relationship between discourse and social practices (Lee & Otsuji, 2009).
The range of CDA “brands” can feel overwhelming and anxiety provoking, so
Fairclough’s Textual Analysis Checklist can be a helpful grounding to cover a
range of textual areas: social event; genre; difference; intertextuality;
assumptions; semantic and grammatical relations; exchanges, speech function,
and grammatical mood; discourse; representation of social events; style; modality;
and evaluation. Fairclough’s (2013) approach to CDA draws from a diverse range
of philosophies and social theories. Identifying himself as being “moderately
socially constructivist,” his method of analysis is interested in the relational
aspects within a text and discourses as elements of social practices. Offered as a
series of questions to “ask” the data, the Checklist creates a dialogue between the
data and the analyst. This in turn creates a description of the text, as an episode
of speech, and as a social event. An interpretation of the data can then be offered,
contextualising the text in wider social theory (Fairclough, 1993).
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Reflexivity
As an interpretive methodology, CDA embraces that the researcher is not a
neutral observer, but an active co-participant in the construction of knowledge.
Reflexivity offers a strategy for quality control, critically explaining the way in
which the researcher goes about the task of conducting and co-constructing
the research endeavour (Berger, 2015). It has been suggested that published
accounts of CDA which fail to demonstrate reflexivity are more likely to have
additional methodological weaknesses (Leith & Palmer, 2010). A reflexive
sensibility encourages the researcher to notice how pre-understandings, hunches,
attitudes, biases, and lived experiences play out in the research. The fingerprint
of the researcher will be all over the research, and when the researcher declares
their relationship with the research, the reader is afforded the opportunity to draw
their own conclusions as to the integrity, credibility, and trustworthiness of the
research (Cutcliffe, 2003; Fawcett & Hearn, 2004). The next section is written in
the first person as Andrea Davies discusses in more detail how she analysed and
drew conclusions from the interview data.
Stage 1: Transcribing and Identifying Themes
Fairclough offers no comprehensive guidance for transcription practices in CDA.
Transcripts do not need to include all of the participant’s non-verbal
communication but should include the majority of idiosyncratic use of grammar,
slang, and longer pauses. I started by reading through the whole data corpus
paying attention to particular questions and themes. Depending on the aim of
a study, it may be feasible to code the entire text corpus, or it might be useful
to attend to particular aspects or questions. Following thorough and multiple
readings of all transcripts, I highlighted areas of interest in each transcript as an
initial stage of coding. The highlighted texts were given a code that described
the context of the selected areas, and I generated themes that described the
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relationships between the codes and the selected text. Five themes were
identified at this stage: TFG, Manager–Clinician tensions, Position in the service,
Practices of leadership, and Power. Reflexivity was advocated at all stages of the
analysis and explanations offered as to why certain interpretations were privileged
over others. The initial theme of Practices of Leadership is summarised in Table
1. Text was coded to this theme when participants spoke about how they enacted
leadership, and a sample of the descriptive codes are presented alongside my
reflections on this theme at this early stage of analysis.
Table 1: Initial Theme – Practices of Leadership.
Initial
theme
Sample for
descripted code
relating to initial
theme
Points of reflection
Practices
of
leadership
• Working in
networks
• Distributing
authority
and
responsibility
• Influencing
• Being
“there”
• Motivating
others
• Recognising
good
leadership in
others
• Diversity of
role
• Being a
leader
• Setting a
tone
All participants talk about the practices of “influence”; how one goes about gaining a
strategic position from which to influence, how one might utilise distributed models of
leadership to influence a department, how one might go about setting the “tone” for
change amongst colleague. What stood out for me was that practice of influencing and
practices of power required a relational context. My biases towards a relational
understanding of reality highlight my role as a multi-dimensional, fallible data co-
constructor, predisposed to notice, hear and respond to, relational talk.
Stage 2: Selecting Texts for Detailed Analysis
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As Power and Practices of Leaderships were areas of inquiry in this study, all
extracts coded in these themes were selected for further analysis (n = 8). The data
exemplar provides the section of text selected from the interview with “Rhys,” a
service manager talking about the development of his leadership role during his
nursing career. The text extract had been coded under the initial theme Practices
of Leadership and selected for further analysis as it offered reflections on the
enactment of leadership.
Stage 3: Analysis and Interpretation of the Text
Fairclough’s Checklist enabled a conversation with the text which moved across
different layers of context: Some questions focus on relations within the text,
others on relations between the text and wider discourses. An overview of the
analytic dialogue between Fairclough’s Checklist and Rhys’ text is provided in
Table 2.
Table 2: Analytic Dialogue Between Fairclough’s Checklist and Rhys’ Text.
Textual Analysis
Checklist (Fairclough,
2003, pp. 191–194)
Analysis of Exemplar 1
Social event: What
social event is the text
part of? What social
practice or network of
social practices can the
events be framed within?
The extract is part of a section of interview text in which Rhys is speaking about the development
of his leadership role during his nursing carer. As outlined in Table 2, the extract can be framed
as a research interview, located as a social event in a chain of events related to the streamlining
of services, and as part of a network of social practices, namely conversations between multi-
disciplinary colleagues.
Genre: Is the text
situated within a genre
chain? Is the text
characterised by a mix of
genres?
The text is characterised by a mix of genres; research and collegial. Assisted by the semi-
structure interview schedule, it was my responsibility to privilege the genre of research, and to be
mindful of noticing when the genre became “too” collegial.
Difference: What
characterises the
There is an implicit notion of “difference”; Rhys speaks of embracing and working with different
views to change service provision. There appears to be an openness, acceptance, and
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orientation to difference
in the text? recognition of difference.
Intertextuality: What
other voices are
included?
Despite the relational content of the extract, Rhys does not reference the voices of others either
directly or indirectly. Consequently, difference is not demonstrated in the extract in its true
dialogical sense as an exploration and value of difference.
Assumptions: What
existential, propositional,
or value assumptions are
made? Is there a case
for seeing any
assumptions as
ideological?
There is a dominance of existential assumptions that relate to an ideology of objectivism: “I like
influencing things in what I see as things being done the right way”; “I make the decision as to
what is better for the service.” This is positioned alongside a propositional assumption that
people have different perspectives: “someone else might see things differently”; “I am not
reluctant to hear other views.” Value assumptions privilege “learning and looking for new things”
and a “passion to improve.” It seemed to me that an objectively correct situation which can be
weighed up and presented as evidence serves to legitimise individualism and hierarchical power
in leadership. This then appears to marginalise the value of working with others to distribute
leadership.
Semantic/grammatical
relations between
sentences and clauses:
What are the
predominant semantic
relations between
sentences and clauses?
The extract offers a discursive report using a logic of appearances to describe the enactment of
leadership. The semantic relations are predominantly elaborative and causal as Rhys offers a
legitimisation for his choices and actions. The extract also contains contrastive semantic
relations, highlighting some of the tensions and dilemmas for those in leadership positions: not
being a “dictator,” but liking to do “things my way.”
Exchanges, speech
function, and
grammatical mood:
What are the
predominant types of
exchanges and speech
function? What types of
statements are there?
What is the predominant
grammatical mood?
A knowledge exchange characterises the speech function, with many subjective statements; “I
think”; “I like.” The grammatical metaphor is one of evaluation, containing a declarative grammar
and a logic of appearance, that is to say, what is offered is an evaluation of reality as it is.
Discourse: What
discourses are drawn
upon in the text and how
are they textured
together? Is there
significant mixing of
discourses?
There is a mix of organisational and health-related discourses, underpinned by an objective,
realist ontology. Rhys demonstrates the tension between authoritative and authoritarian
leadership styles: “I like doing things my way”; “I don’t think I’m a dictator.” He talks about the
decision-making responsibility that is part of his role in the organisation but acknowledges the
need to consult with others. The leadership style that Rhys describes is akin to discourses of
transformational leadership: “passion”; “always learning and looking for new things.”
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Representation of
social events: What
elements of represented
social events are
included or excluded?
How abstractly or
concretely are social
events represented?
Then extract talks to the social event of working with others; working with others to make a
decision. Rhys has made abstractions over a number of repeated social events in producing a
generalised report of practices-of-working-with-others that are textually represented here, and a
range of relational processes are offered: influencing, doing, and deciding. The “object” of
working with others is to make a decision.
Style: What styles are
drawn upon in the text
and how are they
textured together?
Rhys represented himself textually via a range of style identities: interview participant, manager,
and motivator.
Modality: What do
authors commit
themselves to in terms of
truth?
The text offers a high commitment to the truth of “how things are” via the use of modalized
propositional assumptions and statements of fact: “I am not someone who would just sit and let
the world go by.”
Evaluation: To what
values do the authors
commit themselves?
How are values realised?
In talking about his practices of working with others, Rhys states his values of working with
difference, learning, change, passion, and improvements.
The analysis is presented in an unabridged prose format below:
There is an embracing of the notion of difference in the text and a privileging of
working with difference to enable service change. Whilst there is an openness
and acceptance of difference, there is no reference to the voices of others or
different positions. Consequently, difference is not demonstrated in the extract
as an exploration and value of difference. The existence of an “objective correct
solution” which can be “weighed up” and presented as “evidence” serves to
legitimise individualism and hierarchical power in leadership. Rhys’ evaluative
report of leadership-in-practice highlights some of the tensions and dilemmas for
those in healthcare leadership positions: not being a “dictator” but liking to do
things “my way.” Having decision-making responsibility as part of his position
but needing to consult to others neatly juxtaposes authoritative and authoritarian
styles. The metaphorical landscape is of dynamic action and movement; “strive,”
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“change,” “being stuck in a rut.” Rhys identifies himself in the text as a participant,
diplomat, and manager, valuing learning, change, passion, and improvement. The
extract is easily re-contextualised within leader-centric discourses, and a range of
healthcare and organisational discourses are layered within the text: organisation-
as-machine, multi-disciplinary practice, transformative leadership, and
objectivism.
After each extract was analysed in the method outlined above, the analysis across
the eight extracts was drawn together in an overall summary before offering an
interpretation of the way in which power was socially constructed in the text:
The action of the text was knowledge exchange in the genre of discursive
reporting. It was suggested that the managers and clinicians intended to represent
reality as they experienced it, and a range of leadership, healthcare, and
organisational discourses were textured in the extracts:
Organisational discourses Healthcare discourses Leadership discourse
Organisation-as-structure Evidence-based healthcare Charismatic
Organisation-as-organic Medical dominance Transactional
Organisation-as-machine Multi-disciplinary practice Transformative
Six of the extracts offered a logic of appearance; an account of how things are,
as if language offered a representation of reality. Two of the extracts offered
an explanatory logic, tracing causal elements within the genre of discursive
explanation; an account of “why” things are as they are. The managers and
clinicians spoke about social events at the level of abstract generalisation made
over varying time frames, indicating a commitment to the “truth” of what they
were describing. Social relations were constructed as structural and hierarchical,
and the extracts were readily re-contextualised within leader-centric discourses
of leadership, e.g., heroic leaders. The managers and clinicians represented
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themselves via a mixing of styles, demonstrating the multiple roles that they held
within the organisation:
• Manager
• Protagonist
• Diplomat
• Team member
• Leader
• Follower
• Consultant
• Guest
• Collaborator
• Motivator
• Research participant
• Colleague
A number of values were implied in the text which conveyed competing agendas,
competing discourses, and divisions of power, for example:
1. There was a distinction made between core and not core professional
groups in the text which implies a tension between the value of multi-
disciplinary working and medical dominance.
2. The importance of taking ownership and demonstrating one’s
leadership ability was privileged at the expense of any critical reflection
on how this might impact on cultivating relationships within teams or
involving others in decision-making processes.
To summarise, managers and clinicians drew from dominant discourses of
leadership; charismatic, transformative, and transactional, as well as dominant
epistemological discourses; objectivism, realism, and individualism. Such
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discourses were maintained by the way in which participants constructed power
as existing in people, roles, and professions. Power was experienced and
constructed in language as to create hierarchal social relations, and it could
be suggested that the practices-of-power they experienced have been repeated
often enough for them to become a “true” reflection of the social reality of the
organisation.
Stage 4: Drawing Conclusions
The analysis and summaries of the data were considered in light of the move
away from leader-centric leadership discourses in contemporary UK healthcare
literature. It was concluded that despite an anticipated shift to distributed and
engaged leadership approaches, healthcare leaders may continue to experience
and create their social organisational realities as ones in which power is
hierarchical and objectified. As such, a structural distribution of power does not
necessarily create a distribution of power.
Summary
In this dataset, we have attempted to demonstrate how Fairclough’s Checklist
can be used as a guide to a CDA of interview transcripts. The transcribed data
generated some 38,000 words, and the selected extracts were not intended to
represent the dataset as a whole but as a way of attending to areas of interest
in relation to the aims of the research. Moving from the initial stages of analysis
of the text corpus to smaller extracts requires transparency and candour on the
part of the researcher. The Checklist offers a consistent method from which to
work through a number of selected texts before summarising across layers of
meaning to make interpretations of the data in relation to the study aims. Finally,
the interpretations are re-contextualised within the literature in order to draw
conclusions and recommendations.
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Reflective Questions
1. The two extra data extracts were coded within the initial theme of
Power. Frank, Service Manager, and Sarah, Allied Healthcare
Professional, offer different perspectives on the social event of group
membership. Using the Checklist questions in Table 2, consider each
participant’s approach to the power and difference between “core” and
“other.” How do they talk about the activity of “inviting”? How can this
activity be re-contextualised in wider healthcare discourses?
2. How do your own experiences of power and working in an organisation
impact on your analysis of these texts?
3. How do you understand the relationship between language and social
realities?
Further Readings
Etherington, K. (2004). Becoming a reflexive researcher: Using our selves in
research. London, UK: JKP.
Fairclough, N. (2013). Critical discourse analysis: The critical study of language.
UK: Routledge.
Morris, M., & Davies, A. (2018). Being both researcher and subject: Attending
to emotion within collaborative inquiry. In T. Loughran & D. Mannay (Eds.),
Studies in Qualitative Methodology: Vol. 16. Emotion and the researcher: Sites,
subjectivities, and relationships (pp. 229–244). Bingley, UK: Emerald.
References
Berger, R. (2015). Now I see it, now I don’t: Researcher’s position and reflexivity
in qualitative research. Qualitative Research, 15(2), 219–234.
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Cutcliffe, J. R. (2003). Reconsidering reflexivity: Introducing the case for
intellectual entrepreneurship. Qualitative Health Research, 13(1), 136–148.
Fairclough, N. (1993). Discourse and social change. Cambridge, UK: Polity
Press.
Fairclough, N. (2003). Analysing discourse: Textual analysis for social research.
Hove, UK: Psychology Press.
Fairclough, N. (2013). Critical discourse analysis: The critical study of language.
UK: Routledge.
Fawcett, B., & Hearn, J. (2004). Researching others: Epistemology, experience,
standpoints and participation. International Journal of Social Research
Methodology, 7(3), 201–218.
Lee, A., & Otsuji, E. (2009). Critical discourse analysis and the problem of
methodology. In T. Le & M. Short (Eds.), Critical discourse analysis: An
interdisciplinary perspective (pp. 65–77). New York, NY: Nova Science.
Leith, S., & Palmer, I. (2010). Analysing texts in context: Current practices and
new protocols for critical discourse analysis in organisational studies. Journal of
Management Studies, 47(6), 1194–1212.
Locke, T. (2004). Critical discourse analysis. London, UK: Continuum.
O’Reilly, D., & Reed. M. (2010). “Leaderism”: An evolution of managerialism in
UK public service reform. Public Administration, 88(4), 960–978.
O’Reilly, D., & Reed, M. (2011). The grit in the oyster: Professionalism,
managerialism and leaderism as discourses of UK public services modernization.
Organization Studies, 32(8), 1079–1101.
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