a critical discourse analysis of constructions of power by

A Critical Discourse Analysis of

Constructions of Power by

Healthcare Leaders

© 2019 SAGE Publications, Ltd. All Rights Reserved.

This PDF has been generated from SAGE Research Methods Datasets.

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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SAGE Research Methods Datasets Part

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of 14 A Critical Discourse Analysis of Constructions of Power by Healthcare

Leaders

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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