The contestation of archetypes: negotiating scripts in a UK hospital trust board

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.