Author: Warne T, McAndrew S, King M, Holland K
Journal: Nurse Education Today, 2007
Volume/pages: Vol 27, pp947-954

About the study
The authors conducted a study of primary care staff at strategic, management and service delivery levels to explore how they dealt with the recent substantial changes within primary care and the development of integrated ways of working. They used written questionnaires, individual interviews and workshops to elicit the views and experiences of 350 primary care staff. They became interested in the rhetoric used by particpants.

Findings
The study found that four kinds of rhetoric were used by participants to make sense of their experiences of the changes in health and social care: 1) rational; 2) technical; 3) normative and 4) fantasy rhetoric. The authors suggest that the use of rhetoric by participants in this study shows that managers need to look beyond the words that people use in order to better understand what they are actually saying and what it means. By doing this, managers can use it to more effectively support staff through the change process.

Key messages

• Rhetoric is a way of ‘making sense’ of what is happening during times of uncertainty. It is often used as a defence mechanism to cope with the disruption that ongoing change provokes.
• Managers responsible for managing change should create a safe environment for staff to explore new ways of thinking, behaving and working with others.
• Rhetoric can be used to develop a nurturing organisational culture that supports staff through times of organisational change.