Locating our research
For over 20 years we have worked as qualitative researchers in healthcare, gaining much of our research experience working in medical schools. Over the years we have undertaken research and evaluation projects about various aspects of health policy and practice, using interviews, focus groups and occasionally some observation. As is the norm in the medical school environment (where controlled trials, systematic reviews and surveys dominate), these qualitative methods were underpinned by an implicitly neo-positivist view of language and meaning. Like many qualitative researchers in medical schools, we were trained as analysts to look for 'themes' in our data. We treated language as a transparent medium, a lens through which we could unproblematically examine and understand the real nature of events and people's views and experiences (Gubrium and Holstein, 2003; Hammersley, 2007). Our exploration of meaning was limited to identifying and documenting respondents' intentional, stated meanings (Wagenaar, 2011).
We then came across a body of work in policy studies that proved to be a turning point in our thinking. This work not only recognised the empiricist emphasis (grounded in instrumental rationality as a means of explaining human action) as naive, but also regarded policy analysis and policy outcomes as 'infused with sticky problems of politics and social values' (Fischer, 2003, 11). We engaged with writers such as Frank
Fischer, Carol Bacchi, Murray Edelman, Dvora Yanow, Deborah Stone, Maarten Hajer and Henk Wagenaar who opened our eyes to the emerging field of Interpretive Policy Analysis. The work of these writers differs in many respects (indeed, some may not regard their work as being grounded in interpretive policy analysis). However, what ties them together is the way that they understand policy and policy analysis as involving dialogue, argument and interaction and their analytic focus on meaning-making. They see policymaking not simply as a means for finding acceptable solutions for preconceived problems, but as the dominant way in which social conflicts are regulated. They connect policy and planning with politics and encourage us to focus, not only on what a policy means, but also on the role of language in constructing and enacting policy and social life more widely, and thus how a policy means (Yanow, 1996; Wagenaar, 2011). Through the lens of interpretive policy analysis, policymaking is no longer a value-free, technical project, but is essentially argumentative. The stories that we referred to at the start of the chapter capture a condensed form of narrative in which particular arguments are employed by people as shorthand in discussions about policy. The argumentative character of policy plays an important role in positioning actors (Rydin and Ockwell, 2005), as they are drawn to particular stories that represent common interests and form 'discourse coalitions' around them (Hajer, 2006).
Through this body of work, language and social interaction increasingly became focal points of our work. However, lacking any background in linguistic analysis, we were uncertain how to incorporate this into our research practice. A course in Key Concepts and Methods in Ethnography, Language and Communication provided immersion in micro-level data analysis sessions, allowing us to learn through practical engagement what it means to undertake an analysis based on the study of language-in-use (Shaw, Copland and Snell, this volume). It encouraged us to combine our existing interests in ethnography with our emerging interests in language, and to employ an eclectic mix of methodological strategies in our research, an approach often referred to as 'bricolage' (Kincheloe 2001), which made more sense to us than the narrow, compartmentalised focus on specific 'schools of thought' we had previously encountered in learning about discourse analysis.
The majority of UK health research remains firmly wedded to the positivist conception of healthcare planning described above. There is, however; a growing community of researchers who are bringing interpretive approaches to bear on issues of health policy and health service delivery (see, for instance, chapters by Jeff Bezemer and Sarah Collins in this collection). We locate ourselves within this community, adopting linguistically sensitive approaches to healthcare planning. Our recent research exploring how think tanks shape health policy provided us with an opportunity to examine the role of language and interaction in the context of evolving health policy.