Foucault on targets
Leeds Teaching Hospitals NHS Trust, Leeds General Inﬁrmary, Leeds, UK
Keywords Targets, Discipline, National Health Service
Abstract This paper seeks to gain an insight into the behavior of a large NHS trust, in its attempt
to meet a 90 percent patient access target, in a week long national audit in March 2003. Why did
individuals act in dramatically different ways to their norm over this period? The work of Michel
Foucault is used to explore these issues. The discourses of power, knowledge, discipline and
governmentality are identiﬁed as key foucaudian themes that offer an alternative interpretation of
how individuals behave in their place of work. The importance of the historical context of discourse
within the NHS cannot be underestimated in shaping the behavior of individuals and groups today.
Power and knowledge permeate NHS organizations through disciplinary practices and dressage.
Governmentality seeks to maintain the status quo through disciplinary processes such as national
healthcare targets. The natural response of NHS organizations is therefore, to seek order and
conformity rather than disorder and conﬂict.
Reform of the NHS has been the mantra of the Labour government since its election to
ofﬁce in 1997. Since then the NHS has seen a plethora of key documents published,
most notably, The New NHS, Modern and Dependable (Department of Health, 1997),
The NHS Plan (Department of Health, 2000) and pertinent to this piece of work,
Reforming Emergency Care (Department of Health, 2001). This document identiﬁes a
key target I wish to consider. Point four on page 1 states:
By 2004 no-one to wait more than four hours in an A&E department from arrival to
admission to a bed in the hospital, transfer elsewhere or discharge. The average length of
waiting should fall to 75 minutes (Department of Health, 2001).
In this piece of work I will examine how the organization in which I work reacted to a
week long audit of A&E trolley waits in a week of March this year. I will give a
descriptive account with analysis of the “goings on” within the organization prior and
during the audit period. I will then use the work of Michel Foucault to analyze the way
the organization responded. The Foucaudian concepts of power, knowledge, discipline
and governmentality will be utilized to achieve this.
The organization and the audit
Smith et al. (2001) identify the last four years have seen the largest and least debated
reorganization of the NHS in the past 20 years. The target from April 2003 identiﬁed by
reforming emergency care is that 90 percent of all patients seen in A&E departments
must be “seen and sorted” within four hours. Patients requiring admission to hospital
will have to access an appropriate bed within four hours of arrival. This target applies
to the organization I work for.
The organization was not even close to achieving this target of 90 percent in the
early part of the year. In February of this year 61 percent of patients had their A&E
The Emerald Research Register for this journal is available at The current issue and full text archive of this journal is available at
Journal of Health Organization and
Vol. 18 No. 2, 2004
q Emerald Group Publishing Limited