Planes, straws and oysters: the use of metaphors in healthcare reform

Ross Millar (University of Birmingham)
Helen Dickinson (Associate Professor Public Governance, Melbourne School of Government, University of Melbourne, Melbourne, Australia)

Journal of Health Organization and Management

ISSN: 1477-7266

Publication date: 21 March 2016



The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform.


A study of healthcare reform in England carried out a series of semi structured interviews with senior managers and clinicians leading primary and secondary care organisations. Qualitative data analysis examines instances where metaphorical language is used to communicate how particular policy reforms are experienced and the implications these reforms have for organisational contexts.


The findings show how metaphorical language is used to explain the interactions between policy reform and organisational contexts. Metaphors are used to illustrate both the challenges and opportunities associated with the reform proposals for organisational change.


The authors provide the first systematic study of patterns and meanings of metaphors within English healthcare contexts and beyond. The authors argue that these metaphors provide important examples of “generative” dialogue in their illustration of the opportunities associated with reform. Conversely, these metaphors also provide examples of “degenerative” dialogue in their illustration of a demarcation between the reform policy proposals and existing organisational contexts.



Millar, R. and Dickinson, H. (2016), "Planes, straws and oysters: the use of metaphors in healthcare reform", Journal of Health Organization and Management, Vol. 30 No. 1, pp. 117-132.

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