Tracing discourse, power, and identity in NHS complaints.

The act of complaining requires negotiation of discourses and identity positions, because by definition complaining is a site of struggle that threatens norms and relationships. In institutional contexts, complaining involves navigating both micro-level interactions and macro-level identity positionings. Complainers must attend to issues of identity and accountability in the interactive event, and to the prevailing discourse formations
and perceptions of the institution in the wider context. This necessarily involves negotiation of power and, as such, invites a Foucauldian approach: ‘there is no power relation without the correlative constitution of a field of knowledge, nor any knowledge that does not presuppose and constitute at the same time power relations’ (Foucault 1991). Crucially for Foucault, while institutions hold more power than individuals, power is (re)produced not only top-down, but also bottom-up. This is allthe more relevant for the focus of our paper, the UK National Health Service (NHS), which is a powerful institution, yet one whose aim is to be enabling to every individual who has need of its services, and as such somewhat contradictory and difficult to negotiate territory. We explore the ways in which a complainer self-positions in relation to the official, public discourses of the institution, in order to manage their identity as simultaneously a complainer and a ‘reasonable person’. As
part of this analysis, we examine the ways in which the public discourses are reproduced and/or challenged through the act of complaining, and how these actions are reinforced or mitigated through the complainer’s
narrative construction of events. In the present paper, we trace specific discourse formations through analyses of the spoken and written complaints of one complainer. We show how the act of complaining evokes specific
discourses and positionings. The complainer, while reproducing those formations, also uses narrative structures and identity strategies to challenge their own ascribed positioning within the public discourse, and mitigate the
force of the challenge where necessary, in order to maintain the status of both the complaint and the institution.