Changing Organizations

Clinicians as Agents of Change

Alan Cooklin

• Publisher: Routledge
• Year: 2018
• Topic: Business
• eBook ISBN:
  9780429911774
• Subtopic: Management
• Index: Business

This work provides a rich mine of ideas to stimulate thinking about organisational interaction, and organisations in relation to various socio/cultural values.

CHAPTER ONE
Frameworks for the organization and for the agent of change

Alan Cooklin

This chapter first outlines some frameworks for considering the nature of different organizations and institutions using a number of dimensions. These dimensions are principally:

1. the relationship between the way in which the human needs of the members of the organization are expressed in relation to the primary task;
2. the relationship between a person, his or her role, and the system of which he or she is a part within the organization;
3. the dimensions of flexibility versus rigidity, compliance to authority versus encouragement of initiative, intimacy versus isolation, and other dimensions of the ways that dimensions (1) and (2) above function.

The chapter then considers a number of roles within which individuals may commonly attempt to achieve change within institutions and organizations. The principle roles defined are:

• The outside "Invited Consultant".
• The "inmate" who attempts to initiate change—"The Irreverent Inmate".
• The "Line Manager" who tries to effect change from within the management role.

Such change is usually geared to moving the organization towards focusing on its primary task. Alternatively, or in addition, the aim may be to achieve a change in the ethos or belief systems represented by an organization, or to improve the working environment of the members of the organization.

Institutions/organizations, the "human need", and the "work or task" need

In Western industrialized culture, the work setting has become divorced from the social context. In fact, we explicitly define maintaining "boundaries" between social life and work as a virtue. When this is achieved, the social intercourse that is often part of the work life of less industrialized cultures is unavailable, and work is more likely to be associated with boredom and disconnection from pleasure. Miller and Rice (1967) distinguished work groups from "sentient" groups; they defined the latter as organized to promote the security and comfort of the members. It may therefore be that the failure of many Western institutions to recognize and acknowledge their social functions plays a major part in the constraint and dehumanization that we often associate with institutionalization. But this failure may in no way reduce the need for the "security" that is promised by the collective nature of organizations. Whilst Attachment theory (Bowlby, 1969, 1973, 1980; Ainsworth, Blehar, Waters, & Wall, 1978) has provided an elegant set of proposals to explain the behaviour of humans in "two-person" relationships, it has been of limited use in the thinking about human groups. Psychoanalytic thinking has also been limited to explanations of the meaning of behaviour in groups, rather than the human need expressed in the formation of such groups. The function of group collective formation and function has tended to be examined more by organizational psychologists (Ackoff, 1960; Emery & Trist, 1965; Katz & Kahn, 1966), and there has remained a gap in the thinking between this and individual psychology.

For the purposes of this chapter, I shall assume that the following "sentient" human needs are sought to be met from becoming a member of an institution:

1. To gain a sense of collective security or invulnerability, based mainly on the principle of "safety in numbers".
2. To find a "low-cost" (i.e. demanding little personal intimate investment or risk ) context of comfort and intimacy.
3. To achieve mutual validation of the task of the group. This is of particular importance when the task is one that may be criticized or even proscribed in the dominant culture (e.g. a particular religion or cult).
4. To develop a shared and mutually confirming identity.

The Old Testament legend of the Tower of Babel described a group of people who thought that they would construct a monument or an icon for themselves, and then had the illusion (building the tower up to heaven) of belonging to a permanent group and borrowing some elements of immortality from the size of the thing that they were going to create. The ambitious tendency of some institutions for self-promotion and the expansion or multiplication of themselves seems set towards a similar goal, as may the institutions or even the books or ideas we leave behind us. The problematic aspect of that tendency is in relation to its effect on the processes of development. The individuals in an institution may develop, they may "grow", their thinking may change, but the institution that was set up in the service of their original idea may not change, either with them or with the development of the original idea. It is then that the membership—the reason that people go on belonging to that organization—may become reified, turned into "a thing", and maintained for its own sake rather than for the needs of the task for which the institution was set up.

The sentient needs, and the search for a sense of permanence through the institution, are often represented by special rituals (particularly in relation to eating habits in residential organizations such as schools, colleges, etc.) or special words or language. The latter are, of course, criteria that could also be applied to family therapy associations, conferences, and journals. An interesting example is illustrated in the rules imposed in an institution that institutionalizes "not being an institution". In this case, a psychiatric hospital that was set up as a "therapeutic community" (Jones, 1968) in the 1960s espoused the virtues of "democracy, openness, and informality". Whilst these may have been laudable goals, their institutionalization was based on the myth that the patients were really being allowed to share in the government of the hospital—a belief for which there was ample evidence to the contrary. One junior psychiatrist expressed his protest against what he saw as the falseness in this arrangement by insisting on referring to staff and patients by their formal titles and second names. His action was treated by the director of the hospital, who insisted on the informal use of first names throughout, as insubordination, for which he reported the junior to the hospital board. This was an unusual and perhaps extreme example of pressure within psychiatric institutions to adopt particular rituals and language, but within the mental health field in particular many such "languages" and practices, whose rationale is rarely explicit, still abound. To the "uninducted" observer they are often rife within the "ward rounds", "ward groups", and particularly the arrangements for overnight or weekend "leave of absence".

All organizations concerned with social control or change, particularly because they are usually paid for and commissioned by governments in some form or other, have to develop their own closed idea of themselves (Goffman, 1959). Ironically, mental health workers in particular, and family therapists especially, may have been seen by their other (medical in the former and psychiatric in the latter case) colleagues as revolutionaries, as "strange" people, people who do not really fit in. But in the construction of our institutions, whether mental health institutions or learned associations, many of us have developed our own languages that other people do not understand, and such "private" languages are also to be found throughout all work organizations. Gorell Barnes (1990; Cooklin & Gorell Barnes, 1988) has described the confirmation of self which can similarly emanate from the intense team camaraderie and rituals common in the executive groups of many companies and financial institutions.

Most of us associated with the systemic movement are also "iconoclasts"; in my case a lapsed Jew, doctor, in some ways psychoanalyst, psychiatrist, and perhaps even a lapsed family therapist (even though I see a great many families). But as one grows older the "lapsing" can go full circle. In my case, this has meant reconnecting with at least some of the Judaic culture (the religion more than the rituals), I feel more of a doctor now than I used to, I have taken on some psychoanalytic ideas and found them useful again having given them up, and I find myself strangely being accepted nowadays by my psychiatric colleagues. I have been asked to chair committees that I used never to get involved in, and to take on management roles. Discovering that one can "leave" an institution or an institutionalized role or set of practices and later find value in the practices or ideas that were embedded in that institution supports one's capacity to see the positive elements potentially available in that institution. To enter an institution with some sort of brief to effect change requires that one respects the human need for "permanence" and stability at the same time as finding ways to challenge those aspects of the institution which lead to constraint or "dehumanization". Respecting the "need" may mean temporarily joining with, and using the language of, that institution whilst at the same time challenging the reverence in which it may be held. For the "agent" of change, this could be experienced as an ethical dilemma. How can one remain true to oneself at the same time as joining with an institution that may be part of a process of constraint and "dehumanization" or in other situations represent some ethos of which one does not approve?

The agent of change therefore needs to operate in a way that allows respect for the institution at the same time as irreverence for the forces that promote "institutionalization" and such practices that act against the development of the individuals or the creative aspects of the primary task.

A model for the functioning of organizations in relation to the primary task

John Cleese (1991)—comedian but also author and producer of many training videos about management skills—summarized four components of "successful" businesses:

1. "Excellent" companies—defined as those that are consistently successful in the long term—treat people more positively.
2. Good companies trust their employees, and only 5% of employees ever take advantage of this trust.
3. Effective selling has become a cooperative activity between sales person and potential customer, in which the sale is the result of effective problem solving.
4. Separateness of teams and individuals—or at least enough autonomy to allow entrepreneurial creativity—are the life-blood of a successful company.

In the past twenty years, management training programmes and manuals have increasingly stressed the correlation between these sorts of principles and effective business planning and marketing. Thus, what would more commonly be represented as humane and ethical treatment of employees has a new and added validation from profitability. Therefore, to reflect on, or intervene in, organizations, the agent of change needs a framework of function which as much as possible brings together his or her beliefs about a "humane" organization with the need for the organization to be productively effective.

The development of ideas represented in this chapter originated from a number of sources:

1. Main's classic paper "The Ailment" (1957), which described how hospital units could become organized around certain "special" patients, with apparent "secrets" being held by, but not shared by, different groups of staff. Each staff member (or group) was sworn to secrecy. The "special" patients then became the central focus of the whole organization, complained about but also revered.
2. Menzies' "The Functioning of Social Systems as a Defence against Anxiety" (1970), described in the introduction.

Both Main and Menzies, at that time, conceptualized their ideas about the organizations in terms of the psychopathological states or processes in the individuals organizing the behaviour of the organization.

• 3. The work of Trist and Sofer (1959), and of Miller and Rice (1967) who although basing much of their original thinking on psychoanalytic principles, particularly those of Bion (1961), eventually moved beyond individual and group psychology to a model that included primitive unconscious processes in an organizational framework. The work of these groups led to the useful distinction between the "primary" task of a work group and the "covert" task, and between "work" groups and "basic assumption" or "sentient" groups.
• 4. The attempts to apply the principles derived from structural family therapy (Hirschorn & Gilmore, 1980), which added a systemic dimension. The latter placed the arrangement of roles within the organization as the primary frame of reference.
• 5. The work of Irving Borwick (1986), coining from a background in organizational development, who for a time joined forces with members of the Milan associates (first Boscolo and Cecchin, and later Boscolo) to try to apply the principles of their systemic model in the consultation to large business organizations.

FIGURE 1.1

Borwick's own framework focused on the relation between the Person, the Role, and the System (Figure 1.1). This is an interesting systemic framework if only because clearly the Person is still a person in the differing roles he or she may fill, the person in role makes up the system (or at least plays a major part in organizing its internal structure), and the system organizes the roles that the person fills. Non-biological "intimate" human systems will be organized by their size, their task, their philosophy (or religion), and the power differentials between the leaders and the led. For example, a dictatorship or non-constitutional monarchy assumes a considerable power differential between the leaders and the "led". The survival of such an organization in that form will depend on its size, on its relationships with other such organizations and their proximity, and on the political cultural and "power" environment surrounding it. Such an organization may or may not be dependent on a particular ethic or philosophy. If it is, it is likely to be some such notion as "The Divine Right of Kings", the "mature and strong" knowing "what is best" for the "immature and weak", or a variant of these. A democratic structure assumes certain ethics, such as "everyone equally deserves a voice", "the strong should care for the weak or disadvantaged", and so forth. Business organizations will also be organized by size and by power differentials, but they may be equally organized by the need to generate profit against the background of these other variables. Figure 1.2 represents a framework I have found useful in considering the interaction of the person, in his or her role, in some form of "managed" work organization. The formal structure of the organization is represented in the bottom line of the "system" box ("line" management, "dual" management, or "complex" management). Simple line management is that which would apply in a small family business, or in any organization that has only one chain of command. Larger organizations commonly employ dual reporting structures: the individual manager has overall "line" responsibility to his or her immediate superior but is commonly dependent on separate chains of command for different functions such as personnel or human resources, financial control, or purchasing. Whilst this more complex structure allows for some sharing of tasks and responsibility and provides some checks and oversight in the larger organization, it can also be the source of greater inefficiency or of increased stress in the manager. The structure of nearly all organizations poses a dilemma for the leaders. On the one hand, authoritarian rigidity kills enthusiasm and generates bitterness or rebellion, whilst weak leadership is often associated with low productivity, chaotic organization, and low efficiency. Highly authoritarian structures, coupled with high levels of ambiguity, lead to maximum stress in the members of an organization. Borwick (1978) described this structure being taken several stages further in a number of multinational companies, and in a case report he looked at the workings of senior management of ITT. In what he called the "Multigon", the top of the "pyramidal" structure was lost, leaving the senior managers not only with multiple reporting but also potentially in immediate competition with each other. Whilst this might potentially lead to increased productivity, it also meant that these personnel were working in an environment of maximum stress. In that case, it was probably a deliberate strategy to keep the management at high levels of stress.

FIGURE 1.2

How do staff in "stressful" organizations commonly respond to such dilemmas? The responses that one most commonly obtains from people in the lower or middle ranges of management are the following:

1. To seek and develop "informal" alliances to combat their sense of loneliness and powerlessness. These alliances are usually an attempt to bypass, and often to try to deny the existence of, the power of the formal authority structures (the "old lags" group in some factories, which often includes workers, supervisors, and sometimes junior managers, and which sometimes fulfil an informal deciding role).
2. To develop "sentient" or comfort relationships, so that more of the organization's time and energy goes in to comforting social contacts, with lowering of productivity and increase in inefficiency ("gossip groups" or "cosy" meetings that tend to complain and avoid taking effective action).
3. To hold back the development of new skills and competencies, partly in an attempt to avoid redundancies, and partly to promote a shared belief that "nothing can change".
4. To engage in conflictual relationships that promote blame of others (the "fight/flight" response ).
5. To increase absence through sickness.

Organizational consultancy, on the other hand, often tends to promote the converse—namely, to increase the participation of senior management, by pushing conflict "upwards" and by increasing the focus on, and definition of, the formal hierarchy. The former combats a common management strategy of devolving decisions to the ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• EDITORS' FOREWORD
• ABOUT THE AUTHORS
• FOREWORD
• INTRODUCTION
• CHAPTER ONE Frameworks for the organization and for the agent of change
• CHAPTER TWO Language, practices, and record-keeping: a reflective consultation and some institutional changes that resulted from it
• CHAPTER THREE Connecting personal experience to the primary task: a model for consulting to organizations
• CHAPTER FOUR The feelings of the consultant as indicators of problems and solutions
• CHAPTER FIVE Black people working in "white institutions": lessons from personal experience
• CHAPTER SIX Organizational change in the Probation Service
• CHAPTER SEVEN Collaborative inquiry: a postmodern approach to organizational consultation
• CHAPTER EIGHT "Inside" consultation through self-differentiation: stimulating organizational development in the IDF's care of intractable, war-related, traumatic disorders
• CHAPTER NINE Family-school collaboration: consultation to achieve institutional and community change
• REFERENCES
• INDEX