On values

This post sets out some thoughts provoked by my reading Ralph and Chris’ contributions. It is intended to provoke further conversation and act as an invitation to others to make a further comment.

The observations made by them that speaking about management differently can appear to others as though I am not taking ‘the game’ seriously or calling ‘the game’ into question can be seen as ‘anti-management’; that re-thinking the dominant discourse invites us to think of ourselves differently and therefore to question our identities as managers, and to rethink management from within the practice of management, resonate strongly with my own experience in my working life as a nurse manager. Hence, as I challenge many of the theoretical assumptions I had previously made about management, so my practice as a manager shifts because, quite simply, it no longer makes sense to do some of the things I was doing before. To try and explain more clearly what I mean. I shall write a short piece of narrative based on a conversation that struck me as interesting. Reflective narrative is an important component of the research methodology we are developing on the D.Man programme as part of the theory of complex responsive processes of relating.

I am talking to a friend of mine who works in a senior management position in the UK National Health Service (NHS), where I also used to work. She is talking about one of the numerous reviews shortly to be subject to in her own organisation.

With her agreement, I made some notes to reflect her story. This is what she said.

…..So somebody said in the meeting, “Well, it says in this document that we need to produce our values for this review.” Somebody else said, “I did see those some time ago, but I am not sure what happened to them. Does anybody have a copy of them?” Somebody else said they remembered doing them. My colleague thought that he might have a copy in his drawer. Someone said to me, “You must have them, you’re organised!” Luckily, I then found our Values on my computer. We looked at them together and another member of the team said that we needed to update them. I said, “Update them? We haven’t got time – it took us two years to develop these!” Somebody else suggested that we needed to make sure we had them on all our OHPs, so everyone knew what our corporate values were. Another person suggested that we should do a questionnaire to see if these were “embedded”.

In my time working in the NHS, I recall having similar kinds of conversations. The management courses I had undertaken up to that point largely subscribed to the ideas Ralph refers to as the ‘dominant discourse’. Grounded in the notions of rational planning, I worked with my colleagues to collaborate on ‘visions’ and missions in order to give the belief this would give direction to my organisation. As part of this process, we would engage in discussions with ‘key stakeholders’ to generate our organisational values which we would write down. These would typically include statements like ‘Putting the patient first’, ‘doing the sick no harm’, ‘treating staff with respect’, ‘valuing diversity’. When these were completed, we would then ‘raise awareness’ through a variety of campaigns and we talked about instilling or embedding the values in our organisation. From time to time, we carried out audits like my friend’s colleagues suggested – in order to see if the values really were ‘embedded in the organisation’. When we discovered they were not, (for example staff scoring poorly on questions asking if they were treated with respect), we would feel disappointed and frustrated. Blame was either implicitly or explicitly focused either on ourselves as managers for not implementing the values properly, or on the staff for not understanding or ‘demonstrating’ them. After repeating this cycle a number of times and as a consequence of some of my work on the D.Man, I started to question my management practice. With regard to how I thought about ‘values’, namely what they were, where they come from, and the belief that somehow those at the ‘top’ of an organisation can control and manipulate values in some way through corporate initiatives.

Coming from a clinical background, my profession places great emphasis on the ‘evidence base’ of the treatment we were carrying out on patients. I started to wonder about the evidence base for these kinds of approaches to improving quality. Through my subsequent study, I came to realise that the development of this kind of management approach was grounded in systems thinking and in cybernetics. Hence we set our target, put controls in place to measure it and seek to move it back to equilibrium if it does not fall within the specified range. This way of understanding has, I noticed, become so endemic in many organisations that I think many intelligent hard working senior managers are having the kind of conversations described in the above narrative without seriously thinking about ‘the game’ they have been invited into playing. And if we do, how difficult it is to challenge? The price of failing such reviews, of failing to tick the embedded values box is a high one to pay.

So how does complex responsive processes understand ‘values’?

Mead’s work describes how we generalise our habitual patterns of interactions with each other to imaginatively construct a unity of experience, which we understand as some kind of ‘whole’. We also inevitably idealise these. He points to how we have a tendency to individualise and idealise a collective whole and treat it ‘as if’ it had overriding motives or values, amounting to processes in which the collective constitutes a ‘cult’. The visions described by leaders of organisations are examples of the ‘whole’ which promises a utopian future shorn of all obstacles to its realisation. It is emphasised that cult values can be both good, bad or both. So I now notice in my work how we talk about abstractions such as my ‘organisation’ (the ‘Trust’, the ‘NHS’) and ascribe motives or values to it; for example ‘the trust does not respect people’; or “the NHS is not taking infection seriously”. I notice how this way of speaking removes the sense that ‘The Trust’ or the ‘system’ are made up of individual human beings, interacting locally with each other. It can encourage us to locate the reasons for problems and accountability in what is actually a reified concept – what Ralph calls ‘an abstraction’. My concern is, that this way of thinking encourages us to fail to see that ‘we’ are part of that organisation, and the outcomes are the consequences of the daily activities we do, (or fail to do) together. There is no ‘system’ with its own values at another level that is compelling us to act in certain ways. What concerns me is that in stopping seriously thinking about what we are doing, and blindly locating the reasons for human action (including our own) in some higher ‘system’, there is a danger we are starting on the road to totalitarianism.

Drawing on Joas, Dewey, James, Mead, complex responsive processes defines values as themes organising our experiences together, a ‘voluntary compulsion to act’ in an ethical manner. Norms are defined as a theme of being together in an obligatory, restrictive way. These definitions constitute a paradox. When we interact with each other, we enable and constrain our actions. Hence in the narrative above, I may find it very difficult to challenge how my colleagues are talking about values, because a strong norm has emerged about what is regarded as legitimate management practice. I could also be constrained with my knowledge of the consequences of not being seen to comply. Hence the criteria for evaluation are at the same time, both obligatory restrictions, taking the form of what I ought and ought not to do (norms), and voluntary compulsions, taking the form of what I am judging it to be good to do (values). I see the evaluative themes forming and being formed at the same time (i.e. no one of us is in control), by our interactions, our norms and values, at the same time – which together constitute ideology.

So why is this important in my practice as a manager? I am reflecting this happens in a number of ways. First, I notice how we are speaking about the NHS as if it is a collective identity, a ‘we’ that is inseparable from all the ‘I’ identities of those of us that work in it. Mead would define this as a ‘social object’, by which he means that those of us working within it have generalised tendencies to act in similar ways in similar situations.

I also now appreciate that of course, the NHS is not one monolithic entity, one social object but many. Different hospitals or GP surgeries have their own identities as do the different kind of professional groups who work within them. Ralph notes in his book how cult values, such as providing free health care, doing no harm and latterly performance and quality are essential features of what the NHS means to us. Our generalisations and idealisations are recorded in written artefacts and other media, which often takes the form of policy documents, procedures and directives from the Department of Health. Those of us working within it then use these artefacts as tools for our communicative interaction and power relations between ourselves. What is crucial here is the recognition that these are just artefacts, not the idealisations and generalisations themselves. They can only have any meaning in our local interaction as we work together to try and make sense of these. For example, those designing the instruments to test the idealisation around values in my earlier narrative described by my colleague were interacting locally. This is taken up in a myriad of ways as it is disseminated – and in each case processes of local interactions, local negotiation takes place. Hence as Ralph notes;

“The meaning can not be located simply in the gesture that these artefacts represent but only, at the same time, in the myriad of responses this gesture calls forth”.

Again, one may be prompted to ask the question so what? For me, the ‘so what’, is a fundamental shift in my own practice. This way of understanding human organisation is radically different to theories I had previously been taught, where I believed in a ‘sender-receiver’ model of communication, and that my role as a leader was to send effective messages which will deliver the desired results. I became increasingly frustrated when this did not seem to be the case, and the only conclusion I could draw from within the theoretical perspective I was adopting was that I was either not being effective enough in transmitting the message, or that the individuals themselves were subverting this in some way. It is not surprising when working within such a paradigm that blame and shame therefore become significant issues. I now believe it is not possible for me to design ‘values’ and start ‘implementing them’ persuading others to commit to them through ‘raising their awareness’. What I am doing is actually participating in interactions with my colleagues and through these experiences the values are arising in which I and others come to imagine that we are embodying them. So I try and draw attention to this as we try and work together, and I endeavour to pay more attention in my work to what we are actually doing together, rather than activities to ‘design’ what we think we should be doing together.

Critical to this is the notion of ‘particularising’ such cult values into our everyday working life. For example in functionalising a cult value, such as ‘doing the sick no harm’, many exhortations are made to clinicians on the importance of washing their hands. In the dominant discourse, there is a clear evidence base on the importance of hand washing, and one would expect all professionals to comply with this. However, in a specific situation on a specific day, (i.e. as we particularise these values), there may be a range of reasons why clinicians don’t wash their hands properly. Thus in all specific situations there are always conflicts between the ideal and what we do in practice. I may say more on hand washing, but that I think is a subject of another blog…..