I was recently reviewing a research narrative in which Max, the researcher, was describing what was happening in a health care organisation that was undergoing an organisational merger. Max had responsibility for leading a programme of work aimed at improving the care of patients with diabetes. This involved redesigning their treatment pathway to improve their disease management and reduce what were regarded by the organisation’s management as unnecessary and expensive admissions to hospital, which it thought could be better managed in the community. This work required him to bring together clinicians and managers from three former organisations, one of which he had worked for prior to the merger. His research interest is in exploring the concept of “transformation” and the narrative describes a series of meetings he is having with staff about the work. These meetings are proving difficult, because it is clear from what is being said that the groups from the three organisations have strong “we” identities arising from their former organisations and are all involved in stigmatising gossip based on their prejudices about each other. Max finds himself defending his former organisation when this is being criticised and also feels surprised and uncomfortable when it begins to appear as though the perceived source of the problem- the hospital- may not be the only cause of the problem – as he and his colleagues had formally perceived.  He describes vividly the detail of a very difficult meeting in which one of the influential Doctors loses their temper and refuses to co-operate with colleagues from one of the other former organisations on the grounds that what is being proposed could compromise patient care. Max describes the frustration and anxiety this raises for him and others – including a discussion with his manager Carl, in which he is told that “failure is not an option”.

What I notice in the narrative is that the conflict that is being described is arising as the values and beliefs of those involved are being articulated and felt, and these are then being made sense of and renegotiated (or not), by those now forced to work together in this new organisation and the power figurations (after the theories of the German sociologist Norbert Elias) which are at play. Elias explains how, because of our interdependence and the way our actions intermesh, people form power figurations whilst at the same time these figurations form us. He argues that power is not a thing like an amulet (bracelet) owned by an individual, but a structural characteristic of all human relationships because we depend on each other and so enable and constrain each other. The basis of power is need, whether that need be love, status, money or anything else, so if we need others more, they have more power over us than we them. He emphasises that such power can never be absolute because the more powerful are dependent on the recognition by the less powerful that this is the case.

In a previous blog, I introduced a perspective on values grounded in the theory of complex responsive processes of relating, which draws on the work of George Herbert Mead (Stacey, 2010). Values are described as a voluntary compulsion to act and are therefore a potential  motivating and enabling call to action in our everyday life. They assist us in choosing from our desires what to do because we will be judging whether the intended outcome of our action is “good”. In making this judgement, we take account of what Mead calls the “generalised other” – which is our capacity to take on the attitude of our social group and consider what they might think of such a choice. Norms are described as constraints, the “ought”, which may constrain our choices of action because in our society or culture certain ways of acting are not acceptable to others, or to ourselves. Whilst the separation of values and norms is helpful in explaining these ideas,  it is important to note that spitting them in this way is an  abstraction from lived, practical experience in which norms and values are inseparable aspects of the evaluative themes, the ideologies, which are the basis of our choices of actions (Stacey 2010).

Max points in his narrative to certain organisational value/norms.(I find myself linking them deliberately here to try and avoid the paradoxical split that Stacey cautions against.) I am coming to see through Max’s narrative and insights from  Elias that the emergence of norms are part of the ongoing particularisation of the values at stake – which means, of course, that there is always the potential for either the value or the norm to be called into question and renegotiated or changed,( i.e. transformed). So, for example, Max is constrained by a norm based on his prior experience of how his social group ( Mead’s “generalised other”)  will judge ill of him if he does not show a united front to outsiders because of the groups “cult value” (Mead’s term), of loyalty. This constraint prevents him from challenging members of his own group in front of other groups, what he calls  a “united front”.  In practice, generating agreement within the newly merged group even in private is proving problematic. In a memorable section, Carl tells Max he has heard from the management consultant that the meeting had not gone well as the new process map had not been designed. Max  replies: “well, at least I now know what everyone’s objections to the project are”, a response that clearly does not satisfy his boss. This story strikes a chord with me, as I have often found that others judge a meeting to be “good” if we have a completed policy which gets approved, preferably with consensus, and “bad” if conflict and friction arise and agreement cannot be reached.  To explore what might be happening here further, I would like to look  more closely at what Norbert Elias has to say about norms.

Elias notes that social norms are often described in a way that suggests that the norms of one and the same society are  “all of a piece”. He challenges this notion, drawing attention to the fact that inherently contradictory codes of norms can exist in varying degrees of amalgamation and separation and that each may be activated in different situations and at different times.

In his book The Germans Elias notes the emergence in German society of a moral code emerging from a humanist tradition, and later, a nationalist code – and postulates that the conflicts between these two codes leads to struggles for dominance, tensions and conflicts and can express themselves in tensions and struggles of a state population or in struggles of the same individuals with themselves. Although focusing on the German society, he observes that the 20th century nation states cope differently with the contradictions emerging from the representative self image and self ideals. Observing a taboo around the ability to explore nationalistic or patriotic articles of faith dispassionately, he observes that one of the manifestations of this taboo is the widespread use of the term “norm” as if norms were always benevolent, socially wholesome and integrating facts.  He is critical of other sociologists of the time who consider the role and function of social norms by separating form and content, rather than considering that different norms can have different social functions, or that most types of norms have integrating as well as dividing and separating functions. Hence norms in that way of thinking are conceptualised in a highly idealised manner, which he notes allows the user to see those functions which they wish them to have, and blocks the perceptions of those functions that they do not wish to perceive. He challenges the view of writers such as Kingsley Davies for seeing only the integrating and not at the same time their dividing and excluding character- thus  ignoring the double edged character of social norms, i.e. the fact that they bind people to each other, and at the same time turn people so bound against others.

He notes:

“Their integrating tendency …is also a disintegrating tendency, at least as long as humanity as a whole is not their frame of reference. “

I think these observations are useful in exploring the kinds of phenomena in Max’s narrative. Although Elias is referring to nation states, I think that the conclusions drawn are equally relevant to any we-group identities which are interacting  locally and are therefore interdependent on each other, as evidenced in his other researchThe Established and the Outsiders,  in which even in  seemingly similar social groupings of the same nationality,  power figurations emerge which stigmatise more recent inhabitants of a local community by the longer-residing “established” group. I notice in the narrative how members from  each of the former organisations groupings in Max’s newly merged organisation are therefore struggling with the consequences of the merger and what this means for them, their group and their individual identity. Talking about the differences between the three former organisations  is difficult to do dispassionately, especially when it calls into question their clinical or managerial practice. Hence a cult value (to use Mead’s term), such as “doing the sick no harm,” a generalised and abstracted value – has to be made particular in Max’s meeting by those present about what this means for diabetic patients and those caring for them. In this instance, this means that some may be seen by their GPs and not the Consultant any more and this has implications for all of them.  Some take great exception to this, leading them to appeal to a core value of “patient safety” as grounds for either changing or remaining the same – with many parties providing evidence and statistics to support the reasons for their choice. In thinking about the values/norms emerging in Max’s organisation- it can be seen that  as Elias suggests, these  do indeed have both integrating as well a dividing and separating functions. (For example, a value such as intolerance of failure in a target-led culture has very clearly integrated some groups and ideas within the NHS and at the same time caused the  disintegration of others). Those present are also struggling with what this new “organisation” means for them – both between them, as they come into conflict with each other.  Max describes internal conflict within himself as he finds values such as loyalty to his new organisation and loyalty to a former peer group come into conflict and require him to behave in ways which will bind his allegiance to one group, whilst potentially at the same time excluding him from another.

To be continued in part 2…..

Elias, N. and  Scotson, J.([1965]/1994), The Established and the Outsiders, London: Sage.

Elias, N. (1996) The Germans, Cambridge: Polity Press.

Mead , G.H. (1934) Mind, Self & Society, Chicago:  The University of Chicago Press.

Stacey, R. (2007) Strategic Management and Organisational Dynamics: the Challenge of Complexity, London: Prentice Hall.

Stacey, R. (2010) Complexity and Organisational Reality, London: Routledge.