Category Archives: NHS

Complexity and Management: Online Symposium/Practicum November 28th – now booking.

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Exploring the complexity of conflict and organising in the time of Covid-19

The Symposium booking site is now open and is available here . You can see the agenda for the day here.

The following is a post by member of DMan faculty Professor Karen Norman which speaks into the theme of the conference:

Exploring the complexity of conflict in organising in the time of Covid: washing our hands of a problem?

Infection prevention and control (IPC) in hospitals is essential at the best of times, but especially so in a time of Covid. From my previous experience as a Board Director responsible for Infection Control in hospitals, I understand the challenges facing staff in maintaining high IPC standards. In 2003, I was involved in a national initiative to reduce the incidence of hospital acquired Methicillin Resistant Staphylococcus Auereus, (MRSA) bacteraemias, because 9% of hospital inpatients had infections acquired whilst in hospital,[1] equating to100,000 incidents a year, costing the National Health Service (NHS) around £1 billion (N.A.O. 2000)[2]. The term ‘hospital acquired infection’ sits uncomfortably with me, given Florence Nightingales’ founding values that hospitals should ‘do the sick no harm.’ A significant causal factor in their spread cited was the poor hand hygiene of the health professionals when caring for patients. Thankfully, progress has been made in recent years, with the hospital I refer to in this blog meeting their target of zero cases of avoidable MRSA in the last year. But what I have noticed amidst the intense discussions we have been having of late with regard to stopping the spread of Covid, is how similar problems are re-surfacing to those we faced when reducing the spread of MRSA, most notably with regard to compliance with ‘best practice’ as set out in our IPC policies and procedures. I share the following narrative to help think about why implementing corporate values such as ‘patient safety’, or ‘doing no harm’ might not be so easy as people seem to think.

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Complexity and Management Centre. Symposium/Practicum Saturday November 28th 2020.

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Exploring the complexity of conflict and organising in the time of Covid-19.

The following is a contribution to the discussion leading up to the Symposium from Professor Nick Sarra, who is a member of the DMan faculty and a Consultant Psychotherapist in the NHS in the South West of the UK. Nick also teaches at Exeter University.

The booking page for the Symposium/Practicum will open to the public from Weds 14th October.

The potential for conflict in the clinical setting and in the time of the Covid pandemic.

Multiple narratives arise from all clinical situations. We have the narrative of the patient or those receiving care. We may also have narratives from all those involved in the patient’s life such as partners and relatives.Then again there are the narratives of the health care professionals involved and perhaps other agencies such as social workers or the police.

The increasing negotiation of these narratives in online environments adds further complexity.The compulsive tendency to keep on ‘self view’, the ability to see yourself along with others on the screen, amplifies a performative preoccupation which may lead to overly mannered gestures from participants. This sense of there being an environment of many eyes without the intimate communication of the directly experienced gaze leads to a quality of the Panopticon, the all-seeing other whose gaze  can  never directly be ascertained, but which may nonetheless always feel present.This panopticonic quality undermines the fullness of communication through the filmed theatrics, and the experience is impoverished through the absence of live bodies.

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Last few places remaining – Complexity and Management Conference June 10-12th 2016

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What practical difference does it make to take every day organizational experience seriously?

What ways of working may help better illuminate how we co-operate and compete to get things done?

How helpful is it to understand the patterning of human interaction as complex responsive processes of relating?

If you are interested in hearing about some concrete examples where taking a complexity perspective on improving practice and developing strategy has made a difference in organizations in the UK and Denmark, then there are still some remaining places at this year’s conference. This is an opportunity to listen to others, to participate in conversations, as well as to talk about and reflect on  your own work situation.

We can also promise a diverse and interesting group of delegates and good food. The conference fee includes all board and lodging, and the conference begins Friday at 7pm and ends on Sunday lunchtime.

The booking page is here.

 

On organisational culture change

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There is a great deal of discussion in contemporary organisational life of the need to ‘change the culture’ in organisations. This is a way of talking that assumes that organizations do have discrete cultures and that they are manipulable, although the discourse can have it both ways with the term: on the one hand culture is known to be symbolic, intangible and abstract, on the other it can be the object of conscious and rational redesign and reframing. A good example of this way of talking about organisational culture can be found in the 4th edition of the eminent management scholar Edgar Schein’s book Organizational Culture and Leadership[1].

Usually a prime role is assumed for leaders or senior managers in making the changes to organizational culture because they are considered to have the necessary abilities and skills to diagnose what is wrong with the current culture and to design a better one: one which fits better with the environment. Schein states this very explicitly in his book: ‘In this sense culture is ultimately created, embedded, evolved and ultimately manipulated by leaders’ (2010: 3).  As a result of their leaders’ efforts, employees will be obliged to commit to a fresh set of values, or reaffirm an existing set which are thought to have become moribund, as well as demonstrating a suite of required ‘behaviours’ or new procedures. The new values and procedures are then set ‘at the heart of everything we do’, are vigorously communicated and disseminated and form the basis of widespread training programmes for staff, and are then subject to regimes of inspection and performance management. Such change programmes can consume weeks and months of organizational time and resources.

The whole process is a good demonstration of the systemic assumptions behind organizational realignment: values, behaviour, systems, procedures, training, communication and quality regimes are all supposed to line up and fit over each other and form a coherent whole. The emphasis is on integration, stability and alignment. It is a huge reduction of the complexity of what is at stake when attempting organisational change.

A book recently published calling for radical change in the NHS is a refreshing attempt to explain why ‘culture change’ in organisations is likely to be highly problematic. [2] Instead of assuming that whatever we might mean by the term culture is contained within one organisation, even one as big as the NHS, Ballatt and Campling, an ex-senior manager and psychotherapist within the NHS, explain why the institution reflects much wider conflictual social processes, as well as provoking profound questions about what it means to be human. That is, they try to bring together society-wide trends in social patterning in the UK and beyond in terms of their impact on changes in the NHS, and they wrestle with the profound human difficulties and dilemmas involved in professionalising the often spontaneous and improvisational human response of caring towards another human being in need. Though written specifically about the NHS, I think the book also raises important questions for anyone thinking about what is involved in processes of organisational change and echoes some of the themes from the perspective of complex responsive processes of relating. There are some key differences, however, which I will also explore below. Continue reading →

3 Critiques of Leadership: preparing for the CMC conference

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At the Complexity and Management Conference in June this year we will be hosting discussions about leaders and leadership from a critical perspective. As a way of warming up for the event it might be interesting to rehearse three recent and different critical perspectives on the ineluctable rise of ‘leaderism’ in contemporary society. The first, by Rakesh Khurana[1] (2007), charts the development of the discourse of leadership and the way it has colonised and captured American business schools coterminous with the ascendancy of neo-liberal economics. The second, by Martin and Learmonth (2012)[2], looks at the way that the discourse on leadership is used to co-opt a broad range of actors into particular projects to ‘reform’ the public sector, and the third, by Alvesson and Spicer [3](2011), explores the way that a more nuanced critique of leadership might be developed to help employees struggle with the exercise of authority in organisations. Mats Alvesson is a previous guest at the CMC conference. Continue reading →

Values and Norms – insights from Norbert Elias (Part 1)

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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”. Continue reading →