WORK IN PROGRESS

Skirmishes in the war between human nature and organisational change

Tim Dartington

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I have run out of ways of saying we are in a new situation of greater complexity, confusion and incremental change than ever before, while at the same time acknowledging that the sun will rise tomorrow as it rose today. It may be true, but then again, when was it not true? Listen to this account of feeling out of step, unbalanced even, in the face of a changing world.
‘I had experienced a period of inner uncertainty, a state of disorientation … the pressure which I felt was in me seemed to be moving outward, as though there was something in the air … The sense of oppression no longer sprang exclusively from a psychic situation but from concrete reality … I had to try and understand what had happened and to what extent my own experience coincided with that of man in general.’ (Memories, Dreams, Reflections, pp 175-80.)

This was Carl Gustav Jung at the time of the first world war. The quotation raises the question. is it me, or is the world I am in on a dangerous trajectory. Tom Peters said that we have to learn to love change. Perhaps we do, if we want to be on the side of life, creativity, survival into an unknown future. However, I also like the idea that we don’t always want leaders who know exactly where they are going. We also need leaders who want to find out where we are going.

I like to be reflective but I also want to be useful. So what has this got to do with your state of mind when you get up to go to work next Monday? I want to address that question. My proposition to start with is that there is an inherent struggle between our innate desire for stability and containment in managing our experience of work and our desire, which we associate with our professional identity, to make a difference.

There are times, often on Monday mornings, when we hate change. I want to hold open the possibility, taking the risk that I will be associated with the dark forces of conservatism, that there are times even when it is all right to hate change. As long as at the same time we acknowledge also our experiences of others, and how we feel about them, when from our point of view they are being negative and obstructive, when we are frustrated and fed up with the inability of others to see that their lack of imagination and jobsworth mentality is getting in the way of what we are wanting to do.

It is a difficult dilemma that we face. We need to accept that we are having to survive in a turbulent environment. And that our evolution as social animals, where we are still in our individualism at odds with our groupishness, is slow and painful and lagging far behind the immediacy of the changes that we are facing and making.

The social scientists who introduced the idea of the turbulent environment were dismayed that we snatched at the phrase without waiting to understand the thinking behind it They also said this: , ‘values are psycho-social commodities that come into existence only rather slowly …. For a new set to permeate a whole modern society, the time required must be much longer – at least a generation, according to the common saying – and this, indeed, must be a minimum. One may ask if this is fast enough given the rate at which [turbulent] environments are becoming salient.’ (Emery and Trist, 1965) And that was back in the 1960’s, when the world was young.

So without being judgmental, or taking sides, let’s look at the battles that go on in the workplace between the commitment to values, which are historical and therefore backward looking, to do with the desires we had in committing ourselves to this or that training and subsequent career decisions, and the commitment to new certainties, which are immediate and untested and political.

From this start point I want to share some reflections on working with a CMHT.
How was I to understand the sense that I had, in agreeing with a management team that I and colleagues would consult with the CMHTs in the Trust, that I was being thrown to the wolves?

We were working from the premise that a reflective stance is helpful in working with intractable problems – in the individual, in the group, and in society at large. We were on the side of human nature, you might think. – but not we thought against organisational change. The CMHTs are working very much with the more dysfunctional aspects of human nature. The Trust itself is suffering under a projected £2 million deficit, which the chief executive blames on the high cost of agency nursing and social care staff and locum doctors. Or, as I would say, the work is so destabilising that it is difficult to recruit and retain a professional workforce.

The irony is that as organisational consultants we were quite as convinced as the management of the need to achieve a change of organisational culture to achieve the desired integration of health and social care in the delivery of services.

And yet, as I say, we were thrown to the wolves. We were thrown to the CMHTs to be savaged, while the management hurried on. The management – I am talking about middle management at this point, not the chief executive – were I suggest fearful of what they were managing, because they did not believe it could be contained or constrained into the realities of their management imperatives. They were, I suggest, fighting human nature rather than working through people to meet their objectives. This splitting, when it happens, is I believe, destructive of effective management, so we have to understand what makes it pervasive in the NHS at this time.

Organisational change, in the sense that I am thinking of, is a response to an external opportunity or threat. It is rooted in the cause of doing things better, of improving on current performance. The reason that there is so much of a continuing attempt at change in the NHS is, because of an increasingly powerful tendency to move away from a spiritual or fatalistic acceptance of morbidity and death and instead to find fault with an incompetent management. Acts of God by definition do not involve liability, but we have created any number of authorities on earth that we can berate with our thwarted desires, and the NHS is one of examples best know to us. We have now arrived at a situation where politicians know that in an imprecise but real enough way they are going to be held accountable for the next flu epidemic.

There is nothing more stressful than being responsible for something you can’t do anything to help. Which is why in the past the highest levels of stress have been found in manual workers and long-distance truck drivers and the like, not senior executives, who can at least be doing something about the mess they can see all around them. Back in the First World War, who was most stressed, Field Marshall Haig or the Tommy in the trench? But, in the situation I am describing, managers at all levels are themselves being managed in ways that they are now experiencing their worst nightmare – impotence. And not without reason.

We were always going to have problems when performance indicators were transposed into targets. For example, a reduction in waiting lists is an important indicator, one among others, of a well managed flexible and responsive service; but when it becomes a target, backed by punitive sanctions, then the process is distorted, leading as much to the possibility of abuse as to improved quality of service to clients and patients. Managers begin to display all the symptoms of performance anxiety, and they – how shall I put it? – massage the figures as a way of keeping up to expectations.

I want now to think further about the tensions I observed and experienced in working with the community mental health team. After working with the team for some months, meeting with them weekly to discuss issues of common concern to them, I reflected how one of the CPNs in particular had described himself as an old lag. It was an interesting phrase, implying that he was in some way a recidivist offender. But what then was his offence?

There are ways in which an emotional world– in this case the emotional world of people with severe and enduring mental illness – as it were infects all who come in contact with it. It is not just that it arouses transferential responses in ourselves – it can also elicit a parallel emotional process, mirroring and enacting the worlds we are in contact with.

So I was found I was thinking a lot about ways that the team got angry about management and resentful of them – resentful at times of any authority other than their own. As if this is a world which is potentially hostile unless proved otherwise. At times who have seemed to welcome the opportunities to talk: at other times, not. Very much like their clients.

Then I have also been thinking about my part in this. I turn up, try to be reliable. Try to be consistent. Be responsive rather than impose an agenda. I also follow my own principles of professional practice – meeting regularly with colleagues to share our experiences and think about what is happening.

Nevertheless I feel increasingly uncomfortable. With the group I feel how they think I am being imposed. Yet the management say it is for consultants to work out an agreement with each team. So I am identified with a management but without authority. I begin to experience the impotence for myself.

I want to say to the old lag, if ever you are worried that we might be management spies, forget it – we would not have commented in any detail about what went was said by individuals in the group discussions, but the management remained uninterested to hear even our overall impressions. The kinds of things we were thinking may be summarised here:

The teams have developed a siege mentality, as a way of coping which the demands of them, coming from an environment that is also perceived to be under siege. So they gather themselves to fight back but not always effectively. This is seen in the relations of teams to management.

The teams experience management as vulnerable to their attack. Team managers have been unhappy in their roles, bridging the professional/management aspects of their work.
There is a definite sense of retreat, with the loss of key staff in teams, and an increased pressure on team managers, that it is all down to them now.

Management often has to work through negotiation, and this is appropriate. But at times management here is seen to exist by negotiation. (A example in the CMHT had to do with team members sharing the load in relation to intake. Introduced with a long process of consultation, leading to not such a great impact on the work of teams, but apparently to very different ways of doing this between teams, and now to be subject to review. Review may seem to be an alternative to or postponement of decision-making.)

There is a separation of leadership and management – so that it is also difficult for managers to be seen to give leadership. It is difficult for managers to tolerate the fact that others cannot stand be managed – not to attack back but also not to give in.

Teams have a valency to revert back to their professional leadership as the management they wish they had in the first place. This undermines the ethos of the multi-professional team. Leadership is more partisan than civic – eg, it works better within rather than across boundaries of professional and agency identity.

At times it seems that teams resist both leadership and management. They need leadership to feel they are a team, but that can also feel intolerable, because then they have to acknowledge differences. The differences are not simply between professional groups, but expose other issues – for example, those who are thought to be pulling their weight more than others in taking on and working with difficult cases.

More in the state of mind of a defensive fortress rather than an open system, sometimes team members and also managers demonstrate a commitment to grievance, seemingly always complaining. This has a deadening effect, so that no-one listens and there is not very much linking of experience.

Thinking again of the old lag, one thing that he and his manager could agree on was this – that he was difficult to manage. He was negative and uncooperative, but he was also
representing an important truth about the depression and sense of hopelessness of the work. His clients depended on him and they also hated him. Some of them threaten to murder him. At times he and his colleagues were seriously frightened by their clients. But some things are not to be spoken of. He lived with the pain all right, and found his own ways of survival – by going sick, protecting his work load, taking it out on his own organisation rather than the client. In this way he became become identified with the client. They were both against the system, which is about order in the face of chaos and so cannot fully recognise what it means to be truly vulnerable.

Living with vulnerability means accepting and understanding one’s limitations and yet continuing to live in an area which is unsafe. Clients and professionals both know about their limitations though they both also have to act often as if they do not. In clients this is called pathology. In workers it is professionalism.

They are then subjected to what is in effect a normalisation programme, which in the case of the CMHT means that they are asked to work in a multi-disciplinary team. They are being asked to give up the defences which are their own carefully worked mechanism for surviving and with no promise of any better support in their place.

In this context we have to think about how organisational change is experienced inside the system as imposed from outside in response to an external opportunity or threat. We may even have the sense now also that the organisational change is introduced because of a basic mistrust of human nature, out of a mistrust of the ordinary dynamics of person on person, system on system, and their capacity in time to work things out. Organisational change is then not so much introduced as induced, to hurry up a recalcitrant human nature, that in the fantasy of modernisers would stay in the womb if it could.

I witnessed a fierce exchange between managers and front line workers, during another consultation with a social service department. The front line staff said that the assessments were being made that did not include the assessment of needs for which there was no possibility of provision. I would have thought that quite likely – even sensible from a certain perspective. What was remarkable was the anger of managers about this proposition and their determined denials that this was happening. They had to believe that all unmet need was being accurately recorded. Unmet need that they did not know about was intolerable. If they did not believe their own statistics, they would be overwhelmed by the enormity of failed expectations.

And yet at others times, in the privacy of their own company, these same managers would comment on the stresses and absurdities of monitoring fever. At such times one becomes very aware of the Janus-like qualities of modern management.

Janus was the Roman god of boundaries – hence January as the first month of the year. He had two heads, so that he could both look out and look in. So I think he makes a good image for the manager, who is always working on the boundary of the enterprise, creating and maintaining the conditions in which work can be done. According to mythology, before Janus there was Chaos, which we may think is somewhat harsh as a description of the NHS before general management. But my observation of the manager is of someone who is not two faced in the bad sense but of someone who actually does have a perception of two worlds, the one rational, clear headed and numerate, the other complex, contradictory and resistant to quantification.

There has been a shift in the process of dependency within systems, as they have developed a culture of psychological self-sufficiency. In the weakening or destruction of an external resource – the will of God, the good of the nation, the welfare state, the permanency of corporate life – the experience of the employee is perhaps still of failed dependency of institutions to contain the anxiety inherent in their work, as we have seen, and then increasingly of taking flight into a magic omnipotent fantasy or grandiose narcissism. The myth of infinite resource is maintained, but within a finite system.

While management struggles with the challenge of being truly Janus-like in these difficult circumstances, those working at the front line are likely also to be split between those looking inward to their professional competence and those looking out in a spirit of partnership and modernisation. So we have the old lag, and others, who we might think of more as the ladies of the parish, enthusiastic and keen to support whatever new ideas the vicar has in mind. (These categories are of course not gender or age specific. We are describing states of mind here.)

There are some parallels in fact between evangelical Christianity and management theory and practice. Perfection (quality assurance, excellence) is to be sought by all members of the organisation. Managers are known by their fruits, individual performance targets. Theories and statements about the organisation must be clear, simple and indisputable. Because of their charismatic authority managers are in a unique position to identify the vision towards which the organisation should be working and to empower their followers to bring this vision to reality. The faith of the modern manager is a forward-looking optimism, which is defensive against the anxiety provoked by thinking about chaos. (Pattison and Paton, ??)

But the manager has to look back too. Leaders without followers don’t get very far in the long run. Among their other qualities they have to be able to use their sense of their own vulnerability. Larry Hirschhorn has described how in contemporary organisations
‘the enterprise asks its employees be more open, more vulnerable to one another. But in becoming more vulnerable, people compound their sense of risk. They are threatened from without and within. ...Thus the stage is set for a more primitive psychology. Individuals question their own competence and their ability to act autonomously. In consequence just when they need to build a more sophisticated psychological culture, they inadvertently create a more primitive one’ (1997, Reworking Authority: leading and following in the post-modern organization , p 27).
So, come Monday morning, you will continue to draw on your enthusiasm to make a difference. I am suggesting that you don’t forget at the same time to draw on the experience of the old lag.

Tim Dartington
November 2003


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