by Philip Boxer PhD
The following is the abstract to a paper accepted for presentation at the 13th Annual Meeting of the International Society for the Psychoanalytic Study of Organisations (ISPSO) at Oxford UK, July 2013:
Doing many different things at the same time
What happens when an organisation has to be many different things at the same time in how it relates to its clients? Digitalisation and the internet lead every client to expect more dynamic interaction with their particular situation, context and timing. Familiar examples from the perspective of the client are healthcare, financial services, air travel, mobile apps and the home delivery of food. Organisations that are interacting dynamically in different ways with each of their individual clients are best understood as being without boundaries. This paper uses a ‘quantum’ metaphor to think about this, considering each individual client interaction as a ‘quantum’. Quantum theory argues that the ‘classical’ reality of which we are conscious is quite different to the underlying reality of distributions of quantum states [1, 2]. This quantum metaphor provides a way of thinking about something very similar going on in relation to the underlying reality of organisations. The work of ‘quantum organisation’ by these organisations becomes that of making meaning within the client’s particular situation, context and timing. The paper uses examples from healthcare to elaborate on this use of the quantum metaphor, and draws conclusions about the leadership needed by these organisations without boundaries.
When Jack Welch asked for a ‘boundaryless organization’, General Electric didn’t get rid of its boundaries . It rearranged its vertical, horizontal, industry and geographic boundaries so that it could better thrive, and shifted its focus to creating structured networks [4, 5]. Structured networks are a response to the need to address value creation at the level of the business ecosystem [6, 7]. This shift is apparent in manufacturing , and it is even more apparent in healthcare . Organisations that interact dynamically with their clients are presented with demands that are multi-sided, in the sense that the context of the demand becomes at least as important as the demand itself [10, 11]. Thus, it may be clear that you need a heart transplant, but your healthcare has to be at least as concerned with the context of your body and your lifestyle if the transplant is to be effective. To create value for the multi-sided demands of patients within a healthcare ecosystem, a healthcare clinic must align a unique care pathway to manage the chronic symptoms of each of its patients . The organisation of such a clinic is not easily understood as a socio-technical open system with its boundary conditions “directly dependent on its material means and resources for its outputs” . How then is the work of such an organisation to be understood, if not in terms of how it manages its boundaries?
Distinguishing the ‘operative’ from the ‘regulative’
Emery and Trist argued that while open-systems models enabled material exchange processes to be dealt with between the organization and elements in its environment, “they did not deal with those processes in the environment itself which were the determining conditions of the exchanges”. “Those processes were themselves often incommensurate with the organisation’s internal and exchange processes”  p30. This led Trist to restrict the term “socio-technical” to ‘operative’ organizations, distinguishing them from ‘regulative’ organizations. Regulative organizations are “concerned directly with the psychosocial ends of their members and with instilling and maintaining or changing cultural values and norms, the power and the position of interest groups, or the social structure itself” . Trist later called these regulative organisations ‘referent’ because they were defined by their relation to the ecosystem as a whole , and by their boundary conditions. These regulative or referent organisations were instead focussed on aligning the behaviour of an ecosystem to particular interests, in a way that parallels the work of the healthcare clinic to align care pathways to the interests of its patients. Accepting this difference means losing a direct identification between a physical system and the system of meaning of which it is a realisation. This forces us to abandon the direct identification of boundary with container  and re-examine the concept of containing.
In place of this direct identification, the paper argues that the work of regulative or referent organisations has to be understood as one of making meaning rather than managing across a boundary. This work involves a container-contained relation that returns meaning to the other (the patient) with respect to what the other experiences as ‘bizarre’ or anxiety-inducing (the symptoms). Containment involves making sense through a work of transformation within the context of a ‘vertex’, or a way of organising meaning . Two conditions follow from this for the healthcare clinic to be effective in organising the care of its patients:
- The ecosystem must act as a supporting infrastructure that is appropriately ‘agile’. This means that it can simultaneously support a wide variety of alignments of care services. In this sense, the ecosystem must be able to sustain many different states of alignment at the same time, each of which is a ‘quantum’ state. For the patient, this quantum state is the singular behaviour of the ecosystem, while for the ecosystem, it is one of many simultaneous states it must be able to support.
- Its leadership must make it in the interests of its clinicians to contain the patient’s particular experience within its local multi-sided context, and must make it possible to form effective workgroup collaborations able to align appropriate care pathways [19, 20]. This process of containing the patient’s experience of his or her symptoms becomes the process by which a singular state of the ecosystem is aligned to the local environment of the patient in the form of a unique care pathway. The paper argues that the regulative or referent role of the clinic makes it an organisation without boundaries; the processes by which it is enabled to create agility and alignment are better described in terms of quantum organisation. The paper explores these two conditions characterising quantum organisation using examples from healthcare. It draws conclusions on the leadership demanded of such an organisation, and on its psychoanalytic implications.
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