Archive for January, 2014

The Governance of Quality

Monday, January 27th, 2014

by Philip Boxer BSc MBA PhD
Over a period of three years, 1994 to 1997, I consulted to an organisation providing residential care for men and women with mental health disabilities.  This was in the middle of the changes taking place in the UK to introduce ‘internal markets’ and the de-institutionalisation deemed necessary to providing ‘Care in the Community’.

The work was undertaken together with Barry Palmer[1], and presented at the 1997 ISPSO Annual Meeting in Philadelphia under the title The Architecture of Quality. The work established a way of enabling the organisation to adapt its work to this newly emerging environment in which the proactive pursuit of individuals’ care in the community could be put first.  It did this by tackling the north-south bias in the architecture of the organisation and establishing the need for asymmetric forms of leadership capable of realising east-west dominant forms of governance.[2]

By 2001, the CEO and senior management team of the organisation had left, and the organisation had begun reverting to its previous role as a provider of sheltered accommodation.  A more recent paper describes the subsequent events that led to this eventual outcome – The Governance of Quality. One response to this more recent paper would be to characterise the Trustees of the organisation as lacking courage.  But why should a Board of Trustees choose

  • innovating to deliver new levels of service to residents at lower cost while having to learn a whole lot of new ways of doing things, and
  • dealing with a whole lot of compliance issues for which historically they knew accountability could be reliably ‘delegated’, but would no longer be able to be ‘delegated’ so easily?

The Trustees chose the entirely reasonable alternative of running the traditional model of providing accommodation plus basic services under the auspices of housing provision.  The Trustees passed the test of whether the alternative they chose was “reasonable”: a reasonable person could not have been expected to choose otherwise.  But was this work we were engaged in together about what was reasonable? To quote the CEO:

I would not want to just look at the Trustees’ behaviour and motivation. I also resisted stepping beyond my know-how. I carried resistance while simultaneously espousing doing different. This is why I think the link to extreme sports is a useful one and perhaps to courage in general[3]. What is it to do the right thing? And how does one ‘know’? I think that ideas have been under-emphasised in any leadership framework. Instead, the emphasis has been on emotional intelligence which, while being important, is just not enough – being ‘good’ does not guarantee that things will work better!

Two kinds of learning emerged about the intervention from looking back at the process overall:

  1. There was a parallel process going on from the beginning, in which the CEO was receiving personal support in coping with how he took up this new role, support that had preceded his new role.  Having taken up the role as CEO, I was consulting to him concurrently with this other support, my task being to help him develop ways of tackling the leadership challenge he faced.  The splitting of these two aspects of support to the CEO – containing anxiety and innovating – paralleled the way support to the organisation was split between the governance task facing the Trustees and the leadership task facing the CEO. The full implications of this split did not become apparent until 2001.  Barry and I were not able to work the parallel process effectively.
  2. The envisioning of internal markets and de-institutionalisation was accompanied neither by any understanding of how the transition should be managed, nor by any support for the transition itself.  The rhetoric was that all this should be ‘left to the market’.  Even had we addressed the split in our consultation to the organisation, Trustees and Management together would have had to act very strategically to survive the disruptions to funding that would have arisen during the transition – a transition that is still ongoing!  This was because the economics of an east-west dominant organisation are both different to and more complex than those of the north-south dominant form.

But there was something more that we learnt, in that what we thought was the challenge of the case turned out to be much more of a challenge than we realised at the time…

  • Yes, the way the intervention unfolded was hugely particular to the situated nature of both us and the organisation;
  • Yes, both Trustees and Management needed courage, although possibly not as much courage as that of residents resisting being ‘parked’ in their lives by the (counter-resistance of the) existing organisation; and
  • Yes, we consultants needed to grasp the fundamentally different kind of economics that were being engendered by operating explicitly in a turbulent environment in which residents had to be responded to one-by-one.

But beyond all of that,

  • We consultants needed to recognise that what was being demanded of us in our way of working was a relationship to anxiety that involved our being prepared to ‘pay with our being’ – to go beyond what we knew and to put ourselves ‘on the line’.[4] That had to include our relationships with each other, through which the parallel process would have needed to be worked much further [5]

Which brings us back to the place of anxiety, our courage in all this and the different nature of the relationship to anxiety involved in innovation.[6]  Again to quote the CEO:

What I also know now is the investment I had in ego psychology, which Barry perhaps shared. Nailing the attitude to anxiety was one of the most important things noted in both versions of the paper. Any work had to be anchored to making it better for patients, a ‘work’ that we all had to have an investment in.

[1] Alongside the paper on The Architecture of Quality, other relevant papers by or with Barry are Meeting the Challenge of the Case (except that in retrospect, the challenge of this case was more than we thought at the time!), In which the Tavistock paradigm is considered as a discursive practice (thinking about how to situate the approaches associated with Barry’s role with the CEO as manifesting a particular form of discursive practice), and The Tavistock Paradigm: Inside, outside and beyond (laying the foundations for a new set of questions to which we are still trying to find adequate responses).
[2] Simon Western addresses these forms of leadership in his writing on eco-leadership.
[3] This is a reference to current thinking going on about the role of courage in overcoming defences against innovation – see the conclusion to Counter-resistance is always on the side of the supplier-provider.
[4] Which we had nevertheless formulated in 1994 in Meeting the Challenge of the Case, even if we hadn’t realised the extent of it.
[5] This comes up as a central issue in facing the future of the psychoanalytic study of organisations.
[6] This is to be the focus of a forthcoming paper to be presented at the 2014 Annual Meeting of ISPSO in Santiago – ‘Betraying the citizen: social defences against innovation’.