The Architecture of Quality: The Case
of the Specialist Care Organization

Philip Boxer and Barry Palmer

Contents

Preface
Introduction by the Chief Executive

Part I Intervention
A letter to house staff
The client system and the challenge of the intervention

Part II The client system and its context
Engaging with complexity
The consultant’s account of what we were up to

Part III The authority of the consultant
Who knows who knows best?
The ethic of the consultant’s practice

Endnotes

References

This paper describes an intervention within an organization providing residential care for men and women with mental health disabilities. The intervention was concerned with supporting changes in the way the quality of the work of the organization affected the lives of its residents. Three themes emerged from this work which are explored in the paper: firstly, the question of how the consultant’s practice meets the challenge of the case; secondly, the nature and complexity of the client system and its context; and thirdly, the question of the ethic of the consultant’s own relation to his or her practice.

Philip Boxer is an independent consultant working as a strategy analyst primarily with business organizations. An MBA from London Business School, he is a member of the Institute of Management Consultants, an Associate Member of the Centre for Freudian Analysis and Research, and a Correspondent member of L’École Européenne de Psychoanalyse.

Barry Palmer is also an independent consultant and writer, engaged in organization and management development, team-building and training, mainly in the not-for-profit organizations. He is an Associate of the Grubb Institute and of OPUS Consultancy Services, and author (with Nano McCaughan) of Systems Thinking for Harassed Managers, Karnac 1994.

Preface

We wish to describe a consultancy assignment with a British voluntary organization, which we shall call the Specialist Care Organization (SCO). SCO manages seventeen houses which provide accommodation and care for adult men and women who have severe learning disabilities, are chronically mentally ill, or who are elderly and mentally infirm. Philip Boxer was the principal consultant. The assignment arose out of prior consultations between Barry Palmer and the Chief Executive of SCO; and Barry also undertook supporting interventions with sub-systems of SCO during the assignment. The work was carried out between May 1994 and March 1996.

We discussed this work with Mike Goodwin, Julia Green, Alan Rowan and Richard Veryard, who are, with us, members of the Working Group on Groups and Organizations (GOWG). These reflections arise in part from these discussions. We should also like to acknowledge the part played in the development of these ideas by the CEO and staff of SCO, and by Marc du Ry of CFAR[1] who undertook the initial research on the intervention.

GOWG was set up in 1994 under the auspices of the Centre for Freudian Analysis and Research in London. The aim of the working group is to develop members’ understanding of groups and organizations through study of consultancy and managerial interventions in which we are engaged, and through the study of psychoanalytic and other texts which throw light upon this experience, in particular the writings of Jacques Lacan.

Three themes have emerged from this work, which we shall explore through this case.

Firstly, the question of how to intervene, that is to say, how is the consultant to understand the way in which he or she engages in practice with the client system in order to meet the challenge of the case.

Secondly, how is the nature and complexity of the client system and its context to be understood; and how is that understanding to affect the way in which the consultant is to intervene.

Thirdly, what are the implications for the consultant qua subject in terms of his or her authority to intervene – the question of the ethic of the consultant’s own relationship to his or her practice.

Introduction

The entry of Philip Boxer into the consultancy relationship between Barry and myself marked a change in the way anxiety was to be understood and mobilised in the organization. Historically, anxiety had been perceived as a personal response, in part reflecting concerns in the organization, that could be articulated and worked with via a process of interpretation.

Working on this basis, this consultancy would say something about me, about me in the role of CEO, and in the light of all that, about what may be going on in the organization. The underlying assumption was that relief from this anxiety, gained through the consulting process, would make it easier for me to be a decisive and effective CEO. In general terms there was an unspoken contract within the organization between employee and employer that this anxiety would be kept to a minimum.

The work with Philip and Barry was to raise a fundamental question about this – in fact to turn it on its head. Who had this way of managing and understanding anxiety been for? Was there a sense in which the organizational systems (e.g. line management, supervision, care planning) designed on the back of this assumption had been for the benefit of staff? Insofar as this proved to be the case, then interpretations about what was going on were likely to be used to reinforce the culture surrounding the implied employer-employee contract, rather than to ‘out’ it for critical evaluation.

The ethic of the intervention then, as it developed, was to provide an infrastructure and explanatory text which could support a different way of working with anxiety – an anxiety that was mobilised primarily to transform the experience of SCO’s clients rather than that of its staff.

Throughout the rest of this paper, I have interspersed some comments in italics which I hope will enable you, the reader, to retain a critical perspective which reflects something of my own experience.

Chief Executive Officer

22^nd April 1997

Part I - Intervention

A letter to house staff

Rather than lead you circumspectly into this work, we shall parachute you into the heartlands. Here is part of a letter from Barry Palmer to the staff of one of the houses, in which he summarised what he had been told in a series of one-to-one conversations with five members of staff. He had been asked by the manager of the house to give the staff an opportunity to say what they wanted from their managers, in order to be able to meet the needs of the four male residents. These men had been resettled from a large institution, Greystone Manor, into a three-storey terraced house in a lower middle-class neighborhood. In the current discourse of residential social work, they had varying degrees of learning disability and exhibited challenging behaviour. The names used here for the men and their former home are fictitious.

"You are aware that these four men - Ahmed, Robert, Tom and William - are more alive and less conflicted when they are doing what they want to do, exploring new places, doing new things, and meeting new people. And you have found that most of the opportunities for this are outside this house. This house is of course an important place for them: it provides safety, company, care and the necessities of life, in a more personal way than was possible in Greystone Manor. You are good at providing a home for these men which is not like Greystone Manor, but if they are confined to the house for too long, they become bored, irritable, depressed, passive, and dependent, as we do too under similar circumstances, and sometimes they become violent. (Their challenging behaviour may be a sign of life. They are still able to express their anger at the restrictions under which they have to live). So all of you talked about the importance of being able to go out with clients, on day-to-day errands, on trips and expeditions, and for longer holidays. This is good for various reasons, but most importantly because being confined in the house increases their disability: it "makes them worse". It also undermines your expectations of them, so that you come to think of their character and behaviour in the house as normal for them. One obvious restriction on your scope for going out with them is the number of staff available. So all of you also talked about being understaffed. If there are only, say, two people on duty at a particular time, there is limited scope for working with clients, inside or outside the house. It is only too easy for everyone to be fully occupied, dealing with the demands of the house and the sponsoring organizations, and escorting residents on routine trips to the day centre, the post office, the hospital and the shops. It seems to me that the restrictions of being short-staffed are real and require attention. But you are drawing attention to a more profound challenge. This cannot be met simply by appointing any number of additional staff. The challenge is:

how to create conditions for these men, in which they are free to explore and discover what they want, what they like, what they can do, and what they have to give;

and how to do this within the constraints of their own physical and mental limitations, and within the constraints of the world they live in.

As you are well aware, the world in which your clients are required to live - the house, the neighbourhood, the society, the economy - are in many ways unfriendly to them. This fact, as well as their disabilities, makes the challenge what it is. It is of course a challenge not only to the staff of the house, but to SCO, to the Health Trust, and to the society we all represent."

This letter encapsulates several elements of the larger intervention we shall describe.

The letter is an ‘interpretation’, in the sense in which the meaning that every listener makes of what he or she hears is an interpretation. And no staff member said all this - the interviews lasted a total of five hours or more. But everything that is said in the letter had been said by staff members. Thus the ‘interpretation’, although shaped by the way the consultant sought to understand what was ‘going on’ in Greystone Manor, and by his own desire as a consultant, is in essence a re-punctuating of their own words.

The letter implies a direction: towards giving the residents a voice in determining the future organization and practice of the house. It is not actually written in the form of a statement by the residents, although it could have been. But it reformulates as a conscious proposition the awareness of some staff members: that Ahmed and the others are more lively and more content on expeditions outside the houses; that the men want conditions in which they are free to explore and discover what they want, what they like, what they can do, and what they have to give; and that the life of the house, on which the staff expend so much labour, cannot on its own provide this. In fact it ‘makes them worse’. No one said this ‘out loud’, but the consultant has had a go at articulating what cannot quite be said within the current discourse of the house.

In this particular instance it is not possible to say whether this intervention was effective in situating this implied direction for the task of the house staff within their ongoing conversations about their work. When the consultant met the house manager to discuss the report she made no reference to the above statement, and the consultant left without having drawn attention to it himself. Neither was apparently willing at that moment to admit the implied revaluation of the work of the house into their conversation. This direction was nevertheless congruent with the direction of change being addressed within SCO as a whole.

How, then, did this incident fit within the context of the larger intervention?

In thinking about Barry’s choice of including the letter to the house manager at the beginning of the paper, it strikes me that it captures the whole challenge – to write what everyone thinks but which cannot be said.

The staff could not say that they had been told to keep secret from SCO managers that a client had a forensic history and another had been abused in the hospital where some of the staff had worked.

Barry could not talk with the house managers about the letter.

I could not talk to my managers about competence.

The clients could not talk.

 

The client system and the challenge of the intervention

SCO is an organization which was, as its name implies, set up jointly by the local health authority and the local social services department, to manage the seventeen houses and provide professional oversight of staff who were initially still employed by these authorities. The CEO was appointed as Acting Chief Executive after less than a year with the association, after his predecessor was abruptly suspended and then dismissed. He had no previous management experience, having started life as a mental health nurse and subsequently worked as an internal consultant within a health authority, during which time he met and entered into a series of consultations with Barry Palmer, which continued into his time with SCO.

The CEO inherited a tangle of problems, which included the whole problematic of Community Care, its funding, and its relationship to the Local Authority and to the Health Authority. The demise of the previous Chief Executive was probably symptomatic of this tangle in some way, even though the suspension and dismissal came as a result of a lack of performance in the job.

In the first months of his appointment the CEO not only used the consultations with Barry to examine these problems, but also to articulate his concern for the clients of the service for which he was responsible. He imagined one of them, on his deathbed, looking back over his life and asking ‘What the f*** was that all about?’ The question of the good of the client was thus explicit, in his leadership and in this assignment, from the beginning, and, as we shall hear, is still being addressed.

The CEO decided that he needed a strategy for the development of the organization and services of SCO as a totality, and at Barry’s suggestion engaged Philip as consultant. What follows is a selective track through a process which, for our purposes, started in May 1994, and ended formally in March 1996, although informal contact continued.

Key Events

The process of the intervention can be described in terms of a number of phases of work, punctuated by what appear in retrospect as key moments. We shall discuss the asterisked elements in more detail:

The initial process of engagement (May to August 1994):

The Interviews: Meeting with 5 individuals, both from within and outside SCO, involved with different aspects of the charity’s work.

The Workshops: meetings with the senior staff, formulating initial hypotheses around dilemmas* and development challenges confronting SCO, and exploring issues around cost structures, organization* and constitution.

Tackling the basics (September 1994 to March 1995). This period culminated in the CEO’s confirmation as Director by the Trustees.

Systems: The role of IT and the development of a strategy for developing IT systems.

"QAGs"^*: The setting of four levels of development agenda in terms of ‘Quality Assurance Guarantees’. Negotiation of QAG I and QAG II.

House Managers: Enabling the managers of the houses to begin to develop their own voice and position in relation to senior managers. This laid the foundations for a different kind of working relationship with House Managers; and a recognition of their need to be able to hold problems which they had not got solutions to instead of pushing them up the hierarchy as a ‘crisis’.

Activity Based Costing: an examination of how the way costs are analysed can be aligned with the ‘logic’ of the actual activities in the different kinds of house[2].

Constitution: how can the constitution be modified to make it more congruent with a needs-driven culture?

Beginning to develop a third level of Quality Assurance Guarantee (QAG III), culminating in a re-organization. (May to October 1995):

Development of the ‘red route’ and ‘green route’ concepts of organization^*, and implementation of the ‘green route’ model.

Examination of authority issues in relatedness between the CEO, Barry and Philip: what is the ethic of our mutual engagement*?

Conversations with the staff of one house, leading to the letter quoted above. and with the CEO about what kind of concept of ‘the clinic’ lay at the heart of SCO’s work.

Emergence of new agendas, culminating in restrictions being placed by the Trustees on the use of external consultants (November 1995 to March 1996)

Establishing Service Management Meetings: Critical Process emerging in the Houses. This was a process which was developed from Barry’s work and which was aimed at ‘outing’ the assumptions that drove the way SCO habitually responded to its service users.

Examining the ‘competitive environment’: who is SCO competing with, and on what basis can it remain viable?

The Trustees and the Management Team: what is the relation between direction and management? What are the joint development processes?

As of today, it appears that SCO is facing two major challenges:

Facing up to the ‘crunch’ of how to secure long term viability, through a business planning process.

Tackling the implications of the fourth level of Quality Assurance Guarantee (QAG IV), through obtaining charity funding for a project aimed at developing clients’ rights.

This gives an impression of the scope and span of the project. We shall now elaborate three of these elements in the overall intervention in more detail. The fourth, bearing on the authority issues, we will leave for Part III.

Dilemmas

In the initial workshops, Philip worked with the senior staff to articulate critical dilemmas that they encountered in managing SCO. A management team can be said to be caught in a dilemma when they find they are committed to two propositions such that, it appears, acting upon either one makes them vulnerable to contravening the other. Sometimes one proposition is an explicit ideal or policy, while the other proposition is undeclared. The value of this type of analysis is that it provides a language in which members of a client system can discuss their acutest worries; and it opens up inconsistencies or ‘holes’ in the current conception of the agency which are concealed when the emphasis is upon constructing coherent, holistic models like that of an open system.

The first workshop identified these dilemmas. We hope that you will gather something of the difficulties facing the staff team if we simply list them:

‘We are crisis managers of a process of transferring staff into the private sector’ (our history) versus ‘We are managers of an organization delivering particular kinds of care into the community’ (our future).

‘We are running a room-centred service’ (health service culture) versus ‘We are running a person-centred service’ (local authority culture).

‘We manage through exercising control’ versus ‘We manage through creating collaboration’.

‘We are managing assets’ versus ‘We are managing care’.

‘We are driven by the demands of complying with regulations’ versus ‘We are driven by the real needs of residents’.

‘We will bring about gradual change’ versus ‘We will bring about quantum or step changes’.

‘We are aiming for independence and autonomy as an organization’ versus ‘We are going for ‘cover’ within the local [community care] cartel’.

Confronting these dilemmas, and the question of the position SCO chose to take in relation to them, laid the foundations for how the CEO and the senior staff were to work together.

The ‘red’ and ‘green’ routes

The second workshop closely examined the task structure, work group processes and formal organization of SCO, from the point of view of one of the houses. This analysis led to the formulation of two alternative concepts of the possible organization of SCO, which were referred to colloquially as the ‘red route’ and the ‘green route’. Both were based on a matrix organization with two axes. One axis had the centre-based functions of

Advocacy

Intensive Care, Training and Development

Support Services

Compliance

The other axis comprised the House Managers, grouped according the major types of service being provided:

Mental Illness

Elderly Mentally Ill

Learning Disability

Community Team (a team serving clients living independently).

The ‘red route’ was the present conventional form of organization, in which the house managers were subordinated to the centre-based functions. The ‘green route’ represented a fundamental inversion of this architecture, in which the House Managers had direct access to the Chief Executive, and the centre-based functions were there to provide services in support of the House Managers. This work led to a commitment on the part of the senior staff to move towards a ‘green route’ architecture.

Quality Assurance Guarantees

It was agreed that the essential purpose of SCO was to help the residents to migrate through the care regimes it provided, towards the greatest possible autonomy. One of the first issues to be tackled, therefore, if the change was to be sustainable, was that of the standards of performance which would be required of different parts of SCO, to support the residents in this migration. To give practical form to the process of developing quality, the concept of Quality Assurance Guarantees (QAGs) was evolved. A QAG is a promise or commitment by one part of the organization to another, to deliver its services in a specified way and to standards (of speed, accuracy, etc) agreed with the recipient [3]. Four levels of QAG were identified by SCO, to be fleshed out and introduced in turn over a period of time. Each QAG implied a different ‘cut’ between who was the recipient and who was the provider of a service. This ‘cut’ moved progressively towards the relationship between residents and their communities. They thus provided an indicator of how far SCO itself had migrated towards its intended quality of performance. The four levels were these:

QAG I (between SCO and Government): conforming to the standards of safety, hygiene, care etc laid down by law. It defined the minimum operational requirements.

QAG II (between the Centre and the houses): the Centre provides agreed standards of service to the House Managers and their staffs (e.g. the Personnel Manager specifies the period within which advertisements for new staff will be placed, and how the advertisement will be compiled). In arriving at these standards, the Centre have to balance the sometimes conflicting demands upon them from inside and outside the organization, and make them work in the interest of the residents. QAG II defined the minimum levels of efficiency of the Centre.

QAG III (between SCO and residents, through the house staff): standards of care developed in the houses in response to residents’ needs, as conveyed by care staff to House Managers and thence to the Centre. QAG III includes an explicit concept of the role of each house in relation to the needs of its particular residents.

QAG IV (between residents and their communities): standards of work by all the staff of SCO, in facilitating the process by which the community anticipates and responds to the changing needs of each resident, as he or she articulates them. Strictly, each resident’s ‘community’ is different, and not fixed: it includes his or her family and friends, and all the people and institutions in his or her life space. Ahmed’s community included the local College of Further Education, in which he was enrolled on a cookery course.

The development of SCO’s ability to sustain this progression of QAGs became a core management concern.

In the transfer of staff and gearing up for market change, the risk had been to lose sight of the purpose. To migrate people closer and closer to their communities or to live through the end of their lives in a way that respects who they have been. I think there was a struggle a few years ago when staff collectively attempted, albeit unconsciously, to keep their frames of reference intact. They had already had to move from the hospital to the community. A second move into SCO must have felt like a move too far.

Behind this human struggle there was another going on. Patients had moved into community based housing. But such was the preoccupation with staff anxiety that it was difficult to engage with the client’s experience. Simply working with staff anxiety and thinking this would change client experience was a belief rather than an observable reality.

Both the context, explicit and implicit, and the way the organization’s systems were wired together, confirmed the primacy of staff and managers. It is another paper to explore what caused change, so that the idea of critical process, when it all goes wrong, is at least now intellectually accepted.

But something of the flavour of this change is captured in the following:

Meeting Philip and saying that I was having a really difficult time getting the managers to agree to changes, and being told "that’s interesting. What are you going to do about it?"

Lucky for Philip that in my youth I had my bike taken by three others and when I told my father this (in tears) he took me to the park and said "hit the biggest one and the others will run!"

In the end the people blocking change were ‘forced’ to leave. In a small organization, such changes were personal and bloody. And people wonder why war metaphors abound.

Part II – The Client System and its context

Engaging with Complexity

When the CEO took over, the way SCO was organized was similar to that of many such organizations in the public and voluntary sectors in Britain. The assignment which the CEO gave Philip was to help him consider changes in the constitution and organization of SCO, and to enable the senior staff to develop a new strategy and introduce new working practices in the way the organization provided services to its residents. The challenge was to do this in a way that secured the continuing viability of the organization in a changing funding environment. What types of complexity did this situation present?

The span of events described in the last section started from a consideration of how to describe the ‘architecture’ of SCO when the new Chief Executive took over (which was similar to many such organizations in the public and voluntary sectors), and of what ethical position it institutionalized. From there it considered what ‘organizational architecture’ would be required for a human service organization which aimed to be responsive to what the user wanted. This meant that four points of view had to be considered:

Demand. From the point of view of the users of the service themselves and their families, how were their needs to be understood and characterised? For any of the client groups, a statement of aim like, ‘To provide care and accommodation for men and women with learning disabilities’, skated across the surface of the problem. How was SCO to provide a way of understanding the human subject, such that it was possible to have an intelligent conversation about what, say, an elderly and demented man or woman wanted?

Accountability. From the point of view of the forms of formal accountability under which SCO operated, how was SCO to characterise the matrix of accountability in which SCO was situated, which included managerial relationships within SCO, employment relations with other authorities, professional accountabilities within a number of disciplines (e.g. nursing), and complex legal requirements? Staff working directly with residents were required to comply with a multiplicity of statutory and procedural requirements. It could conclude that these were functioning as defences against somebody’s anxieties, in the sense which Isabel Menzies (1988) elucidated, but there was little scope for ‘working through’ these anxieties in this context. What was necessary was to extricate the staff from their deadening effect, without falling foul of them?

Monitoring Performance: What did managers and staff need to know in order to be able to monitor the performance of the parts of the organization for which they were responsible, and how could they be provided with access to this information, in such a way that SCO can develop beyond functioning as seventeen semiautonomous cottage industries? For example, the CEO inherited a situation in which, in effect, all income was put into one pot, out of which all salaries and other expenses were paid. Early on in the intervention, and on the basis of available data, Philip demonstrated that the costs of providing the different categories of service were very different. Yet referring authorities were being charged the same amount for each of them.

Dilemmas. Finally, from the point of view of the working experience of managers and staff, many of the moments in which rationality, or work group functioning (Bion 1961), were most in jeopardy, were moments which could be characterised in terms of the dilemmas or paradoxes which they faced. For example, the organization defined the residents as tenants subject to legally binding tenancy agreements. Yet the very reason the residents were in the care of SCO was that they were unable to understand or voluntarily conform to agreements of this kind. So the staff encountered radical impossibilities at the heart of their work. SCO might be able to describe how this led them to adopt primitive and dysfunctional mechanisms of defence; but was it possible to characterise the demands of living with these dilemmas, in such a way that a culture could be developed which supported people in doing this? The early work with the senior staff began to describe the work of SCO in terms of the particular dilemmas that it faced.

Critical Process

These four points of view reflected four different aspects of a ‘discursive practice’ built around the central rationale of SCO [4]:

what was problematic about the work of SCO (the dilemmas associated with the ‘why’ of the agency),

how would SCO know that it was ‘succeeding’ (monitoring the performance associated with the ‘what’ of the agency),

what were the hypotheses about what was wanted (the demands associated with the ‘who/m’ of the agency), and

how was SCO to respond to these demands in practice (the accountabilities associated with the ‘how’ of the agency)?

The aim was to explore how ‘answers’ to these questions were built into the very ‘grain’ of the architecture of SCO, and to consider what kind of architecture would be required for a human service organization which aimed to be responsive to what its users wanted. The question of this requisite architecture had to encompass several dimensions of complexity.

In the process that produced Barry’s letter, these questions had been applied to what was going on across the particular boundary between the staff and residents. As we saw in the letter, the last question had a particular force in SCO, where residents were severely limited in their capacity to articulate demands. This questioning process, undertaken in relation to a particular ‘cut’ across a set of relationships, became known within SCO as a "critical process" that was built around four kinds of question. These four questions are based on the ‘what’, ‘how’, ‘who/m’ and ‘why’ questions elaborated in more detail below.

The consultants’ account of what we were up to

What, then were the assumptions underlying this intervention? How, in these terms, was the direction of change formulated within SCO as a whole? The core ‘framework’ within which the intervention could be understood was an ‘up-the-stairs’ schema. This schema provided a way of addressing the question of how we described the development of an architecture appropriate for a human service organization.

This schema was based upon a progressive questioning, or ‘problematizing’, of the assumed boundary or ‘cut’ between the client system and its environment. Thus the concluding statement in the letter did not bottle up the staff in the house with their clients. It opened up the question of the wider systems of relations within which they were lodged and that restricted the options open to them. The challenge to tackle this situation was similarly addressed to wider subsystems of the society that we all represented. This progressive problematizing of the boundary or ‘cut’ was inherent in the formulation of the QAGs. As a result, whatever was experienced as being inside the house was taken as being continuous with what was experienced as being outside, like the surface of a Mobius strip.

Levels

At the very least, individuals may depend on an agency[5] to provide them with a paid job. Beyond that, individuals may depend on an agency for a sense of who they are, as far as it becoming a means of having an influence in the world. If we consider the reverse side of this - of not having a job, not having their work valued, or not being able to ‘act in the world’ - then we would expect this reverse side to cause anxiety. Thus the organization of an agency can be viewed as a defense against anxiety, not only for the individuals who work in them, but for all its other stakeholders and customers. This is a view that follows on from that established in the Tavistock tradition. (Menzies Lyth 1988, Hirschorn 1988, Kets de Vries 1991). An elaboration within the Tavistock tradition of the nature of these issues in Human Service Organizations is to be found in Obholzer & Roberts (1994). Here the emphasis is placed on the interactions between the defenses and the requirements of (primary) task approached within an open systems view of organizations.

Working relations are supported by organization that is spread both across time with respect to short-term and long-term time horizons, and across ‘space’ in terms of the way particular forms of work are organized. Elliott Jacques (1976, 1989) started elaborating this approach to organization based on a Kleinian approach as a psychoanalyst in the form of Stratified Systems Theory (SST). Gillian Stamp (1978) has continued to do develop this approach with Career Path Appreciation (CPA). Jacques has since modified his views (1995), so that rather than viewing organization as having been concocted by individuals as a defense against anxiety, he argues instead the other way around - that badly organized social systems arouse psychotic anxieties and lead to their disturbing acting out and expression in working relationships.

Thus ‘organization’ describes the bringing of complex configurations of behaviour into relation with each other; and it persists over extended periods of time despite considerable variations in what-is-going-on. A fundamental issue which has to be faced when introducing change, therefore, is managers’ ability to cope with the anxiety it generates and/or releases. It is for this reason that the quality of leadership becomes so important during times of change. But how is the efficacy of the form of organization itself to be thought about?

It was Lawrence and Lorsch (1969) who originated the framework of differentiation and integration for describing agencies. Their argument was that there had to be a congruence between the forms of differentiation of behaviour necessary for an agency’s viability; and the forms of integration of those differentiated behaviours needed to maintain the agency’s identity.

Emery and Trist (1965) distinguished between four forms of ‘causal texture’ in the environment in relation to which the agency had to differentiate its behaviour:

Placid randomised, in which opportunities and threats are relatively unchanging in themselves, and randomly distributed throughout the environment. In this environment, which approximates to perfect competition, behaviour simply has to be operationally effective.

Placid clustered, in which the opportunities and threats are not randomly distributed, but cluster together in some way. In this environment, which is more like ‘imperfect’ competition, specialist forms of behaviour have to be available to address the different kinds of cluster.

Disturbed-reactive, in which there is more than one agency of the same kind in the environment. This environment approximates to the economist’s oligopolistic market. Each agency does not simply have to take account of the other when they meet at random, but has also to consider that what it knows can also be known by the others. As a result, the behaviour of the agency has to be ‘positional’ in the sense of focused on being able to sustain positions it takes up in the environment competitively.

Turbulent fields, in which dynamic processes arise from the environment itself which create significant variation for the organization to respond to. The behaviour here has to be ‘relational’ in the sense that it has to be dynamically responsive to the environment – in the case of SCO, both to the corporate environment of SCO itself and to the multiple and changing environments of the houses and their residents.

What distinguishes this progression in behaviours being demanded by the agency in response to its environment is that they have to become increasingly differentiated if the organization is to remain viable. What particularly distinguishes the fourth from the other three is that with turbulence, the ‘environment’ has to be related to by the organization as if it has a life of its own. In the other three, the organization can treat it as if it is passive or reactive.[6]

We might say that the organization is being subjected to the law of requisite variety. For example, in the public sector, including the environment of SCO, the emergence of internal and external markets and of compulsory tendering (CCT) can be seen as a transition from a placid clustered to a disturbed reactive environment, requiring agencies to develop a new repertoire of behaviours to demonstrate that they give value for money, or face closure. Many psychoanalytic writers have got no further than expressing sorrow and outrage about this. See for example Smith (1997).

If we start with this progressive complexification of the behaviours required of the agency, how do we understand the integrating processes needed to bind these increasingly differentiated behaviours together for the agency as a whole?

An agency can be described in terms of the levels of configuration of the activities that are crucial to maintaining its viability. These levels can be identified as relations that embed the organization of task in larger and larger contexts of organization [7]. These levels correspond to different kinds of explanation of the organization of the agency [8]. Four types of level can be identified in a way that mirrors that of the causal texture of the environment [9].

WHAT: the agency structure (what the agency actually consists of)

HOW: the agency organization (how are the structures of the agency organized)

WHO/M: market organization (‘who’ is the agency in relation to the ‘whom’ of different customers/clients )

WHY: demand organization (what is the logic of demand organising the desires and needs which are constitutive of the forms of demand which the market organization is supporting).Thus, at the WHY level, the question of the needs of the residents becomes one of what they want from life (‘What the f*** was that all about?’), not of what they need from the house.

The significance of these levels for the agency can be appreciated by considering the different orders of organization of its relationship to the environment, as more and more levels become variable in response to competitive pressure. Treacy and Wiersema (1995) describe the implications for these different levels of relationship with the environment in terms of three different kinds of value discipline - operational excellence (what and how), service leadership (what, how and who/m), and customer intimacy (what, how, who/m and why). Thus the organization of this relationship needed within a ‘placid randomized’ environment is very different to that needed within a turbulent environment. In this latter case, the environment is not only changing, but can be actively influenced by the agency and its competitors, customers and regulators (e.g. through the introduction of new technologies or through successfully lobbying for changes in legislation).

Lawrence and Lorsch’s insight was there had to be congruence between the forms of behaviour being demanded from the agency, and the organization of the agency. Thus the more an agency had to be relational in order to respond to competitive pressures, the more critical it became to be able to differentiate different forms of demand organization within the agency.

The Strategy Ceiling

In any account of the purpose of an agency, all four levels are always present. But if we define the strategy ceiling of an agency as that level below which it is able to make explicit what its strategy is, and below which it is therefore able to commit its management to that strategy, then all levels are not always made explicit by the agency: senior management may keep to itself, or may take as given, implicit definitions at levels above the strategy ceiling. We could say that, above the ceiling, assumptions about the agency are kept ‘in the family’ (or even ‘in the Family’, for those who have read or seen ‘The Godfather’! (Puzo, 1969)).

We could say that below the ceiling is the domain of work group activity, that is, as Bion (1961) says, co-operative activity, geared to a task, related to reality. If this is a valid cross-reference, it begins to elaborate the concept of work-group activity beyond Bion’s undeveloped definition, problematizing the ‘reality’ in terms of which the task is defined as one moves across the grid. What account then can we give of basic assumption activity? One answer would be that the basic assumptions are defenses against the persecutory anxiety which is aroused by consultant interventions (or any other impingements) which threaten to breach the strategy ceiling and haul covert ‘in the family’ assumptions out into the open. This would be a way of reading Jacques’ (1951) account of the method of intervention employed by the Tavistock team in the Glacier Metal project:

"[We developed] methods of offering technical help to groups… in exploring underlying and concealed forces – whether psychological, cultural, structural or technological – that were impeding their progress or otherwise reducing their efficiency. So far as this meant uncovering forces that had gone unrecognised whether through being consciously or unconsciously ignored or denied, resistances were encountered." (p 306).

Thus, the strategy ceiling may limit the ways in which the agency can explain to itself what it wants to do, and therefore may set a limit on the nature of the strategic options which the agency sees as being available to it. It may also reflect the level above which issues of identity are held a priori - as being constitutive of the nature of the agency itself, or rather of the ‘family’ that governs it.

As a result, issues that arise above the ceiling may either be resolved explicitly at lower levels, or remain implicit in the personal processes that arise between those who have the power to resolve them [10]. The exact formulation of these levels therefore depends on how the identity of the agency is formed. "Raising the strategy ceiling" involves changes in the ways in which individuals with powers ‘above the ceiling’ vest their identities in the agency - ultimately a question of power and politics. Hence it was essential for the intervention to engage with the question of the constitution of SCO; and it was in relation to the Trustees that the CEO ultimately encountered the greatest challenges to the change process itself.

The debate about the type of differentiation of behaviour fundamental to the viability of the agency, and the basis of its competitive advantage, is logically prior to the definition of ‘levels’. Equally, however, a low strategy ceiling may mean that the current definitions of task cannot be called into question. Thus, if there are dynamic changes taking place in the structure of the environment in which the agency is competing, too low a strategy ceiling may mean that the agency is unable to engage with the competitive challenges facing it - other than through the intuitive grasp and leadership of its top management.[11][12]^, Thus when local authority cuts led to the closure of day centres in the borough, the low strategy ceiling of house managers meant that it was difficult for them to imagine any other way of occupying many residents during the day.

Raising the ceiling

So how is the ceiling to be raised? As the demands of the environment demand a shift ‘to the right’ in the behaviour of the agency, so the challenge for top-management is to relinquish implicit forms of power and control and to replace them with explicit forms which can be articulated within work group processes. Thus each change in the ‘level’ at which strategy is formulated is associated with a change in the way power is exercised by top management[13]. "Critical Process" undertaken in relation to the set of relations across a particular ‘cut’ was therefore the means for raising the ceiling.

The 1-2-3 viability step ends up with an agency that is viable, and is capable of ‘planning’ on the basis of a detailed knowledge of how the agency works. The role of the top management - if it exists - is not differentiable from the agency as a whole, because there is a single source of authority operating. It is at this stage that the Centre becomes defined in terms of the interests of a number of strong functions or professional groupings. It was for this reason that QAG II was a profound shock to the Centre in starting them on the next step up.

The second autonomy step 3-4-5 ends up with an agency which can say who it is, and for whom. It can position itself in the environment in which it is competing; and the role of top management is as a guarantor of the rigor of the analytical processes through which it goes in order to arrive at those conclusions, including providing the experience in how to interpret those analytical rules in practice. But there are now multiple loci of authority operating – one for each position. Thus this step corresponded to QAG III, in which House Managers were able to articulate what they offered their respective residents, but would lead to their becoming semi-autonomous barons if top management did not develop their role correspondingly.[14]

The third performativity step 5-6-7 ends up with an agency that is capable of re-designing itself in relation to its competitive environment, of articulating the why of the agency. The role of top management here is to act as a support to this process, not only by helping the agency to be rigorous in the application of its current understanding of its environment, but also to call that very thinking into question. Thus, in this case, the role of top management is to create the conditions in which the dynamic effects of agencies pursuing changing strategies can be included. We use the term ‘performativity’ because – taking the example of SCO – the Chief Executive and his management team have at this level both to enable the parts of SCO to add up to a whole, and to do this in a way which enables the different houses to deliver distinct performances which meet the needs of their different, changing clients in their respective changing community environments.[15]

We will discuss in the next section with what choices the critical process presented the consultant’s practice.

Part III - The authority of the consultant

Who knows who knows best?

For SCO, the critical factor setting the ceiling was not its formal organization or constitution, though these had limitations, nor the defences which the staff had developed to contain the anxieties of the work, though it would be possible to articulate them. The critical factor was the architecture of SCO in the sense of the axiomatics of its discursive and non-discursive practices: the axiomatics underlying the way they conducted their conversations and evoked the ‘realities’ with which they had to deal. People had invested themselves in this architecture in terms of task below the ceiling, and above the ceiling insofar as it acted as a support to their personal identities. Barry’s letter was a glimpse of how, with great difficulty, we sought to bring new distinctions into this architecture, working upon the way the house staff understood the mostly non-verbal communications of the residents. How, then, does the consultant actually intervene[16]?

The following points concerning Philip’s way of intervening were extracted by Marc Du Ry (1995) from his interviews with the CEO. They convey something of the approach:

CEO: "One of the things in looking for a consultant was that I felt I couldn’t capture what felt like an enormous task, I didn’t have the language to make sense of it, and one of the things I was immediately confronted with by Philip was his language". A key part of Philip’s approach was a theory of speech and discourse and their role in organizations. CEO: "He stressed the importance of conversations, and the positions people would take in relation to them, especially ways of improving the quality of conversations and getting clarity about who needs to talk to whom about what." Furthermore, the CEO found that: "it supports this idea which I’ve always believed in, that there have to be lots and lots of stories about what is going on."

While the CEO struggled hard to take on board new terms, he found that everything sank in after a while, and as it did so, it enabled him to get a new handle on what had seemed an ordinary process. The time to understand coincided with the actual use of the concepts.

Speaking well involved not shying away from, as the CEO said, "uttering the unutterable, of what is not being said, which Philip could do, and then just standing there, of being there to live with it, dealing with the projections that arose, working them through, it was good to see him do that." It is an ethic in which interpretation aims at action, not just understanding. The CEO felt that as an ex-Tavistock person and consultant he was often only concerned with finding the right interpretation. The problem for the manager, however, remained performance, meeting the demands of reality.

Philip also made it a habit to send back to the CEO a record of what they had discussed plus any interpretations. Nothing was therefore imposed; on the contrary, the client had to accept and work through the actual complexities uncovered. All the more so "because there wasn’t any premature closing down of the diagnosis of what was wrong, and there was an enormous challenge to my own assumptions" - CEO. In other words, the client was involved in elaborating his "symptom" as well as the most likely cure for it.

Controversially, but in line with an ethical position centred on a "relational" way of working, Philip would speak in such a direct way to people that their identifications to their role, their "positional" stance, might be shaken. Uncomfortable but necessary if one person is not to scupper the work of the whole. This meant that there was always an explicit or implicit invitation for people to take on the challenge of change, including changing their own roles, in order to find their optimum position in the structures they helped to define. CEO: "The way some of them are confronting and challenging where you’d least expect it, to me that’s a test of the validity of the theory. People that have been hammered by their organizations, are now saying this is the kind of service I need in order to meet the client’s need, and doing it in a way that is not full of hatred or rage. That is evidence... It allows us to provide a service that begins to unpack the bureaucratic, hierarchical experience everyone has had in the last 6 years, or in their own training, the last 20 or 40 years. So it is turning the organization, if not on its head, at least on its side."

And Barry: "The result has been to allow house managers to articulate their needs rather than the Centre imposing directives. But without the managers becoming barons dictating to the Centre. Rather, everybody is organizing around one issue: what residents and community at large might want. So it allows people to give service to each other rather than telling them what to do. Furthermore, there is now a clear notion of an end: when each house can articulate what it is doing for residents and why, can hold dilemmas and paradoxes."

Lastly, Philip had taken on board the Plus-one [17] position, developed by Lacan, of one who is not part of a workgroup, but is both inside and outside it at the same time, called upon by each member to prevent it from getting bogged down in non-work problems. CEO: "...this is the ‘orthogonal’ position that he talks about. And that’s where I want him, to be quite honest, otherwise I’m not learning, I just get stuck in dependency, and that’s not why I’m doing this job".

The process of intervention, starting from the identification of dilemmas facing staff practices, rests on an ability to problematize the axiomatics of SCO and the associated questioning of the strategy ceiling. The positioning of the consultant in this is based on a principle of "orthogonality". This is a position in which relationships to members of the client system never intersect with the system as a whole.[18] But how is this principle to be sustained?

In the following diagram, a distinction is made between the forward movement through time of speaking, and the retroactive movement inherent in listening to what-is-being-said. In effect, listening imposes a punctuation on the chain of speaking:

Reduced to its barest minimum, this listening can be said to have the structure of a metaphoric act [19], in which the listener ‘superimposes’ meaning on what-is-being-said. In contrast, the speaking has the characteristics of a metonymic act relative to the listener [20], insofar as it is always taking the listener outside and beyond the meanings constructed. If the current ceiling and architecture are understood as the privileging of particular ways of listening, then the aim of the intervention is to metonymise speaking so that it calls these into question. And what drives this metonymising? As far as SCO is concerned, this metonymising is in relation to the articulation of the needs of SCO’s residents.

Insofar as a discursive practice privileges particular ways of listening, ‘metaphor’ will therefore reflect particular forms of organization. In contrast, the differentiation of behaviours in relation to the environment becomes metonymic in its effects on particular ways of listening. For the consultant to intervene therefore in a way which privileges metaphor over metonymy is to go ‘up-and-over’, while to privilege metonymy over metaphor is to go ‘across-and-up’. And to privilege metaphor is to risk losing orthogonality, taking over leadership of the agency, and keeping the management of the agency "stuck in dependency", as the CEO said above.