Mara Gorli

In search of the structure that reflects. Promoting organizational reflection in a UK Health Authority

IN SEARCH OF THE “STRUCTURE THAT REFLECTS”: PROMOTING ORGANIZATIONAL REFLECTION IN A UK HEALTH AUTHORITY Theme: Methodology Davide Nicolini Research Unit on Cognition, Organizational Learning and Aesthetics University of Trento (Italy) and The Tavistock Institute (London) Mannie Sher The Tavistock Institute (London) Sarah Childerstone Bedfordshire and Hertfordshire Workforce Development Confederation Mara Gorli The Tavistock Institute (London) and Università Cattolica del Sacro Cuore (Milan)

Reflexivity in practice : tools and conditions for developing organizational authorship

In this article, we build on the results of a participatory action research project in healthcare to discuss a number of methods that can strengthen the link between reflexive work and authoring in organizational contexts. We argue that, from an organizational point of view, the challenge is to devise new ways to configure (and consider) people as the authors of their work. This means assuming responsibility for, and constructively contributing to, the goals of the organizations to which they belong. Combining insights from theoretical reflection and experience from the field, the article discusses the tools, process and material conditions for fostering practical reflexivity and organizational authorship. We conclude that much is to be gained if we distinguish between authorship and authoring. Authorship is the general process whereby managers and organizational members contribute to the reproduction of organizational realities. Authoring is constituted by the special circumstances whereby authorship is brought to critical consciousness and becomes open to deliberate reorientation.

Pushing Action Research Toward Reflexive Practice

Managers today increasingly find themselves facing unexpected problems, needing to learn how to cope with complex environments and to take action in an often chaotic flow of events. This article discusses how researchers can engage managers in a form of dialogical action research, capable of nurturing knowledge and change. This is achieved by creating space for collaborative dialogue between managers and researchers, and supplementing it with the integration of a reflexive writing practice. We first present methodological reflections related to the challenges of sustaining management practice through action research. Second, we explicate dialogical action research and illustrate the reflexive writing practice through two vignettes which provide opportunities to reflexively explore “how things work” in managers’ organizational contexts. This forms the basis for sustaining participation and learning at individual and collective levels. Finally, we identify and discuss the specific conditions and limits of such an approach.

Barriers and facilitators to the uptake of computerized clinical decision support systems in specialty hospitals: protocol for a qualitative cross-sectional study

BackgroundComputerized clinical decision support systems (CDSSs) have been shown to improve the efficiency and quality of patient care by connecting healthcare professionals with high quality, evidence-based information at the point-of-care. The mere provision of CDSSs, however, does not guarantee their uptake. Rather, individual and institutional perceptions can foster or inhibit the integration of CDSSs into routine clinical workflow. Current studies exploring health professionals’ perceptions of CDSSs focus primarily on technical and usability issues, overlooking the social or cultural variables as well as broader administrative or organizational roles that may influence CDSS adoption. Moreover, there is a lack of data on the evolution of perceived barriers or facilitators to CDSS uptake across different stages of implementation.MethodsWe will conduct a qualitative, cross-sectional study in three Italian specialty hospitals involving frontline physicians, nurses, information technology staff, and members of the hospital board of directors. We will use semi-structured interviews following the Grounded Theory framework, progressively recruiting participants until no new information is gained from the interviews.DiscussionCDSSs are likely to become an integral and diffuse part of clinical practice. Various factors must be considered when planning their introduction in healthcare settings. The findings of this study will guide the development of strategies to facilitate the successful integration of CDSSs into the regular clinical workflow. The evaluation of diverse health professionals across multiple hospital settings in different stages of CDSS uptake will better capture the complexity of roles and contextual factors affecting CDSS uptake.

The power of professionally situated practice analysis in redesigning organisations: A psychosociological approach

Purpose – This paper seeks to provoke thoughts around the possibility of using the lever of practices and situated knowledge to trigger organisational change and to redesign it with the involvement of the whole organisation.Design/methodology/approach – The paper presents connections between a psychosociological approach and a practice‐based approach. The use of ethnomethodology is offered as a way to detect situated practice and meaning at works.Findings – This contribution underlines how change and learning in organisations can find support in investing in local knowledge and in detecting and reflecting around the living practices of daily activities. Knowing in practice requires the involvement and continuous work of connecting among individuals, groups, organisations and institutions in situated contexts. The paper shows how strategic a process this is, presenting a way to work on situated data.Practical implications – The paper represents a way to work on organisational change grounded on action rese...

Building social sustainability: multi-stakeholder processes and conflict management

Purpose - – The aim of the paper is to investigate social sustainability by focussing on the stakeholder theory and by presenting specific levers and capabilities for building more socially sustainable organizations. Design/methodology/approach - – The paper is based on the analysis of recent academic and managerial literature. Through comparing theoretical and methodological perspectives from multiple authors, a specific theoretical and methodological viewpoint based on the stakeholder theory is proposed. Findings - – The paper discusses the idea that building socially sustainable organisations requires the management of multi-stakeholder processes that are physiologically conflicting and that often create paradoxical tensions. Participative settings of action and reflection and capabilities as reflexivity and “paradoxical thinking” are proposed as key levers for dealing with multi-stakeholders processes towards a more socially sustainable organizing. Research limitations/implications - – This paper raises reflections focussed on the “social pillar” of sustainability and does not consider different types of organizations in different multi-stakeholders processes. Such a perspective does not exhaust the variety of cases and research studies that could be considered in the field and further developed. Originality/value - – The value of the paper is in its construction of a framework for both research and practical purposes in the domain of management and sustainability. The work also attempts to link the concepts of reflexivity and paradox to a methodological proposal for leading the organizational journey towards social sustainability.

A multi‐method approach for looking inside healthcare practices

Purpose – The purpose of this paper is to explore a specific multi‐method approach with which to detect and analyze professional practices in order to support organizational reflection and change.Design/methodology/approach – Based on a case study, the paper describes the methodological choices made during the research process. The qualitative potentials of narrative and ethnographic orientations, and a package of data gathering tools, are analyzed in depth.Findings – The paper presents the advantages and drawbacks of tools to articulate practices and to develop hypotheses for change. It emphasizes the approachs innovative value and potential in contributing to knowledge sharing in organizations, and the implications for researchers and participants.Practical implications – The paper furnishes concrete suggestions on how practitioners and researchers/consultants can be induced to pay particular attention to aspects of the operational knowledge that should accompany change processes. This appears even mor...

The Video Production of Space How Different Recording Practices Matter

This article examines how video recording practices excert an influence on the ways in which an organizational phenomenon—in our case organizational space—becomes available for analysis and understanding. Building on a performative and praxeological approach, we argue that the practical and material ways of conducting video-based research have a performative effect on the object of inquiry and do not simply record it. Focusing in particular on configurations of camera angle and movement—forming what we call the Panoramic View, the American-Objective View, the Roving Point-of-View, and the Infra-Subjective View—we find that these apparatuses privilege different spatial understandings both by orienting our gaze toward different analytical elements and qualifying these elements in different ways. Our findings advance the methodological reflections on video-based research by emphasizing that while video has a number of general affordances, the research practices with which we use it matter and have an impact both on the analytical process and the researcher’s findings.

The social relevance and social impact of knowledge and knowing

The concept of the relevance of knowledge and the relationship between theory and practice has been widely addressed and discussed, for example, in a number of journal Special Issues including Organization Studies (2009 and 2010), the Journal of Management Studies (2009), and the British Journal of Management (2011). In the search to balance “scientific rigour” with “practical relevance” (Eikeland and Nicolini, 2011), various modes of knowledge have been proposed: Mode 1 scientific, Mode 2 contextual (Gibbons et al., 1994), Mode 3 diverse stakeholders (Huff and Huff, 2001), and Mode 0 patronage (Bresnen and Burrell, 2012). The question lying at the heart of this debate seems to be whether organization studies has anything meaningful and relevant to say (Alvesson, 2012).

Reorganising hospitals to implement a patient-centered model of care: Effects on clinical practice and professional relationships in the Italian NHS

The Patient-Centred Model (PCM) is described as an attempt to redesign the hospitals around the needs of the patients, thus contributing to costs reduction, increased efficiency, and improved care. However, the introduction of the PCM may have a profound impact on the social organisation of work, changing lines of demarcation, challenging well established inter-/intra-professional relationships, and prompting the development of new roles and modes of working. This thesis explores the mutual effects between the new organisational model and the pre-existent social organisation of hospital work. The research design is organised in three phases: an extensive document analysis; an interview study; an in-depth ethnographic case study conducted for over one year in a PCM hospital. The findings are organised in three studies. The first shows that the PCM was interpreted differently by hospital managers and by frontline clinicians, thus giving rise to two divergent narratives of change. The second study focuses on the boundaries to collaboration and care integration in newly created hospital teams within PCM hospitals. The third study looks at the impact of the PCM on the medical-nursing boundary. The thesis contributes to management learning and practice by providing recommendations on how to accompany complex innovations, comprising of both their expected and unexpected consequences. It also enriches academic debates on professional boundaries, relations, and identities in healthcare.