Morten Knudsen

Forms of Inattentiveness: The Production of Blindness in the Development of a Technology for the Observation of Quality in Health Services:

Research dealing with governmental and managerial ideals and tools for transparency has observed how these tools co-create new types of blindness. It has documented the existence of three different types of blindness: blindness caused by power games, by cognitive limitations and blindness as a side effect of the categories applied. This paper puts forward a fourth type of organizational blindness in addition to the already documented ones, namely self-imposed blindness to potentially destructive information. This paper studies how relevant - but problematic - information is actively ignored and kept out of sight in the decision processes by looking at a specific case study involving the construction of a model intended to control, and render transparent, the quality of health services in Denmark. This paper outlines the forms of inattentiveness which make communication blind to information that could question the quality model. Five forms of inattentiveness are identified that function as answers to the question of how communication avoids actualizing relevant but also potentially destructive information. This study documents a considerable amount of blindness to potentially relevant themes and it points to activities that produce this blindness as they reduce the probability that potentially destructive subjects are actualized. Information is not only something organizations need, but may also be something they protect themselves against. In that case, the forms of inattentiveness may be a function that forms organizational processes.

Autolysis Within Organizations: A Case Study

Zusammenfassung Der Beitrag zeigt, wie die von Niklas Luhmann entwickelte Systemtheorie für eine empirische Analyse von Lärm und lärmerzeugenden Mechanismen geöffnet werden kann. Die dem Artikel zugrunde liegende analytische Strategie ist die Beobachtung der Operationen, die ein soziales System konstituieren. Eine entsprechende Analyse macht auf das Fehlen von Anschlusskommunikation und auf die aktive Produktion von Lärm (verstanden als Operationen ohne Anschlüsse) aufmerksam, d. h. sie öffnet die Analyse für systemische Autolysis (Selbstauflösung). Darauf aufbauend wird eine operationale Analyse organisationaler Kommunikation durchgeführt, die die Leitdifferenz Ereignis/Rekursivität benutzt. Der Artikel ist in sechs Abschnitte gegliedert. Nach der Einleitung wird eine operational-analytische Strategie skizziert (I). Danach wird das Konzept der Autolysis vorgestellt (II). Eine Fallstudie über das Entscheidungsverhalten in einer Organisation des Gesundheitswesens liefert dann Beispiele für organisationalen Lärm im Sinne von Entscheidungen ohne Anschlusskommunikationen (III). Die Fallstudie demonstriert eine aktive Produktion von Geräuschen und identifiziert vier Mechanismen, die ein Rauschen erzeugen (IV). Danach wird diskutiert, wie die Organisation den Lärm beobachtet, den sie erzeugt (V). Abschließend werden die Resultate einer Zusammenführung der operational-analytischen Zugangsweise und des Konzepts der Autolysis identifiziert und weiterführende Perspektiven skizziert.

Expansive or limitative strategy? A case study of organisational responses to new public health

PURPOSE Since the emergence of new public health in the 1970s, health has not merely been considered the absence of disease, but physical, mental and social wellbeing. This article seeks to analyzes the implications of this broad concept of health at an organizational level. DESIGN/METHODOLOGY/APPROACH The paper presents a qualitative case study of boundary drawing in a Danish municipal agency in charge of planning and conducting health promoting and disease preventing activities from 1989 to 2005. The theoretical framework draws on Niklas Luhmanns organization theory. FINDINGS Two different organizational answers were found to the challenges inherent in the broad concept of new public health. First, the organization tried to increase its size and incorporate as many aspects of the environment as possible. This expansive strategy jeopardised the identity of the organization. Second, the organization tried to keep clear and tight boundaries and from this position irritate entities in the environment. This limitative strategy made the organization spend relatively more energy on organizing and controlling itself than on public health work. PRACTICAL IMPLICATIONS The case study shows how a broad concept of health makes boundary management topical in organizations dealing with health promotion and disease prevention. Organizations in charge of public health activities need to reflect on how they can create intelligent compensations for the disadvantages involved in an expansive or a limitative strategy. ORIGINALITY/VALUE The broad concept of health inherent in new public health has been widely accepted and yet its challenges to organizational boundary drawing have attracted little attention. This paper provides an analysis of these challenges.

Organizational Suspensions: A Desire for Interaction

The participation and involvement of citizens in decision making is a widespread ideal in welfare services. Participation has been widely studied in political science and has been ascribed different functions, such as making public institutions more responsive to the wishes and wants of citizens, improving the quality of decision making, and mobilizing people as part of a deliberative ideal of co-optations of interests (Oudshoorn et al. 2003; Newman and Clarke 2009; Barnes et al. 2007; Pedersen 2008; Kjaer and Pedersen 2010). In welfare services, and particularly in health care, the welfare service area that will be of interest in this chapter, both political bodies and professional associations have emphasized the importance of patient participation and shared decision making.

Structural couplings between organizations and function systems

In Niklas Luhmann’s theoretical architecture, difference comes before identity. This basic theoretical decision finds many expressions with the most fundamental one being the definition of a system as the difference between the system and its environment. It is a theoretical decision which makes relations in need of explanation, as they cannot be taken for granted. This chapter is about the relation between decision-making organizational systems and code-based function systems. The point of departure is the contention that Luhmann’s conceptualization of this relation not only is theoretically inconsistent but also makes it difficult to observe new developments in the relation between organizations and function systems. The purpose of the chapter is to reinterpret the conceptualization of the relation between organizational and function system in a way that makes the theory able to observe historical and current changes in this relation.

Media for Reflection: A Comparison of Renaissance Mirrors for Princes and Contemporary Management Education

This article develops the concept media for reflection in the interest of conceptualizing the interpretative frames that enable and limit reflection in management and leadership education. The concept ‘media for reflection’ allows us to conceptualize the social and cultural mediation of reflection without reducing reflection to an effect of the social structures and cultural norms in which it is embedded. Based on the developed theoretical framework, this article analyses how a renaissance ‘mirror for princes’ and contemporary research-based management education mediate reflection. The content of the mediations is analysed as well as the societal and organizational background. Furthermore, the means by which the two media enable and limit reflection in different ways is compared. Finally, the article discusses possible implications of the analysis in terms of management and leadership education.