Thanks,
Trevor, what you say DOES resonate with me.
I see no harm
in ‘seeding’ for a social movement, for instance. What I would say is that it
may not be wise to DEPEND on it as some sort of panacea. The issues facing the
NHS Modernisation Agency are real and very tough.
That ‘toughness’ does not disappear. By truly
engaging people (and that is a prerequisite for social movements) we CAN
overcome much of the resistance perhaps now felt.
Re
Stacey. As far as I
know Ralph DOES come from a group therapy background and much what he says
(and the social theories he uses to support it) comes from it (Mead, Elias,
etc.). He therefore DOES NOT come from the world of inanimate objects as you
suggest. Actually, many in the complexity community (of which I also am a
member) would DISAGREE with him, because they tend to take lessons from
inanimate nature (like the Complex Adaptive
Systems view) and Ralph believes that may not always be helpful (sometimes it
is, often it is not BECAUSE we deal with people and not with molecules, for
instance)!
Where I very
much agree with him, is that the prevailing way of thinking in modern western
organsations IS the engineering approach. That is
what Ralph mentions on the ‘outsider in’ (‘engineering’) way of management. I
interpreted his talk as a carefully phrased ‘rant’ against this
approach.
Take the
Modernisation Agency. The fact that Helen Bevan’s group is called RE-ENGINEERING to me is quite
telling.
Words ARE
important. As long as we think we can ‘fix’ the NHS via
‘re-engineering’ (which literally is the reshuffling of parts and
business processes) we may live in a paradigm that does not recognize the
richness of human interaction.
So, my take
on it is that he and you may very much agree what is going on. But then again,
that is MY interpretation, based on MY experience and past and MY future
expectations of OTHER PEOPLE’S words
J.
-----Original
Message-----
From: Complexity
and chaos theories applied to primary medical and social care
[mailto:[log in to unmask]] On Behalf Of Trevor Griffiths
Sent: 27 September 2002 22:25
To:
[log in to unmask]
Subject: Re: email
blizzard
Bemused? Enlightened? As a primary
care physician the email blizzard has felt like a consultation in which I
couldn't get a word in edgeways. But now's my
chance!
I've been wanting to say this ever
since Ralph Stacey's talk, when he didn't notice my repeatedly reaised hand. I
came to systems theory via running a project to locate Family Therapy in our
GP surgery. The Milan whole systems approach to Family Therapy places a
therapist in the room with the
dysfunctional family 'system', and in so doing that therapist is recognised
to
become inextricably part of the dystfunctional
system. That therapist is linked by a telephone to
two others behind a one-way screen, who communicate their independent
observations to the family's therapist, whose skill is to seed input to
various members of the system in the hope that they will change their
established patterns of communcation into something more creative.
Consequently, I was surprised to hear someone, Ralph, coming at
systems from an engineering background woith totally different concepts that
allowed
all this talk about external control, programming
computers, manipulating the contextual conditions to bring about social
movement, etc etc. He, dealing with inanimate systems, is bound to feel
outside a thermostatic control system even though its action impinges upon his
comfort zone. I, dealing as a GP with living dysfunctional families, am bound
to feel inside the hot-house or kitchen of webs of communication. Thus, I have
no problem with the Modernisation Agency concept of seeding Social Movements.
I do not see it as external manipulation to fix a problem, rather I see it as
internal qualities of relatedness that birth a solution. What we primary
care physicians need is a few people behind the screen telephoning us to say,
"Have you noticed that the suicide rate is going up in your area. Can you say
something to people locally about that?"
I gave a
short presentation on a conversational model of the consultation,
and how our concepts of time significantly affect the quality of those
consultation-conversations. The same principles apply to population level
interventions such as social movements for health promotion and illness
prevention. We need to give them the right sort of time, and a bit of room to
breathe.
----- Original Message -----
Sent:
Thursday, September 26, 2002 5:11 PM
Would it be appropriate to
summarise this week's blizzard of emails into a cogent form? I feel
(subective assessment only) that we may have said a few useful things of
relevance, but this may not be the general feeling.
I have one
question though, do Primary Care Practitioners feel bemused or enlightened?
Ceri
Dr Ceri Brown
Critical Care Programme
Project Development and Research
0161 720 2342 (Secretary)
07659
120 038 (pager)
07876 230 561 (mobile)
Thanks to my variable
clinical commitments, calls to my mobile won't be answered promptly. Please
leave a message, or page me.
I'm based at North Manchester General
Hospital but my postal address is:
NHS Modernisation Agency,
Critical Care Programme,
4th Floor,
St John's House,
Leicester. LE1 6NB
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