The Healthy Organization by Eric Miller
Creating a holding environment: conditions for psychological security.
(This is based on a talk given at the Clinical Psychology and Organizational Consultancy conference on “What makes a healthy organization – models for intervention”. April 27, 1993.)
I propose first to try to disentangle the rather fuzzy terms “healthy” and “organization”; secondly, to give some examples of “holding environment” and the provision of psychological security; and thirdly, to explore the paradox of trying to create conditions for psychological security in settings where job insecurity is very high. On the way I shall make various observations about intervention.
DEFINING HEALTH AND “ORGANIZATION”
This conference coincides almost exactly with the 30th anniversary of the first publication of a paper in which I introduced the concept of “the health of the enterprise” (Bridger, Miller and O’Dwyer 1964). My two co-authors were, respectively, a colleague at the Tavistock Institute and the then principal medical adviser of Unilever. We had been working together on the development of the medical function in Unilver and the role of the industrial medical officer – which is not irrelevant to the role of the clinical psychologist in a work organization.
Looking back over the history of this function in Unilever we could identify three stages of its development. The first stage was essentially the doctor on the premises (for example at Port Sunlight) whose focus was on the individual and his or her symptom treated in isolation. This was soon overtaken by a second stage in which the concern was with the effect on the individual of the physical environment. This was what became standard occupational medicine with its protective function in safeguarding the health of the individual. In the third stage the industrial medical officer was looking at the individual in the context of the total working environment, both physical and psycho-social.
This third stage had been developing from the early 1950s onwards. Doctors were becoming involved in issues of morale. For example, a job description from the mid-1950s included as one element: “assistance in maintenance of satisfactory human relations in the factory”. In taking up this stance the doctor would often be appropriately treating the situation, as well as or instead of treating the patient and the presenting symptom. This can be illustrated by a simple case from one factory. About a dozen young women were working on a food packaging operation; over a short period nearly all of them became ill. Their symptoms however were quite diverse. This eliminated common exposure to a physical hazard, such as bacterial infection, so the doctor decided to explore other aspects of the work situation. He discovered that one of the women (who had not reported sick) was working at an extraordinarily high rate of output. The others, unable either to increase their own output or to reduce hers, had withdrawn from an intolerable situation by becoming ill. In this case the doctor and manager concerned tried to “treat the situation” by rearrangement of the work which would continue to use the skills of the high producer but not expose the others to her impossibly high norms.
We argued that the aim of the industrial medial officer who was concerned with the health of the individual in the context of the total working environment must be the promotion of the health of the enterprise itself. (“Enterprise” in this sense includes not only its members joined into a social system but also the tasks it is in business to perform and the relations it has with its environment.) Only by accepting this objective and using it as a yardstick in all their activities could these medical officers make the maximum contribution to the health of the members of the enterprise. The doctors therefore in addition to their specialist role, which would involve taking over a problem and dealing with it, were taking on a consultancy role which involved putting the problem where it belongs. For example, a senior manager comes to the doctor about a subordinate manager (X) who has been falling off in his work and making life difficult for colleagues and subordinates. The pressure on the doctor is to act in his “specialist” role and take over the problem of (X). For the doctor concerned with the health of the enterprise, however, it is more appropriate to focus on the manager’s problem and to help him to define the action that he needs to take. To take on this role the doctor needed to be equipped with a systemic perspective and a psycho-social perspective.
It should be emphasised that we were not suggesting that the industrial medical officer was responsible for the health of the enterprise: that responsibility rested clearly with the chief executive to whom the medical officer typically reported and provided consultancy. This seems to be the position of some clinical psychologists in the health service today.
The concern with morale in the industrial organizations of the mid ‘50s was inherited from concern with the morale of fighting units during World War Two. Some of the psychiatrists and others who were to become founders of The Tavistock Institute were actively engaged with this issue. For example, in commando units that had suffered heavy casualties they were implicitly concerned with “the health of the unit”. The healthy unit was effective both in doing its job and in providing psychological security for its members. Psychological safety enabled them to face severe and life-threatening dangers.
The experience in those commando units of being “all in it together”, with officers leading from the front rather than the rear, was a basis for strong cohesion. In the early 1950s my Tavistock colleagues were actively looking for just that quality in the design of work organization. Out of this emerged the concept of the “socio-technical system”, through which could be achieved the joint optimisation of technological needs and the demands of the task in one hand and human needs on the other. To achieve this, various forms of semi-autonomous work groups were designed and implemented in a wide range of settings.
At first it looked as though these could be a panacea and some people still see semi-autonomous work groups in this light. However it became evident that they were appropriate only in relatively stable economic and technological environments and also that they were not suitable for all functions. By the mid ‘60s a colleague and I were reconceptionalising the socio-technical system (Miller and Rice, 1967). We argued that an enterprise requires three types of organization. First it requires an organization for the task system itself. Secondly, it requires an organization for the “sentient system”, as we called it which is a system through which human needs for identity, affiliation and psychological safety are met. Thirdly, it requires an organization to regulate the relations between the task system – the system of work roles – and the sentient system. The boundaries of the task and sentient systems might coincide, as in the case of the semi-autonomous work groups; but mostly they have to be treated separately. One example as in airlines. The task system in flying consists of flying crew and cabin crew who are usually working in that configuration only for perhaps a day at a time or even a single flight. The crews are constantly being remustered in different configurations partly for practical and partly for safety reasons: there is a danger that people working closely together over time will take short cuts. Consequently other settings in an airline were required to meet sentient needs. These were pools of captains, other flying staff and cabin staff to which their members felt affiliated and through which they acquired a sort of professional identity. Much the same applied in industrial research settings where multi-disciplinary teams had to be set up and disbanded to manage specific projects and their affiliation was to pools of say, physicists, biochemists, etc. Multi-disciplinary teams in the health service often have this temporary quality: another form of organization of the disciplines deals with sentient needs.
What emerges from this is that “the organization” is a woolly construct that needs disaggregating. Much the same applies to “health”. For example, it is possible to have a “healthy” task system with high output but also a high casualty rate; or a “healthy” sentient system but a high scrap rate.
THE HOLDING ENVIRONMENT AND PYSCHOLOGICAL SECURITY
I see the holding environment1 as embracing both the task and sentient systems. The way in which they are organised and brought together influences the psychological security of members of the enterprise. I give here two examples from “people processing” enterprises – that is systems in which the essential throughput consists of human beings rather than, as in manufacturing, of physical materials.
The first example comes from a voluntary agency which provides residential day and home care for people infected with HIV and Aids. For staff working with these clients it is part of the philosophy of this agency and indeed a necessary condition that they should make all of the self available. This corresponds to what an American psychologist, William Kahn, has called “psychological presence” (Kahn, 1992). It implies giving up most of the usual defences that nurses and others use to maintain some emotional distance between themselves and their patients.
It involves compassion – in the real sense of “suffering with”. Staff in this agency are often confronted, for example, with the death of clients who are very much of their own age and with whom they have had a very close relationship.
These deaths resonate with past losses in the staff members’ own lives. Consequently this agency recognises an explicit need for time to be set aside for staff support: this amounts to one and half hours a week.
Let me spell out a little more fully the provision that is necessary for the staff member to make for the client. First the staff member has to provide psychological safety through total reliable attention. Secondly the relationship must be felt to be meaningful in that it deals with the really relevant issues of the client. In other words it requires total involvement and identification. At the same time thirdly, however, it has to be an empowering relationship which enables the client to take charge of his or her own life. If staff are to provide that relationship I argue that this has implications for organization design, for management and also for supervision. Corresponding to the requirement on the staff member the organization needs to be designed in a way that provides safety for the staff member through clear role boundaries, a meaningful definition of the task attached to the role, and thirdly authority to enable the staff member to use discretion and initiative. The requirement on the role of the manager is comparable. The manager should provide attention – in other words treating the staff member as a whole person – should relate to the real concerns of the staff member in a meaningful way, and at the same time should be enabling in terms of providing the boundary conditions within which the staff member can exercise his or her own authority to get on with the job. In other words the manager / staff member relationship needs to reflect the desired staff / client relationship. As for supervision, here too it must be safe to bring up the real difficulties that the individual staff member is facing.
Essentially I am putting forward here two inter-connected propositions:
- The quality of the holding environment of staff is the main determinant of the quality of the holding environment that they can provide for clients.
- The quality of the holding environment of staff is mainly created by the form of organization and by the process of management.
Support groups can supplement – some through offering an emotional outlet, others through making it possible simply to relax and have recreation – but they cannot compensate for organizational and managerial deficiencies. Support groups, nevertheless, have another significant function in serving as a sentient system within which people can relate to one another in ways other than through their day to day working relationships. This is a point to which I shall be returning.
The second example comes from an outplacement business whose market had been expanding rapidly during the recession. I was looking particularly at the dozen or so counsellors who were working on a one-to-one basis with their clients. The task of the counsellor is essentially to receive a newly redundant person and to work with him or her over a period in restoring confidence and helping them to obtain a new job. As in the Aids agency this again requires from the counsellor a provision of psychological safety through total attention, meaningfulness in the relationship, and empowerment. The presenting problem was low morale. Some of the staff were talking about “an arena of fear”. Interviews with them led to the hypothesis that the holding environment for counsellors had been fractured by several factors. There had been a change in leadership and ownership. There was a great deal of uncertainty because although the business was expanding there was the question of how long this would continue: competition was increasing and the recession would sooner or later come to an end. Thirdly, they felt a lack of information about what was going on. A further point was that they had a managing director who was perceived as being invisible in that he was preoccupied with issues of sales and of the wider group of which this business was a part and also himself was doing a lot of one-to-one counselling. Consequently the decisions that emerged from his office often appeared arbitrary. Finally, regular supervision which had been inherent in the way of working had largely lapsed. Counsellors found their job inherently satisfying. Essentially it consists of converting tragic beginnings into happy endings and they loved it. However, because of increased demand coupled with greater difficulty in clients getting jobs, their caseload was higher, the throughput of clients was slower and there was thus a lower proportion of happy endings in any one counsellor’s caseload. The consequence of these factors was, as I interpreted it, that the holding environment for clients themselves was at risk. Some identification with clients was inherent in the counsellor’s job. However, what they were increasingly identifying with was the anger and paranoia of clients who had been excluded abruptly from their organization and counsellors carried this into a distrust of their own organization.
The consultancy intervention included various components. First and foremost it was necessary to release the managing director from some of his other preoccupations – in particular to reduce his own counselling caseload. Secondly we created settings to bring the counsellors with him together at “the boundary of the enterprise”. That is to say they were now able to share the issues and dilemmas that he had been facing – interference from which he had been trying to protect them – by generating ideas, contingency planning and so forth. Thirdly counsellors themselves worked out the criteria by which they thought they should appropriately be appraised and these were accepted and put into effect along with a process of self-appraisal. Fourthly supervision, which had lapsed, was reinstated. Within three months there was a transformation in morale and there was also evidence of improved quality in the client work.
The general and perhaps obvious point that emerges from these two cases is the need for a match between the holding environment that staff have to provide for their clients or patients and the holding environment that organizations and management provide for them. There is one additional element and perhaps a key element. In these cases staff had ways of relating to and influencing the wider system, not only through their work role but in other settings and roles as what I have come to call “citizens of the enterprise”. Thus the counsellors in the second example were quite explicitly drawn into discussion and consideration of business-wide issues.
Although both these examples come from treatment systems I believe that the principles of organization design and management put forward are more generally relevant.
PSYCHOLOGICAL SECURITY AND JOB INSECURITY
How can individuals feel psychologically safe when mass redundancies show them that they are eminently disposable? What gives this question added importance is that, partly because of “downsizing” and partly because of technological developments, very many jobs not only in the so-called “helping professions” but outside, are demanding, directly affect overall performance, and require “psychological presence”.
To tackle this problem many companies have been using campaigns and forms of training (perhaps better called indoctrination) in an attempt to make employees feel important, loyal to management, and committed to the enterprise. Two recessions over the last ten years have put paid to beliefs in full employment and consequently to the dependency that went with it. Any fantasy of the organization as “a good mother” has evaporated. Nevertheless these programmes patronise and infantilise employees. Consequently they are counter-productive: the common responses are cynicism and indeed alienation. Too many managers still cling to simplistic, mechanistic theories of motivation. People cannot be motivated to be psychologically present; that is not something that can be switched on. They choose.
In a healthy enterprise employees are treated as choice-making adults – essentially as professionals. What it looks for is commitment to the task not loyalty to management. Psychological safety comes from the form of organization and the processes of management. It comes from safety to speak out, to exercise authority derived from the task regardless of hierarchical status. Importantly the voice of the citizen of the enterprise is heard.
We have here a framework for defining the characteristics of the “healthy enterprise”. This is a framework that can be implemented. However invitations to consultants to work on this task are in my experience rare. Few managers have grasped the implications of changing the relatedness of the individual to the enterprise. The ideas presented here may to many managers feel quite threatening. Often, therefore, we have to do what we can from the actual roles and assignments that we find ourselves in – as, for example, the industrial medical officer’s role as consultant to the chief executive. From this position it is often possible to have a valuable educative function. However all of us in organizational consultancy ourselves have a significant function in providing psychological containment for the system we are working with to make it safe to think about and to implement processes of change.
FOOTNOTES:
1. The concept of the maternal holding environment has been usefully applied in the study of organizational culture by Stapley (1993
REFERENCES:
BRIDGER, H., MILLER, E. J. & O’DWYER, J. J. (1964) The Doctor and Nurse in Industry. A study of Change, London: Macmillan (Journals) Ltd. Reprinted from Occupational Health 1963.
KAHN, W. A. (1992). To be fully there: psychological presence at work. Human Relations, 45, pp321-350.
MILLER, E. J. & RICE, A. K. (1967). Systems of Organization. London: Tavistock Publications.
STAPLEY, L. F. (1993). The Personality of the Organization: a Psycho-dynamic Explanation of Culture and Change. Unpublished.