Thursday, January 22, 2015

The Need for Integration – Part One, Leadership and Management

Before moving on to the subject of leadership and management I will give a little background context. Partly as I intend to write a series of blogs on the subject of integration.

At the beginning of my career the concept of ‘Integration’ was one of the first I learnt about. The particular use of the term was from Donald Winnicott, the child psychoanalyst and pediatrician who described integration as a central part of child development.  According to Winnicott (1962) the infant is born ‘unintegrated’. Through the process of the infant’s fragmented experiences being held together by the ‘good enough’ parent, he achieves integration and a distinct sense of being a whole person. This normally happens by the end of the first year or so.

Since then I have found the concept of integration to be central in many ways - to work with traumatized children; to the way organizations are run; to the way different services, professionals and other stakeholders work together; and also to the way society functions. Winnicott wrote about integration over 50 years ago, and though Daniel Siegel (psychiatrist and pediatrician) uses the term from a neurobiological perspective and may not mean exactly the same thing, it is interesting that he says in 2006,

“The central idea of interpersonal neurobiology is that integration is at the heart of well-being.”

During the years of my work with traumatized children I moved from practitioner based roles to management and leadership based roles. I have moved back and forth between the two. Sometimes I wonder which camp I am in, but am beginning to think I’m clearly in the one that is about joining the two together. Another lesson from many years ago was that management and therapy need to be integrated successfully. Good management is necessary for good therapy to take place and sometimes good management is therapeutic in itself. The same could be said about any kind of practice in the human services – it can only be truly effective in a well-managed context.

I am sure many of us are familiar with the dynamic of management and therapy being at odds with one another, the same with business and care, and also leadership and management.  In one organization, the Executive Director felt frustrated with therapists who would often say that they needed ‘space’ rather than make time to listen to his visionary ideas. And I am sure the therapists felt frustrated that his grand ideas didn’t help much with the immediate realities of their work. Vision is crucial to create an inspiring and important mission, and so is doing the job at hand, however mundane or unpleasant it may seem. It is the integration of the two that is critical. I had a vision when I joined a therapeutic community for traumatized boys, of doing ‘therapeutic work’. I wondered during the first few weeks why most of my job evolved around cleaning toilets, being shouted and spat at, and looking for ‘missing’ boys in the surrounding countryside. It took a while to fully understand that this was part of the therapeutic work necessary for the vision to be achieved. Thankfully those in charge knew this only too well and also what was needed to support the task at hand. The vision was grounded in reality.

An important question is why ‘splits’ tend to occur. One answer put forward is based on the concept of social systems developing as a defence against anxiety (Menzies Lyth, 1959, 1961, 1970). To briefly explain - the nature of the work task is inherently anxiety provoking and involves emotional pain. The difficulty is defended against by creating a more simple and primitive solution. The reality of the task, is replaced with a more bearable but split solution such as, we would be able to do this if it wasn’t for ‘management’, etc.

For example, it is easy for leaders to have a grand vision and not have to worry about how it will be achieved. It is easy for managers to become focused on methods and practices regardless of whether they help meet the desired vision or not. The leader with a grand vision tends towards charismatic and the manager focused on methods tends towards bureaucratic. The charismatic leader blames the stifling, red tape, bureaucratic managers for failure and the managers blame the unrealistic and ‘out of touch’ leader.

It also makes everyone’s job seem easier as only one difficult thing needs to be mastered, rather than the more complex integration of two difficult things. Organizations may fluctuate between the search for a heroic leader or a new management system, as if either might provide a magical solution. This might provide short term relief but in the long term it is ultimately defeating and unsuccessful. The system as a whole is dysfunctional.  What is needed for effective performance is not the splitting of management and leadership, but the integration of them, whether within the same person(s) or between people. The functions of leadership and management may be separated but they need to respect and understand their interdependence, and work together in an integrated way.  The same can be said for management and therapy, and business and care.

Splits, which are based on unconscious reactions to deep anxieties and fears are especially likely in the human (or people) services due to the core nature of the task. For example, trying to provide a service to people in great need (sometimes literally a matter of life and death), when it never feels that enough can be done.  In particular, this is compounded by harsh financial realities such as those in times of ‘austerity’.  The sense of ‘impossibility’ and ‘hopelessness’ is difficult to bear for everyone involved. Leaders can defend themselves by becoming distant from the reality of the work. Those more directly involved can blame leaders for not caring enough about people and too much about business. And everyone is avoiding the deep changes that are required in the organization as a whole.

In recent decades, where every type of business and industry has had to deal with a rapidly changing and more complex world, the same kind of anxieties and fears are becoming common in most workplaces. How many people can say with confidence they expect their job to last for 3 years let alone for life? The life span of jobs at all levels has reduced massively and this is just one of the insecurities affecting the modern day workplace. Survival on an individual and organization level is precarious. Constant change in a complex and highly competitive market is the norm. Without good management, which is in effect good technology, people, methods, procedures and policies, an organization will fail to achieve its vison. Without a vision that is motivating, inspiring, creative and stretching – performance will fall short in today’s demanding environment. To do something well, on its own is not ‘good enough’. There also has to be an outcome that can compete with what anyone else can do at the same cost or less.

What is needed is an improved capacity to face the very real difficulties involved in the task. This means being more in touch with complexity, fears, threats and anxieties. To achieve this, it is necessary to have a culture with structures and processes that enable these difficulties to be acknowledged and worked with. This requires capability and time, and the difficulty of putting it in place cannot be overestimated.  Short term thinking will see this as an extra cost and use that as an excuse to avoid it.  When time and effort is put aside, because the work will be difficult, with potential vulnerability and conflict for all involved, it might feel as if the process isn’t helping. There may be a tendency to give up rather than a determination to work through difficulties. This requires strong leadership and belief in the process. Those organizations that pay attention to the need for integration, which is far more difficult than getting one part rather than the whole to work well, are likely to become the most competent type of organization.

I will finish with a brief example that captures much of what I have said. A few years ago, I was studying on a course in Strategic Leadership for Social Care. As part of this, I had the fortune to visit Bromley-By-Bow in London, which had been heralded as an example of community regeneration based on social entrepreneurism. The picture is of the Bromley-By-Bow Health Centre.  It is in Bob’s Park named after the local man who led the transformation of derelict wasteland into a green space, which has become a haven. The Health Centre is a model of integrated health care.

We met Andrew Mawson who was the church pastor who played a lead role in the regeneration of the run-down community. Andrew seemed without doubt to be a charismatic, visionary leader. He talked about the stifling bureaucratic red tape and the need to break rules, to get anything done. In his book ‘The Social Entrepreneur’ he also describes how he was impressed by the businessman Paul Preston who successfully brought the McDonalds chain to England. Mawson says ‘the devil is in the detail’ and describes how Preston succeeded by first of all focusing on every practical detail in just one shop, down to exactly where the milk came from and how long it took to be delivered. This shows an understanding from the top of how the reality of the work and what is required has to be integrated with the vision. The question isn’t so much about styles of leadership and management, whether it is either or, but about successful integration between the two.

Mawson, A. (2008) The Social Entrepreneur: Making Communities Work, London: Atlantic Books

Menzies Lyth, I. (1959, 1961, 1970) The Functioning of Social Systems as a Defence Against Anxiety, in Containing Anxiety in Institutions: Selected Essays (1988) Vol. 1, London: Free Association Books

Siegel, D.J. (2006) Series Editor’s Foreword, in, Ogden, P., Minton, K. and Pain, C. Trauma and the Body, New York: Norton

Winnicott, D.W. (1962) “Ego Integration in Child Development”, in, The Maturational Process and the Facilitating Environment, Hogarth Press and the Institute of Psychoanalysis: London (1972)

An interesting brief video with Andrew Mawson talking about social entrepreneurism and the challenge of creating something positive out of a nearly bankrupt economy as he put it.

“I think the most important issue is learning to work together, actually, and building teams of people who understand how to do that in creative ways. Because we have all got to move out of the silos that have been put down for us by the public sector and they are often there in business, and learn how to join things up.”

Dr. Dan Siegel video - On Integrating the Two Hemispheres of Our Brains,