Clinical metaphors

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I have just realised how many medical-like metaphors are out there in the world of organisational research/development.  This insight was prompted by my reading of Coghlan and Brannick (2010) which took me off on an interesting tangent…

We ‘diagnose’; talk of organisational ‘pathologies’ and go on to ‘intervene’.

One such example is in the use of the Viable Systems Model – the model can be used as a diagnostic ‘tool’ and Hoverstadt (2008) draws attention to a range of ‘pathological’ archetypes.

So I started to think about what was behind these metaphors… and the possibilities and problems they could bring.

Schein (1995) deliberately coins the words ‘clinical inquiry’.  He claims he does so to draw attention to the psychological facet of the helping relationship between the client and the researcher/consultant/change agent that they take on to help with their problem situation.  In this relationship, the helper must protect the welfare of their client and think about all the possible impacts of all the actions they take – all of their actions are interventions – data-gathering or diagnosis should not be seen as a neutral stage.  For researchers taking on a helping role, their own needs for ‘research data’ take on a secondary agenda but this can prove worthwhile because this approach gets access to a quality of data that can be used to develop much better theories of organisational life.

Elsewhere, Schein (2001) points out that others have criticised his use of ‘clinical’ but defends it as follows:

It is almost the essence of life in organisations to overcome things that are not working as well as they should be, to achieve goals that are beyond what is possible in the present, in other words, to overcome pathologies of organisational life.  By not using the word clinical we are not avoiding the existence of pathology or its effects; we are only denying our own ability to face pathology squarely, analyse it and deal with it” (Schein, 2001, 236).

So, I think he is saying that whether researchers/consultants like it or not, if they engage in work with a client then they have to accept that the client is thinking in terms of a ‘sick’ organisation which needs a ‘remedy’ – and if the client is thinking like that then the researcher/consultant must make sure the actions they take are consistent with the ‘welfare’ of the sick client.

Coghlan and Brannick (2010, 9 and 46) point out that the ‘traditional’ approach to organisational development/research is based on ‘modernist’ assumptions of objectivist diagnosis.  They touch on a couple of assumptions contained in that approach and how the approach you adopt needs to avoid negative consequences:

1) It assumes that ‘systems’ are out there in the world

You diagnose the system’s problems and then intervene to make them better.

Linking across to Ison (2010, 46, Fig 3.4) this fits more with “I spy systems which I can engineer” than “I spy complexity and confusion but I can organise exploration of it as a learning system”.  So the mindset of ‘diagnosing’ could lock you into a certain choice about the way you engage with a situation.

This is why Coghlan and Brannick moved on from notion of ‘diagnosing’ as a first step in Action Research to that of ‘constructing’ what the issues are as a provisional basis for taking action.

2) It assumes that you have a model of what it is to be ‘healthy’ and draws attentions to deviations from that

Coghlan and Brannick (2010, 92) cite Harrison and Shirom (1997, 7) who use the term diagnosis to:

refer to investigations that draw on concepts, models and methods from the behavioural sciences in order to examine an organisation’s current state

The concepts, models and frameworks, and I put my earlier example of the Viable System Model into this category, are useful diagnostic tools.  They can help with a common language, enhance shared understanding and provide a way of categorising and interpreting data.

The danger comes if you see the activity as creating an objectivist ‘truth’ from a single partial perspective.  For example, carried out by a single outside ‘expert’.

It is important to see the frameworks as providing a vehicle for dialogue, shared sensemaking and joint action planning.  This fits with the ‘[We] spy complexity and confusion but [we] can organise [our] exploration of it as a learning system’ mode of working.

Importantly, Coghlan and Brannick (2010, 93) also remind their readers that you can become trapped by these frameworks and it is important to critique the ones that you use.

I have thought of another potential problem – You can be led into spotting particular pathologies (pattern matching) and ‘prescribing’ the ‘treatment’ you used before.  I see the need for caution in problem-solution matching – everything has to be situated in the local context – effectively home-grown not ‘prescribed’ from the outside.

I guess the question here is does it really matter that this clinical diagnostic model is a common approach in organisational development/research?  Coghlan and Brannick (2010) do draw attention to some pitfalls of some of the assumptions behind it and suggest ways of avoiding it.

But, if I draw from my world of health there is a growing concern about the focus on ‘deficits’ or ‘needs’ of communities.  In a paper I recently wrote for work  I drew on a number of sources to say that the focus on deficits can lead to communities being more disempowered and reliant on public services (if you are interested see Agenda item 6 page 125 of this set of public papers). In a sense, organisations are communities – could the ‘deficit’ based approach make staff more disempowered and reliant on organisational consultants! 😆 Or managers perhaps!  Asset based approaches are being promoted in community development arenas (see for example Appreciating Assets a new report by International Association of Community Development) – and I have been familiar for a while with Cooperrider’s Appreciative Inquiry which takes a similiar stance in organisational contexts.

So I am only half with Schein – yes, I agree that our Western psyche makes us think of problems/pathologies and the need for a solution/treatment and as long as we do ‘helpers’ should think continuously of the implications of all their actions.  BUT I am not sure whether that is really that ‘healthy’ (whoops) for us all to spend so much time worrying about deficits/needs/problems/pathologies/illnesses and to think of organisations as ‘sick’ because they need to become more efficient or effective or simply learn to do things differently.  Surely this negative focus is part of the problem itself – shouldn’t organisational researchers/consultants take a responsibility for the potential harm that reinforcing certain discourses can cause (a challenge also evoked by Vaara, 2011) – surely that is part of the helping relationship too.  Words such as ‘learning about ourselves’ rather than ‘diagnosing’; enabling people to see the great things they are doing and the great skills they have.  I think I’d like to be part of that discourse.



Ison, R. (2010) Systems Practice: How to act in a climate-change world, Open University/Springer, Milton Keynes/London

Coghlan, D. and Brannick, T. (2010) “Doing action research in your own organisation”, 3rd edition, Sage Publications, London.

Schein, E.H., 1995. Process consultation, action research and clinical inquiry: are they the same? Journal of Managerial Psychology, 10(6), pp.14-19

Schein, E.H., 2001. Clinical Inquiry/Research in Reason, P. & Bradbury-Huang, H., 2005. Handbook of Action Research Concise Ed Edition., Sage Publications. (Also available through Google Books – I found that clicking between two different edited previews of different book editions  (2001, 2005)  meant I could access nearly all of the text in the chapter.  Cheeky I know!)

Hoverstadt, P., 2008. Fractal Organization: Creating Sustainable Organizations with the Viable System Model, John Wiley & Sons.

Harrison, M. and Shirom, A. (1999) Organisational diagnosis and assessment: bridging theory and practice.  Sage [cited in Coghlan and Brannick, 2010, 92]

Vaara, E., 2011. On the Importance of Broader Critique: Discursive Knowledge Production in Management Education. British Journal of Management, 22(3), pp.564-566.

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