Last week there were a couple of events that reminded me of a previous posting of mine on the National Health Service (NHS) in England, but also more broadly of organisational life. As I have mentioned before, in England the Health and Social Care Bill is working its way through Parliament. If successful it will bring about substantial change to health and social care.
Firstly there was the Nuffield Trust Conference where the Health Secretary and others gave polished performances of future problems if nothing was done and how the future would be better if the changes are introduced. And that going back was not a viable option. The language on the podium was confident with graphs, metrics along with a few narratives the audience could relate to.
The second event was a small far less formal gathering of MPs, peers and those with an expert contribution on health and/or leadership that I was invited to. The short presentations, the questions and answer sessions and the conversations on the fringes took an understandably different tone. Instead of future focused rhetoric of the benefits of the new world here the practicalities of today were explored. In talking with the attendees at this session it is clear that the reforms are generating an enormous number of quality conversations. GPs are now talking with hospital doctors, doctors are now talking with managers, and there are serious conversations as to how people will work together as they go forward. In other words, there is a process of joint sense making as people come to think and understand what the future will bring and how they will respond.
These events reminded me of Gilbert Ryle’s observation on how we use language. Ryle was an English philosopher of the mid twentieth century who was influenced by Wittgenstein, particularly with respect to language. Ryle (1949) discussed the problem between what he refers to as “task verbs” and “achievement verbs” and how these often go unnoticed. The former refers to activities, processes and actual experience and the latter only to the outcomes that the activity will have:
Many of the performance verbs with which we describe people …signify the occurrence not just of actions but of suitable or correct actions. They signify achievements. Verbs like … “catch”, “solve”, “find”, “win” …and countless others, signify not merely that some performance has been gone through, but also that something has been brought off by the agent of going through it. They are verbs of success (p125).
Turning back to the above events, very few of the public discussions centred upon the unfolding activity and sense making people were making together as we inched forward with the reforms, or ‘task verbs’ as Ryle put it. Those conversations legitimately occur behind the scenes. However, to me these conversations form the energy and local direction to make change happen. I am not saying those private conversations are more or less important than the public rhetoric. What I am drawing attention to is the importance they both have together. Descriptions of future success, or ‘achievement verbs’ in Ryle’s words, are vital; but in themselves they are insufficient to bring about change. In other words the ‘gesture’ of the politicians and legislation, will have to be responded to by the myriad of local interactions and conversations – change can be encouraged, but ultimately it is complex and self-organising.
Reference: Ryle, G (1949) The Concept of Mind, London: Penguin