Collective voicing as a reflexive practice

Abstract

This article focuses on the co-construction of a reflexive practice in a public health-care organisation. We study how the reflexive methods of applied drama and theatre facilitate ‘collective voicing’, specifically in the context of dental health-care professionals’ reflections on their own practices in perplexed situations. Our emphasis is on research-based theatre as a way by which the employees of an organisation can become more reflexive in their relationship with customers. This study makes use of the research-based theatre approach, illustrating how various voices – even those of young customers – are expressed, heard and discussed in order to interpret the status quo of perplexed situations and relationships and to imagine possible choices for disentangling the perplexity. Our study demonstrates the value of post-Boalian applied drama and theatre practices and presents a path for collective voicing as a learning process enabling reflexive practice in organisations.

Keywords

Perplexity post-Boalian practices practical reflexivity reflection research-based theatre

Introduction

An increasing number of public organisations highlight the customer’s perspective; ‘listening to the customer’ seems to be the mantra of new public management. However, what actually happens at the grass-roots level from the perspective of a customer frequently ends up a blind spot and an unknown for service providers, both managers and employees alike. The customer perspective seems to be a cliché that does not take advantage of any real process of mutual discovery or interaction between professionals and customers (Hennala, 2011; Langan, 2000). Listening to the voices of customers is one of the keys to dissecting the power tensions between health-care professionals, as provider–experts, and patients, as consumers and objects of treatment in public organisations. Reducing this tension requires a shift from an authoritative monologue held by the professionals, into multi-voiced dialogue between professionals and their customers and towards more critical, responsible and ethical actions (Cunliffe and Jun, 2005; see also Oswick et al., 2000). The work of applied drama and theatre (ADT, which has its roots in Dewey’s philosophy of learning and art education) of theatre director Augusto Boal (1979/2000) offers a potential form for constructing reflexive practices for organisations.

The shift is made possible through learning from experience, and key concepts in this process are reflection and reflexivity (Cunliffe, 2009b; Vince, 2002). As ways of refining our interpretation of collective voicing, we suggest that reflection organised by embodied actions of various ADT techniques is a stage towards practical reflexivity. Reflection and practical reflexivity are related but distinct from each other. Reflection is not only about helping employees and managers collectively to learn and change but also highlights a paradox – that people’s attempts to reflect collectively on an organisation tend to mobilise power relations that in practice resist reflection, learning and change. Practical reflexivity goes further in questioning what it is that people take for granted.

In this study we strive to co-construct learning from experience by first following Dewey’s (1916, 1933/1998) notion that the foundation for learning lies in perplexed situations: when a situation containing bewilderment arises, the person who finds himself facing it begins to reflect. The second notion we follow is a co-construction of organising reflection via research-based theatre (RBT), and the third is an emerging reflexive practice, which takes place in the embodiment actions during drama activities. According to Dewey (1933/1998), ‘There is a troubled, perplexed, trying situation, where the difficulty is, as it were, spread throughout the entire situation, infecting it as a whole’ (p. 140). In other words, learning from perplexity and perplexed situations are aspects of problems and their solutions. The challenge is that managers often attempt to repair perplexed customer-relation situations, as if they were rationally controllable processes, and try to discover efficient solutions through a ‘neutral’ analytical process rather than by ‘unsettling conventional practices’ (Cunliffe and Easterby-Smith, 2004).

Boal’s life work focused on development and social change. His theatre, as a form of emancipatory theatre, was one way of organising reflexive practices for oppressed people in Latin America, Africa and later in Europe. His work was a practical example of how critical pedagogy (Freire, 1970) and ADT can be combined. Boalian practices offer a path to discovering a revolutionist ontology of the truth, and although he was a Marxist-oriented activist–artist, he did not work with organisations (Mutnick, 2006). In our study, Boalian practices are applied as an epistemology for gaining knowledge about social reality in the context of public organisation, and so we created the concept of post-Boalian theatre for such organisational use, as distinct from the revolutionist ontology of Boalian theatre.

The core of the post-Boalian reflexive practice of ADT involves setting up a scene anchored in sensing an everyday perplexed situation that allows the observation of a familiar, taken-for-granted reality from an unfamiliar angle: an angle that uses the familiar elements and signs of daily life in a new combination and context of meaning.¹ As an activity of critical pedagogy, post-Boalian ADT resonates with Cunliffe and Easterby-Smith’s (2004) practical reflexive approach of unsettling conventional practices through theatrical investigation. This led us to the research question of our study: How can ADT methods be used to facilitate, first, joint reflection and later, reflexive practice among managers and employees of public health-care organisations, specifically in terms of their teenage customers’ experiences, and help them create understanding from perplexity?

The research question systematically led us to adopt a specific artistic ADT-based approach to our action research orientation of RBT (Leavy, 2009; Mienczakowski, 1995, 2001; Mienczakowski et al., 1996; Mienczakowski and Moore, 2008; Mienczakowski and Morgan, 2001; Saldaña, 2009). As a research strategy, RBT involves using theatre as a way of conducting and representing scholarly research. It has been used, for example, as an educational process in the health sciences and the health-care field (Colantonio et al., 2008; Grassau et al., 2006; Gray et al., 2000; Nisker, 2008; Wager et al., 2009). After collecting data, RBT researchers integrate and theatricalise the data into a script, which is then rehearsed and performed by the researchers themselves or actors (Beck et al., 2011; White and Belliveau, 2011). Our emphasis is on RBT as a way by which the employees of an organisation can become more reflexive in their interaction with customers. In this article, we present an RBT process that takes place in a dental health-care unit operated as part of Finland’s public health and social services system. The customers, employees and managers of this unit participated in the process together with the researchers, an applied theatre instructor (ATI), a graphic designer and four students studying youth outreach from an educational institution focused on social and health services. The reflexive practice was therefore co-constructed by exploring perplexed situations via RBT.

The process involved a cycle with three stages: expressing, listening to and interpreting the various voices involved – with the voices of the teenage customers being the ultimate focus of interest. This cycle of theatre-based practice allowed reflexivity to emerge, as the various participants heard, felt, acted and interpreted their own emotions and experiences and those of the other parties involved in the perplexed situation. Learning from experiences was related to these various voices, to the resonance of the dental-care professionals’ voices and the customers’ voices as expressed, performed and interpreted in reality and in imaginative roles. Conventional practice was unsettled through imaginary roles, paving the way for professionals to question how they interact with their customers and how they could act differently.

Next, we will describe the key theoretical concepts in greater detail. After that we will go on to explain the RBT methodology and present our empirical collective voicing case. We will conclude by discussing collective voicing as a useful approach to disentangling perplexed situations.

Perplexed situations, reflection and reflexivity

When making organisational decisions, professionals can dehumanise themselves, their customers and practices, acting as if encounters between professionals and customers were objects to control, measure and dominate and any emerging feeling of perplexity something to be avoided. This may lead the parties involved to consider perplexity to be the result of an individual’s mistake, rather than an element of problem-solving. For example, accusations such as ‘Who has broken the rules and disturbed the process?’, ‘Who has allowed chaos to emerge and didn’t control the situation?’, or ‘Could you please leave emotions out of this?’ are common among both managers as well as employees.

Instead of trying to avoid perplexed situations, Dewey (1933/1998: 137–140) stresses that we need to understand them as triggers for learning. When a person starts to deal with a difficulty by facing the situation, he or she begins to reflect. Reflection is defined as an intentional attempt to understand something from our experiences of a specific situation (Dewey, 1916: 151, 1933/1998). Vince and Reynolds (2009) condense this description, defining reflection as a collective process where learning from experiences is linked to understanding of past action and to improvement in future action. To Dewey, knowledge and action are inseparable processes (Elkjaer and Simpson, 2011: 64), and the perplexity of a situation can be transformed into understanding through reflection on the experiences related to the situation. This leads to reflection on emotions of uncertainty, tensions in relationships and assumptions.

Dewey’s ideas about reflection have been integrated further into managerial practice through Schön’s (1983) work on reflection-on-action and reflection-in-action. According to him, reflection is ‘on-the-spot surfacing, criticising, restructuring and testing of intuitive understanding of experienced phenomena; often it takes the form of a reflective conversation with the situation’ (pp. 241–242). Developing this, Reynolds and Vince (2004) argue that reflection is a collective rather than primarily individual learning process, one that takes account of social and political processes. Other authors underline that critical reflection does not actually arise from reflection-on-action or reflection-in-action, but from practical reflexivity (Cunliffe, 2002; Reynolds, 2011; Trehan and Rigg, 2007; Vince, 2002). In particular, Cunliffe (2009b) and Cunliffe and Easterby-Smith (2004) suggest that practical reflexivity emerges from an ‘unsettling’ of a situation in order to introduce the potential for learning or change. Reflexivity therefore goes further than reflection in this ‘unsettling’: ‘an insecurity regarding the basic assumptions, discourse and practices used in describing reality’ (Cunliffe, 2009c).

The differentiation between reflection and reflexivity in the learning process is important and can be described as follows:

Whereas reflection encompasses learning by reflecting on experience, a reflexive approach embraces learning in experience. Reflection is generally characterised as a cognitive activity; practical reflexivity as a dialogic and relational activity. Reflection involves giving order to situations; practical reflexivity means unsettling conventional practices. (Cunliffe and Easterby-Smith, 2004: 2)

This difference is further explained by Cunliffe and Jun (2005: 226), who contrast the notions of reflection and reflexivity. According to them, the concepts ‘are often used synonymously but carry different ontological and epistemological assumptions and consequently generate different intellectual and social practice’. In their paradigm, reflection is based on a realist view of the world, while reflexivity is grounded in constructionist and deconstructionist view of the world. This distinction is illustrated in Figure 1.

Figure 1.

The distinction between reflection and reflexivity.

Despite their different epistemological roots, both reflection and reflexivity provide opportunities for critical thinking. Reflection does not, however, necessarily require the questioning of one’s taken-for-granted assumptions (Cunliffe, 2009a; Cunliffe and Easterby-Smith, 2004).

In this study, which is based on the previous work of Vince (2002), Cunliffe and Easterby-Smith (2004) and Cunliffe (2009c), we consider reflection as being related to that which employees and managers already know and consider practical reflexivity as being related to employees’ and managers’ intent of questioning what it is they take for granted, and gaining emerging, novel-knowing knowledge as it is reconstructed or maintained within perplexed situations. The concept of ‘knowing’ is put into sharper relief, as to ‘know’ something is to be at the intersection of what is ‘already known’ and what is becoming, what is emergent in one’s knowledge (Cunliffe and Easterby-Smith, 2004; Keevers and Treleaven, 2011). We use the concept of practical reflexivity in constructionist terms: exposing the situated, tentative and provisional nature of knowledge.

In contrast to reflection, then, practical reflexivity involves a deeper questioning what we take for granted (Cunliffe, 2001, 2002; Reynolds, 2011). This is why it is a useful tool in cases where traditional learning methods are unlikely to support learning (Vince, 2011). At least in their formal strategies, public health-care organisations include reflection as a part of their professional and organisational identity,² whereas practical reflexivity, as a practice which seeks to reveal the assumptions behind organisational situations and events by destabilising taken-for-granted ‘truths’, is for the most part lacking within organisations and managerial routines (Cunliffe, 2009c; Nicolini et al., 2004).

Within an ADT framework, reflection, as a critical conversation with the perplexed situation, and reflexivity, as an embodied engagement with questioning what is taken for granted in the perplexed situation, are grounded differently. Practical reflexivity in ADT involves learning during experience by addressing how one’s assumptions and actions reform or maintain situations. Practical reflexivity is, therefore, focused on organisational transformation rather than on maintaining situations (Cunliffe and Easterby-Smith, 2004; Cunliffe and Jun, 2005; Elkjaer and Simpson, 2011; see also Freire, 1970). The question of how to construct reflexive practices for perplexed situations directed us to Augusto Boal’s ideas of critical pedagogy and ADT. During ADT, the participators’ experiences of a perplexed situation are repeated and investigated within a theatrical frame.

Critical pedagogy and ADT

ADT is an umbrella concept for various theatre practices that operate outside of the traditional art world and arts institutions, for example, in development projects, social and health-care institutions and adult education (Prendergast and Saxton, 2009; Taylor, 2003). Recently, ADT has received increasing attention as an approach to organisational change (e.g. Clark and Mangham, 2004a; Meisiek, 2002). In addition, the number of practical applications of ADT has increased (Berthoin Antal, 2009, in press; Barry and Meisiek, 2010).

One common element among ADT’s complex roots is the idea of learning as a process, whereby learners investigate their own experiences and views of reality in a dramaturgical frame (Jackson, 2007; Needlands, 2004; Nicholson, 2006). Figure 2 illustrates different ADT traditions (Prendergast and Saxton, 2009) and the ways in which theatre and action research are linked in this study.

Figure 2.

The relationships between applied drama and theatre (ADT), participatory action research (PAR) and research-based theatre (RBT).

ADT and RBT are of particular relevance to participatory action research (PAR), which is an inquiry process for exploring messy, real-world organisational actions and dynamics between people, by interpreting and creating shared understandings of ongoing action (Bradbury and Reason, 2008). PAR is a branch of action research that aims to improve organisational practices and facilitate the problem-solving processes of organisational actors.

Boal’s philosophy of a participatory approach to theatre aimed at developing critical thinking (Schutzman and Cohen-Cruz, 2006: 1–9) and was inspired by the work of Paulo Freire (1970) on critical pedagogy and Bertolt Brecht’s (1964) work on carnival and the circus, the Brazilian avant-garde theatre of the mid-20th century. It was also influenced by political theorists such as Hegel and aesthetic theorists such as Aristotle. Eriksson (2011) and Errington (1992) emphasise that drama is a practical form of critical pedagogy, a way of learning critical thinking and higher awareness. It thus offers a potential for organisational actors to tune in to their customers’ experiences and, from that point of view, learn.

ADT brings together individuals, their knowledge of social practice and framed situations. Using simultaneous multiple existences – ‘as it was’ (past action and situation), ‘as it is’ (present action and situation) and ‘as if’ (alternative future actions and situation) – organisational actors take a critical gaze at the perplexed situation. Their multiple actions construct practical reflexivity; they themselves unsettle the assumptions. In this study, post-Boalian ADT practices are methods for voicing the lived experience of situations as well as a method of inquiry for exploring hidden assumptions, emotions and tensions within an organisation. Emerging reflexivity takes place in a fiction of ‘doing’, ‘making’ and ‘voicing’ – the crucial aspect is embodiment. Participants create images of their reality and start to play with these images; body, intuition, co-creativity and imagination are central to this process (Boal, 1979/2000). A unique characteristic of incorporating practical reflexivity within an ADT framework is, therefore, that insights emerge through the participants’ acting with their bodies and engaging on a sensory level with perplexed situations.

Even if it can be an at-times messy and complex learning process, the practices involved in post-Boalian ADT facilitate the creation of multiple insights through patterns of theatrical inquiry and performance, uncovering of contradictions, the testing of variations and the trying out and questioning of events from several points of view (Boal, 1995; Saldaña, 2003). The reflexive practices involved in post-Boalian ADT are formed through the senses by ‘work[ing] together to dramatise collective stories activating the whole body through nonverbal and verbal expression’ (Linds, 2006: 115). One example of non-verbal expression are still images (Boal, 1992, 1995: 77), which illustrate a still moment of an actual action from the participant’s own experience, one that is still ongoing or could happen again. The ATI helps participants to ‘make’ the still images – to strike a physical pose with their body that expresses an action – in order to sense and express their experiences. A still image can be realistic, allegorical, or surrealistic. For example, in this study, the health-care customers created post-Boalian still images of encountering a doctor and gave voice to their lived experiences. These images were photographed to serve as data for the later analysis. After this, the ATI helps participants to explore narrated and performed situations.³ The ATI and the participants start to interpret on what is going on in the situation expressed by the still image: what is happening, what has happened, what will happen, what kind of a power relationship and emotions it involves, how it echoes the participant’s own experiences and what should change in order for the situation to change. This type of interpretation and discussion are part of collective voicing. Whether the mode is narrative (linguistic) or performative (dance, still images and acting), for participants, the emergence of novel knowing via collective voicing is situated in ‘imaginative doing and making’ when they were in the midst of a dramatic embodied activity (Boal, 1992; Linds, 2006). Boal (1995) describes this state as one of

… belonging completely and simultaneously to two different, autonomous worlds: the image of reality and the reality of the image. The participant shares and belongs to these two autonomous worlds; their reality and the image of their reality, which she herself has created. (p. 45)

This is the idea of voicing via post-Boalian theatre: to offer a stage – an aesthetic space – within an organisation for interplay between the actual lived experience and wish-fulfilling fantasy, the tangible and intangible (Gabriel, 2000; Gabriel and Connell, 2010: 507; Linds, 2006: 114). In an ideal situation, theatrically framed perplexed situations – ethnotheatrical vignettes – allow reflexivity to emerge and the participants to gain knowing together; in the worst possible scenarios, it only causes confusion and meaningless conversations within the organisation by maintaining existing and oppressive relations (Clark and Mangham, 2004a, 2004b). Next, we will discuss, through our empirical case, how reflexive practice was created within a theatrical framework.

A practical example of RBT

Research design and method

The research design applied in this study was based on the RBT tradition (Beck et al., 2011; Mienczakowski, 1995, 1998, 2001, 2003; Mienczakowski et al., 1996; Mienczakowski and Moore, 2008; Mienczakowski and Morgan, 2001; Saldaña, 2008; Wager et al., 2009), which implies the application of artful inquiry, scripting and performance in research (Finley, 2011; Saldaña, 2008, 2009). As a research method, RBT is an inquiry process in which various actors (in this case, the employees and managers of an organisation, the researchers and the artists) gain collective and personal knowledge by sharing experiences through linguistic and non-linguistic arts-based methods (Davies and Ellis, 2008; Finley, 2008; Leavy, 2009). Utilisation of visual methods of inquiry (Vince and Warren, in press) and theatre-based methods of inquiry (see Beck et al., 2011) has been noted as particularly useful in research projects that seek to evoke and articulate embodied and tacit knowledge (Weber, 2008), and so we used such methods (for example, theatrical images and drawings). The artistic process was used as a way of sensing and examining the experiences of the people involved in the study (Denzin, 2003; Finley, 2008, 2011; see also a 2010 study by Fook on critical reflection as a research method).

In this study, theatre is an investigational tool involving data collection, analysis and reporting. RBT proceeds through four phases:

The process begins with separate inquiries for customers (the Customer Story), employees and managers (for both of these latter groups, the Work Story). The aim is to give voice to – that is, express, investigate and reflect – the participants’ experiences. This inquiry is facilitated through storytelling methods and theatrical images (see Figure 3).⁴ The storytelling sessions can be described as a collective scripting of perplexed situations. The researcher is embodied in the research process as a researcher and as an ADT practitioner; this status allows the researcher–ADT practitioner to gain a rich description of key events, perplexed situations and problems.

The stories of the customers, employees and managers are then analysed by the researchers and the ATI, who devise performative theatre scenes from them (Saldaña, 2009). The idea is to make various voices heard and present the perplexity of the situations. The ‘voices’, that is, the themes in the script, are validated by the customers and members of the organisation; we played stories back to the customers and members of organisation to ensure that their authentic voice was still present in the scripted scenes.

In an ADT session, the multiple voices of the perplexed situation are aired as theatrical scenes. This is a participatory session in which professionals interpret the perplexed situation and take part in acting out scenes. This offers interplay between reflections on the ‘known’ and reflexivity as emerging knowing that challenges the known.

The process later continues through multiple sessions striving for agreement on development actions.

Figure 3.

Theatrical images.

Personal reflection

Evaluative discussions were organised throughout the research process and embedded into each inquiry. In those discussions, we attempted to raise the question of power in order to avoid our maintaining of existing tensions as RBT research practitioners. We also paid attention to sensing what the others were feeling and sensing, even though this was different from what we were feeling and sensing. In order to maintain our own appreciative yet critical gaze during the research, we collected anonymous feedback, videotaped our interactions (whenever acceptable to fellow participants) and scrutinised afterwards our own actions as evident in the videotape (gesture, tone voice, eye contact and words).

Setting the stage for collective voicing in a Finnish public dental health-care unit

This study elaborates an RBT process, wherein teenage customers, dentists, nurses, dental hygienists, assistants and managers from a dental health-care unit, as well as researchers, an ATI and a graphic designer, organise and construct a reflexive approach together. The research process started with the need to understand the experiences of the teenage customers (aged 13–17 years) and learn from them in order to change the perplexed situations affecting the health-care professionals and their customers.

There were a total of 100 teenage customers who participated in the workshops, another 150 who wrote narratives without participating in a workshop, 36 employees and managers, five researchers, the ATI and four students involved in the research process, which lasted over a year during 2008–2009. The RBT process included many functional stages, which are described in Table 1 in detail. All interactions were documented via participatory observation, meeting memos and photographs; in addition, some were videotaped. The data consists of two researchers’ field notes, five hours of videotapes, photographs, customer stories told via theatrical images, employee stories, teenager drawings and feedback survey responses.

Table 1.

The research setting.

Those involved	When it took place	What took place
Meetings with RBT team employees and managers from the case organisation, five researchers, ATI and the graphic designer	22 September 2008–9 October 2008	The RBT team negotiated the aim of the research and decided how to organise it A researcher and the ATI designed theatre-based inquiries
Customers (eight classes from two schools: 150 pupils) wrote stories Six storytelling sessions (two schools: 100 pupils) Storytelling session with 36 dental health-care professionals	10 October 2008–9 January 2009	Researchers analysed the students’ texts A researcher and the ATI organised Customer Story sessions and analysed themes Researchers and the ATI organised a Work Story session
Analysis and dramatisation of collected data	1 November 2008–13 January 2009	A researcher and the ATI sorted the data into themes and plotted and dramatised the themes into theatrical scenes: dramatised imaginary perplexed situations based on data were created
Applied theatre rehearsal process	1 November 2008–23 January 2009	Four youth outreach students from a school of social services and the ATI-scripted and rehearsed scenes Discussion between a researcher, the ATI and the graphic designer about the aesthetic possibilities; symbols, visualisation, lighting, sound and costumes
Validation of the dramatisation with the customers (one class: 30 pupils)Meeting with a researcher, the ATI and the graphic designer	9 January 2009–23 January 2009	Triangulated data is returned to the customers for additional comment The ATI and the four students who formed the theatre group modified the applied theatre script Planning of the participative elements for interactive collaboration between the professionals, a researcher and performing students for the applied theatre session
Applied theatre session with 36 dental health-care professionals, five researchers, the ATI, the graphic designer, a lighting and sound expert and four performing students	23 January 2009	The plotted and dramatised imaginary perplexed situations were performed for the professionals who participated (by taking different roles or using distancing, for example, ‘hot seating’) and interpreted the situation by reflecting on, from the perspective of their own practices, oppressive roles, patterns based on assumptions that are taken for granted, power tensions, emotions and professional visions and meaningful elements in their work
Evaluation meeting with the ATI, four students and a researcher	24 January–2 March 2009	Feedback discussion; what was learned through this process Researchers turned their field notes into Word documents and discussed emerging themes
Meeting with researchers and the ATIMeeting with a researcher, the ATI and the graphic designer		Roundup from the theatre session from the perspective of how to facilitate reflection and reflexivity and the list of the development ideas the professionals created during the sessionDiscussion about aesthetic complexity during the research process
Meeting with the RBT teamAction planning session with 36 professionalsFeedback surveyRoundup from the idea generation of the action planning sessionMeeting with the RBT teamA total of 36 professionals involved in the actions	3 March 200927 March 200928 March 2009–2 April 20093 April 20093 April 2009–23 November 2009	Feedback discussionProfessionals from the case organisations categorised ideas created in applied theatre as follows: (a) a platform for a teenage-oriented dental health-care service process, (b) holistic interaction and encounters with teenage customers, (c) novel types of communication with teenage customers, for example, through social media and (d) assessing the value of practices with teenage customersThe RBT team negotiated how to take the next steps and started to organise an action planning sessionThe professionals generated ideas based around four themes defined earlier by the RBT team Researchers turned their field notes into Word documents and discussed what emerged during action planningRoundup from the action planning session focusing on how to facilitate the process whereby plans are implemented as actionsFeedback discussionProfessionals from the case organisation prioritised the development ideas created during the action planning session, decided on the timetable and defined the actions for the next stageFour different development processes started: two facilitated by ATI and the graphic designer, one facilitated by the researchers and one by the case organisation itself
A total of 36 professionals involved in evaluation session, facilitated by the ATI and the graphic designer	2 December 2009 – work continued	Session: observation on what has happened, what was learned and evaluation of where we are now and next steps

RBT: research-based theatre; ATI: applied theatre instructor.

Giving voice to the customers’ experiences

Boal (1995) uses the term voicing thoughts to describe acting out embodied experiences theatrically. We followed this method when organising participants’ learning on the perplexed situation.

The first phase of data gathering and analysis focused on 150 teenagers’ written experiences of dental health care. All the texts were analysed by three researchers, and after that, a researcher and the ATI used the analysis as a map to design ADT-based inquiries with the customers.

The second phase of data collection focused on three inquiry sessions conducted at two schools, for a total of six sessions. Figure 4 illustrates the nature of the visual data; some of the inquiries were facilitated with the help of comic strip drawings.

Figure 4.

The nature of the visual data.

After each inquiry, a researcher and the ATI analysed the data through ethnodramatic framing (Saldaña, 2009), resulting in ethnotheatrical vignettes. In one inquiry, an imaginary character, Netta, who represented a teenage customer, and two ‘dentists in white jackets’, who represented dental health-care professionals, were created together with the customers. After the creation of the imaginary character Netta (later on, Netta was also a character in a theatre scene), she was used as a stimulus for practical reflexivity.

Different types of encounters – including emotions, power relations and tensions – between Netta and the two dentists were explored together with customers (see Figure 5 for an example of exploration from one inquiry) via post-Boalian theatre practices.

Figure 5.

ADT inquiry with teenage customers.

A typical setting analysed and dramatised from the data was as follows: the worlds of Netta and the dentist do not meet on a personal or emotional level. The dentists take care of Netta’s teeth skilfully, but that does not automatically guarantee a good experience for Netta. The dentists’ assumption of neutral medical treatment, ‘we handle problems related to teeth’, creates feelings of ‘they can’t even see me’ powerlessness and ‘whatever’ resistance in customers. The dentists in turn interpret the customers’ emotions as antagonism, ingratitude and indifference. Both customers and professionals live in their own, respective worlds, and the other world disturbs the peace of their own. Through this inquiry, one of the key elements of the perplexed situation emerged: how professionals interact with their customers. This element was named encountering.

Giving voice to the professionals’ experiences

One type of inquiry, created by the first author, the Work Story, was organised specifically for the dental health-care professionals. During the inquiry, professionals went through their experiences with teenager customers (Figure 6). The professionals reflected on their own role and relation to customers, concluding that inner conflicts and being in a rush created perplexed situations in which there was not always time to engage with the teenage customer in a respectful way (our idea of organising reflection is based on Vince, 2002 and Reynolds and Vince, 2004).

Figure 6.

A Work Story session: employees sense on their experiences with the help of theatrical images.

The professionals’ reflection and gradually emerging reflexivity was indicated in various ways in the stories. In one storyline, the professionals construed the customer’s experience from the customer’s point of view: ‘It feels like we’re always in somebody’s way’. The customer’s experience of a missing caring dimension in the treatment affected the quality thereof. In the emerging reflexivity, the professionals were on the defence; they assumed that their customer seemed to be expressing that ‘I couldn’t care less’. This became an excuse for not unsettling their conventional practice (blocking practical reflexivity) and explaining that their customers actually ‘don’t pay attention to our advice’, and therefore, the professionals ‘just take care of the teeth, not the person’, and that they ‘are health-care workers, not social workers’.

At this point, the professionals realised that one common emotion being experienced by their customers was fear and a missing feeling of trust, and fear, in turn, transforms into different kinds of reactions. The lack of caring made the customer feel worse. One of the key findings was thus revealed by the professionals’ adopting an attitude of reflexivity: their own response is also based on emotions, rather than neutrality, and involves more than medical procedures. They were questioning what they were taken for granted: ‘to keep emotions out of it’. This embodied subjectivity (actual demonstration conducted by themselves) within the perplexed situation stimulated via stage helped the professionals to question what it was they took for granted.

Collective voicing: Interpreting images of reality together

The pictures in Figure 7 illustrate one situation as presented via post-Boalian theatre practice.

Figure 7.

A perplexed situation as presented on stage.

In this situation, dentists (‘two dentists in white jackets’) are talking to each other; they are gossiping about their boss and complaining about their work. The customer (Netta) has a question for them, but they do not have time to listen, and then, after they put all kinds of instruments into Netta’s mouth, they start asking her questions. Netta is afraid of pain, but the dentists laugh at her and say, ‘This is a minor procedure that even little kids don’t need painkillers for’. The existing relationship between professionals and customer was thus illustrated.

The dental-care professionals discussed that being able to tolerate strong emotions and engage with power dynamics would improve their encounters with customers. We researchers understood the discussion as a reflection. Professionals talked about their relationships with their customers through the situation on the stage. They created shared knowing novel to them but were not yet questioning anything. But then during one of ethnotheatrical vignettes, the health-care professionals were enabled to question encounters between the customer and the professionals and between the professionals themselves. This resonates with the idea of critical reflection as engagement with the power relations that structure the situation (see also Cunliffe, 2009c; Vince, 2002). Simultaneously, when they were involved in imaginary action with an imaginary customer; they were sensing, creating and interpreting different viewpoints of a perplexed situation that resonated with their own lived experiences with teenage customers. Professionals transformed the power relations on the stage. They shifted from their ‘neutral’ professional identity to a professional one exposing himself or herself and unsettling the situation by questioning,

Who am I? How do I relate to others? How do I encounter other people? How do I sense customers’ feelings? How do I respond to my own emerging feelings and those of colleagues and customers? How do my actions, emotions, and language reform or maintain this perplexed situation?

These questions are examples of emerging practical reflexivity. To summarise, by questioning what it is they take for granted in the role of Netta staged in a frame of RBT, they were questioning a taken-for-granted assumption about their own practice. Practical reflexivity emerges through the role of the customer and outside of the role, advising themselves and seeing the complexity of the perplexed situation through the imaginary roles of ‘two dentists in white jackets’.

Discussion

In the empirical case, RBT was conducted through the use of the post-Boalian ADT practices of collective voicing; inquiries were organised, which produced data that were analysed into an integrated script, which was then rehearsed and performed. The emphasis of the RBT study was to explore the relationships between the actions of health-care professionals and customers by capturing the customers’ experiences. The use of post-Boalian ADT as a reflexive practice focuses on sensing, sharing, repeating, amplifying and interpreting perplexity in work processes and social practices, especially between employees and customers.

Post-Boalian ADT practices of collective voicing started with the sense that something is wrong in the situation that was being performed; professionals interpreted on what was wrong, what the nature of the obstacles was, and what resistance needed to be overcome.⁵ The professionals broke the assumption of their authority by questioning what they had considered ‘neutral and rational actions’ when encountering customers. Seeing from the customers’ viewpoint revealed to them that ‘Netta felt that she was invisible to the dentists and that they probably wouldn’t notice her absence’. The treatment situation was routine and familiar, even boring, for the dentist, while for Netta it was unique and new. Practical reflexivity took place when sensing emotions guided them to understanding their own actions and power in the treatment situation shifting their professional perspective from medical treatment to a more holistic caregiving situation, where emotions and power relations were included as a part of organisational dynamics. Through this acting on stage, practical reflexivity took place at the intersection of experience in fiction, the reflection of experience in fiction and the lived experience of reality.

Issues that were ‘unwanted’, ‘painful’ and ‘surprising’ were made visible; therefore, it was important to us as researchers and ADT practitioners to recognise the political and social dynamics within the organisations. In striving for its aim of unsettling conventional practices, practical reflexivity is not value-free or neutral, but tightly woven into the existing organisational power relations into which I was also woven.

Professionals asking critical questions about what they are doing with their customers and why they are doing it opens the door to questioning existing assumptions about these topics. The following generative questions (see Table 2) are examples for unsettling conventional practices. The questions are summarised from data of this study.

Table 2.

Generative questions for unsettling conventional practices.

Questions for knowing what	Questions for knowing how	Questions for knowing practices
What is it like to be a customer?What is it like to be a teenager?What is non-encountering?What does non-encountering affect?What is a good encounter?What emotions emerge during good encounters?What kind of encounter would teenager-driven dental care be?	How do I receive a young person?How do I interpret a customer’s reactions?How do I act?How do I control my own attitudes?How are power relations seen?How is treating a young person different from interacting with other customers?How will encountering a young person and getting to know him or her proceed?How does a good encounter manifest itself in my work?	What are ‘good practices’ when encountering teenagers?What facilitates this process?Where have I been treated well?What do I remember about it?What can I utilise from my good experiences of treating an adolescent?How do I know whether a practice is good or not?What are the biggest challenges in our practices?What is encountering in words and actions and as a practice?

These questions guided the professionals to question what it was they took for granted and the situation as subject to change. This resonates with the idea of reflexivity as collective and ongoing construction (Cunliffe, 2009a; Cunliffe and Easterby-Smith, 2004; Keevers and Treleaven, 2011; Reynolds, 2011) rather than a retrospective mirroring of a reality (Schön, 1983) from which we can separate ourselves.

In summary, the practical reflexivity gained via post-Boalian ADT practices allowed professionals to question power dynamics and emotions related to their practices and to accept responsibility for co-construction. They became more aware of different voices – their own and those of their colleagues and customers. In this paradigm, participants move from reflection as a conversation with the situation, to critical reflection as engagement with the power relations that structure the situation, to practical reflexivity as exposing and unsettling the situation.

Post-Boalian ADT links practical reflexivity and sensing in non-linguistic ways; it facilitates professionals themselves discovering situations and problems. The interplay between actual lived experiences and multiple imagined interpretations of the perplexed situation and the actions and emotions related to it sheds light on taken-for-granted aspects of practice. Practical reflexivity of the post-Boalian ADT practices is about novel knowing, questioning what it is we take for granted. We propose that collective voicing is one path to revealing what is hidden, tacit and embodied in organisational dynamics. As an example of practical reflexivity, collective voicing thus makes a contribution to promoting managerial comprehension of listening to the voice of customers (see Figure 8).

Figure 8.

Collective voicing of a perplexed situation as a path to reflexivity.

In public health care, collective voicing is a way of questioning one’s taken-for-granted reality; it could be an approach that invites managers and employees to think of themselves as reflexive practitioners and question their own assumptions. If the organisational actors, as reflexive practitioners, are able to ask critical questions and inquire about what they are doing with their customers and why, then they are more able to question the assumptions behind their actions and allow practical reflexivity to be a professional competence among others while increasing their awareness of resistance and encouraging them to deal with their customers’ and their own anxiety.

The focus of RBT is to help organisational actors become more able to ‘unsettle conventional practice’ and through that become more reflexive in their relationships with customers. In order to understand the complex dynamics of which they are a part, organisational actors ought to use perplexed situations and emerging tensions creatively. They should focus on letting go of what they already ‘know’ about their customers.

Conclusion

In this article, we have described a collective voicing process as an example of reflexive practice in a public health-care organisation. We posed the question of how the methods used in post-Boalian ADT practices can facilitate professionals’ reflecting on and learning through and with their customers’ experiences. We grasped the temporary potential that perplexed situations staged in a frame of RBT offer for reflexivity and constructed a process for articulating, hearing and interpreting the various voices of experiences in such situations.

The results of our study support the idea that construction of reflexive practices via perplexed situations staged in a frame of RBT offers possibilities for the renewal of thinking and acting. However, collective voicing in the context of a perplexed situation is a dialogue with dissonance. We note that constructing reflexive practices is not something done easily or readily, but that it is worth spending the time and effort on.

We turned to post-Boalian ADT, presented a path for collective voicing, and noted that among its essential elements are customers being invited to ‘voice their thoughts’ and professionals being willing to sense different voices and voicing as a starting point for transactions (Boal, 1995; Dewey, 1933/1998). Practical reflexivity raised a discussion about the power relationships between the professionals themselves, as well as between them and their teenage customers, and led them to investigate and develop the encounters and generate customer-oriented health-care services.

However, collective voicing does not guarantee change – in actual practice, any changes must be collectively organised and made by practitioners in their everyday work and encounters with their customers. We also understand the importance of the structures that allow collective voicing to be organised. The challenge of creating a customer-oriented structure will be a future research avenue in our next action research process.

Footnotes

Funding

The authors wish to thank the European Regional Development Fund and the Regional Council of Päijät-Häme for the opportunity of presenting their research in the Management Learning.

Notes

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