Voiced inner dialogue as relational reflection-on-action: The case of middle managers in health care

Abstract

We look to the experiences of middle managers in a health-care setting to empirically develop and explore the concept of voiced inner dialogue. Voiced inner dialogue is conceptualised as a form of reflection-on-action whereby fragments of narrative self-reflection reveal an organisation’s unspoken backdrop conversation or interpersonal mush. The normalised intensity that characterises many health-care settings, an artefact of increased governmentality and responsibilisation, leaves middle managers experiencing increased work and personal pressures. The interpersonal mush in this context is centred upon individuals’ felt disconnect between espoused and enacted organisational values. Voiced inner dialogue was triggered in dialogic conversation with the researchers, a type of participant-focused reflexivity. From our qualitative analysis, we present three themes to illuminate how organisational context can inform the creation and maintenance of interpersonal mush, impeding managers’ reflection. Voiced inner dialogue offers an opportunity for managers stuck in the silence of interpersonal mush to engage in reflection-on-action. We conclude with the implications for reflection, reflexivity and management learning.

Keywords

Dialogic conversation governmentality health care participant-focused reflexivity reflection work-life balance

Introduction

Much has been written about the need for managers to engage in reflection-in-action, on-action and self-reflexivity (Cunliffe, 2002; Cunliffe and Jun, 2005) in fostering learning (Jordan et al., 2009) and well-being (Pipe, 2008). The crisis culture of health care (Mendleson, 2010) offers a rich context for exploring the reflective practices of middle managers. The normalised intensity that characterises many health-care settings leaves middle managers experiencing increased work and personal pressures (McCann et al., 2008). As managers seek to negotiate order among competing demands (Bryant and Stensaker, 2011), time for reflection is frequently compromised. Here we look to the experiences of middle managers in health care to empirically develop and explore the concept of voiced inner dialogue (VID) as a form of relational reflection-on-action. We take forward research on background conversations (Ford, 1999), interpersonal mush (Bushe, 2006, 2009), theories-in-use (Argyris and Schön, 1974), defensive routines (Argyris, 1999) and implicit voice theories (Detert and Edmondson, 2011) to illustrate the significance of organisational context in fostering silence and impeding reflection. We incorporate the idea of governmentality (Foucault, 1991) and responsibilisation of health care (Rose, 1999) to better understand how such a context ‘acts upon individuals’ very subjectivities, so that it is their own will that guides their actions’ (Martin et al., 2013: 81; italics in original). Furthermore, we extend the work on reflection-on-action (Schön, 1983) and participant-focused reflexivity (Corlett, 2013) to offer VID as a form of relational reflection-on-action triggered through dialogic conversations.

The development of VID was an emergent and unexpected outcome of a larger study. Our starting point was a wider study of leadership development (LD) needs for middle managers in a health-care organisation where LD was aligned with fostering healthy workplaces. We were intrigued by what we interpreted as participants’ struggles; verbal confessions and body language suggested participant discomfort with a felt disconnect between espoused corporate messages about healthy workplace, their experience of that culture and their own realised unhealthy work practices. As a result, we became interested in how context might inform the development and maintenance of an unspoken backdrop conversation – an individual and organisational interpersonal mush (Bushe, 2006, 2009) marked by an unspoken felt disconnect between individuals’ experiences of espoused and enacted organisational values, fostering particular subjectivities and impeding reflection and reflexivity. We developed VID as a conceptual lens to better understand such complexities and it is elucidated here as emerging through public reflection (Jordan, 2010) activated through conversation (Cunliffe, 2003) with the researchers. We contend that such dialogic conversations trigger managers’ self-awareness of ineffective taken-for-granted practices amid an espoused discourse of healthy workplace. From our empirical analysis, we present three themes, namely, Reacting not Reflecting, Noticing Cracks in Espoused Values and Lived Experiences and Questioning the Implications for Leading and Living which illustrate how VID emerged through our conversations.

Methodologically, we build upon studies that suggest qualitative interviews and narratives offer an opportunity for participants to retrospectively make sense of their experiences (e.g. McCann et al., 2008). Following Corlett (2013), we take forward Riach’s (2009) ‘sticky moments’ in interviews as a site for reflexivity and Cunliffe’s (2002) ‘striking moments’. We demonstrate the potential for interviews as a relational setting where ‘dialogic processes of meaning making happen and participant-reflexivity may occur’ (Corlett, 2013: 456) to explore the implications for management learning. Empirically, our focus upon middle managers adds to the limited studies that set out to understand aspects of leading from the middle, particularly in the health-care setting.

The context for this study

The empirical site for this study is a regional health authority, Horizon Health Network (Horizon), situated on the east coast of Canada in the province of New Brunswick (NB). In 2008, NB’s eight existing regional health authorities merged into two. Four regions were amalgamated and rebranded as Horizon to serve a population of 700,000 in a largely rural environment covering two-thirds of the province. The restructuring of services meant the integration of different structures, operational processes and unique subcultures across a geographically dispersed organisation. With a 1 billion CAD budget and 12,900 employees distributed across 102 facilities in an economically depressed jurisdiction further challenged by an ageing and declining population, the scale of change was extensive and the impact significant. While the espoused culture of Horizon included a vision of ‘leading for a healthy tomorrow’, a mission of ‘care for people, educate, innovate and foster research’ and values of compassion, respect, integrity, collaboration, excellence, sustainability and innovation (Horizon Health Network, 2014), the amalgamation effort was clearly intended to effect efficiencies and reduce costs. Health care has been referred to as the worse run industry in Canada with blame attributed to

pervasive inefficiency that is preventing the system from running even close to as well as it could … the failure to adopt even basic business management principles is what’s standing in the way of preserving universal health care for generations to come. (Mendelson, 2010: 1)

We suggest such efforts to increase efficiency have an ‘ideological basis in its assumption of the superiority of private markets over perceived inefficient public organizations (Ferlie et al., 1996)’ (Doolin, 2002: 371).

Middle management in health care: governmentality at work

Many middle managers in health care combine a clinical role in patient care with supervision of staff, budget and planning responsibilities. A key role is that of cascading information – up, down and sideways – within the organisation (Checkland et al., 2011). They also require negotiation and political skills for engaging a range of stakeholders (National Institute for Health Research, 2013). As such, the middle management role is one of ambiguous buffering within a complex inter-professional environment (Harding et al., 2014).

Persistent and often unpredictable change has come to characterise Canadian health care where years of cost-cutting, downsizing and restructuring have left the workforce coping with conditions that diminish both quality of working life and organisational performance (Lowe, 2002). McKinley and Scherer (2000) have noted, ‘leading “from the middle” is fraught with the challenges of brokering strategic change with limited resources amidst expansive expectations’ (p. 543). Many middle managers in health care are working in ‘extreme’ or unmanageable jobs characterised by long hours, fast pace and high intensity (Buchanan et al., 2013). Furthermore, Martin and Learmonth (2012) suggest the current discourse in health care is marked by decentralisation of ‘leadership’ responsibilities but maintenance of centralised power. Amid an espoused culture of caring, middle managers in health care face considerable challenges, complexities and ambiguities.

Over the past quarter century, notions of neoliberalism have percolated into public sector management, including health services. This has instilled a culture of enterprise and efficiency through public sector modernisation (O’Reilly and Reed, 2011) and rationalised myths (Kitchener, 2002) (e.g. LEAN, Six Sigma) as the public sector is realigned with the ethos of commercial enterprise and its enterprising behaviour (Du Gay, 1996 in Doolin, 2002). Managers are encouraged to understand the organisation’s reality as ‘grounded in economic notions of value and commodity’ (Doolin, 2002: 379). This governmentality (Foucault, 1991; Rose, 1999) as applied to health services management can be understood through a subjectification perspective (Ferlie et al., 2012) whereby ‘[p]revailing organisational subjectivities and identities become definitive of the enterprising self’ (Doolin, 2002: 373). A well-performing employee (and manager) is assured through their working long hours, complying to ‘unreasonable’ demands (rather than resisting through voice), enacting decisiveness and prioritising timely responsiveness over personal ‘down time’. Adopting ‘certain habits and dispositions allows an individual to become – and to become recognised as – a particular sort of person’ with ‘… a bundle of characteristics such as initiative, self-reliance and the ability to accept responsibility for oneself and one’s actions’ (Du Gay et al., 2005: 41, 44). As managers govern themselves to fulfil espoused agendas that accompany this shift, they engage in re-creating subjectivities that internalise responsibility for the system and ‘active use is made of the self’ (Hall, 2012: 583). A discourse of excellence emerges to mobilise the subjectivity of managers in pursuit of intended organisational outcomes (Du Gay et al., 2005):

Governmentality is about ‘instilling a set of rules for the conduct of the self’ [Gibbings and Taylor, 2010: 35]. Who puts forth the rules determines what appropriate conduct is. Through various techniques and forms of knowledge and discipline, authorities seek to reshape a subject’s conduct by reshaping her desires to conform to the norms and ideals of the hegemony. Hospital protocols and policies are examples of normalising tools. These technologies of power engender new sets of rules by which subjects begin to govern themselves. (Bludau, 2014: 878)

We suggest that LD programmes can serve as one such technology of power within which health-care professionals learn to govern themselves. More than a decade ago, a competency-based LD programme called the Healthcare Leadership Model was introduced in the United Kingdom (Marchildon and Fletcher, 2015). Shortly thereafter, Canada followed suit with LEADS in a Caring Environment.¹ These competency-based programmes can be fertile ground for instilling particular subjectivities. For example, a main theme in the LEADS competency framework calls upon the individual to ‘Lead Self’ by being self-aware, managing self, developing self and demonstrating character. The competency ‘Manages Self’ makes explicit a responsibilisation expectation by simultaneously reconstructing and defining a manager’s role around qualities that focus on self-governance and enterprise (Du Gay et al., 2005):

Self-motivated leaders … are self-aware. They are aware of their own assumptions, values, principles, strengths and limitations … They take responsibility for their own performance and health … They actively seek opportunities and challenges for personal learning, character building and growth … They model qualities such as honesty, integrity, resilience, and confidence. (Leaders for Life, 2013: 2)

This competence approach not only promises to improve organisational performance but ‘offers managers the prospect of self-improvement. Indeed, becoming a competent manager is equated with becoming a better, more autonomous, accountable self’ (Du Gay et al., 2005: 51). With performance measured against the competencies articulated in the LEADS framework, managers also assume responsibility for promoting this subjectification among subordinates. Here, we align with Doolin’s (2002) argument that ‘[o]ne of the fundamental power effects of discourse is the way that it constitutes the problem for which it claims to be a solution’ (p. 386). Such a context may silence middle managers, consciously or otherwise, because any type of resistance such as speaking out against such pressures involves risk of humiliation, perceived failure or job loss.

The use of critical reflection in health-care contexts has had more success in the classroom than in the complexity of practice (Heel et al., 2006). This is not surprising given the governmentality of health care. In practice, reflection is impeded by interactions characterised by prescription, low engagement, high role-based demarcation, politics, threat and task orientation and where individuals must engage in multiple overlapping activities that frequently conflict (Heel et al., 2006). This paradoxically makes reflection even more important (Hedberg, 2009), yet taking time for public reflection (Jordan, 2010) may suggest hesitancy and uncertainty in a context that values decisiveness as indicative of professional competence (Bellou, 2007). Given this, even managers who might wish to effect change may not initiate it for fear of retribution, professional isolation (Cunliffe and Jun, 2005; Heel et al., 2006) or threatened subjectivities. Such contexts are ripe for the generation of silence, thereby limiting opportunities for reflection.

Interpersonal mush, theories-in-use, defensive routines and silence

‘Knowing’ and subjectification as constituted through the mundane practices of governmentality involve social relations (Ceci, 2004). Knowledge-intensive contexts such as health care rely on conversations as a primary medium for organisational learning. Ford (1999) speaks of the network of background conversations in organisations as an implicit, unspoken ‘backdrop’ within which explicit conversations occur and on which organisational members rely for grounding and understanding. These backdrop conversations assume a taken-for-granted familiarity that is presupposed in every conversation. Developed from extensive research and consulting experiences, Bushe (2009) offers the concept ‘interpersonal mush’ to describe these background conversations, a ‘subconscious inner dialogue that has powerful effects on the organisation’ (p. 39). Interpersonal mush is a sense-making tool that individuals use in organisations when they experience ambiguity in a relational context. In making sense of this ambiguity, individuals may share their understanding with those they trust in backdrop conversations or their inner dialogue is left completely unvoiced. Rather than verbally expressing their uncertainty in a public forum with supervisors or subordinates to seek clarity, they make assumptions to fill in relational and information gaps. According to Bushe (2006, 2009) and Bushe and O’Malley (2013), this often results in further ambiguity, misunderstandings and silence, thereby negatively affecting individual and organisational learning. ‘Under conditions of interpersonal mush, what appear to be agreements and consensually made decisions don’t get implemented well, if at all’ (Bushe, 2006: 159) because individuals have simply been ‘acting’ for the benefit of various audiences (Bushe and O’Malley, 2013). This creates a context where an interpersonal mush is sustained.

Interpersonal mush can also arise from inconsistencies between our espoused theories and theories-in-use (Argyris and Schön, 1974). Theories-in-use are the theories (beliefs and values) that we actually use in practice. Such theories are often in contrast to what we espouse as our beliefs and values. When we are unaware of the inconsistencies in our own espoused and theories-in-use and circumstances do not foster reflective learning to surface these inconsistencies (e.g. no time to reflect, unwilling to listen to others), interpersonal mush is created and sustained (Bushe, 2009).

Problematic patterns resident within such interpersonal mush can reduce a manager’s capacity to understand ‘material’ issues. Argyris’ (1991) defensive reasoning would be an example of such problematic patterns. Argyris (1991) describes defensive reasoning as the actions we take to prevent the risk of embarrassment or threat, and the use of it prohibits questioning our reasoning. An organisational defensive routine may be manifested through sending mixed messages (Argyris, 1991). Without recognising and confronting such issues they remain unresolved. Attempts to enhance organisational learning by changing patterns through formal organisational interventions such as training and workshops have little or no effect unless they increase interpersonal clarity (Bushe, 2009: 43).

Bushe acknowledges that hierarchy and authority contribute to the creation of interpersonal mush and that ‘interpersonal mush is greatest in situations of unequal power’ (p. 26). Yet we contend that Bushe and others adopting an organisational development perspective (e.g. Argyris) overemphasise how much control/agency individuals have in unsettling interpersonal mush without fully taking into account the pervasiveness of macros forces of power. We extend Bushe’s work to more fully take into account context and how it can serve to create and sustain interpersonal mush, specifically how the complexity that middle managers face in health-care serves as a ripe context for creating interpersonal mush and the implications for this on reflection and reflexivity. We also acknowledge more explicitly the broader discursive considerations, power dynamics and material effects middle managers in health care face in such socially constructed realities regarding the governmentality of health care. We agree with Bushe (2006) and Argyris that talking or writing (e.g. Left-Hand Column technique, see Putnam, 1999; learning conversations, see Bushe, 2009) through the ambiguity that individuals experience may provide opportunities for individual and organisational learning (e.g. outcomes such as improved retention, productivity and collaboration, see Bushe, 2009) and that senior leaders need to champion this process. We do not, however, align with Bushe’s (2006) view that ‘the fantasies and stories’ that individuals construct ‘tend to be more negative than the reality’ (p. 158). Our intent is to recognise that the context that middle managers negotiate is just as much, if not more, constructed by others who hold more ‘powerful’ positions and by broader macro-discourses that influence ways of thinking and doing to foster a responsibilisation (Rose, 1999) response. Under such circumstances, the risks associated with voice include considerable negative material effects, thereby creating a context where defensive routines persist.

Research on implicit voice theories also helps to explain how interpersonal mush contributes to silence and unvoiced inner dialogue, impeding reflection. Implicit voice theories explain ‘taken-for-granted beliefs about when and why speaking up at work is risky or inappropriate’ (Detert and Edmondson, 2011: 461). Individuals seldom discuss these without prompting or provocation and are largely unaware of their impact on behaviour. While managers may be vocal on many issues, as expected in their roles, they may remain silent on other issues (Morrison, 2011). Such silence can be traced to structures and practices that reflect top management’s implicit beliefs, beliefs that are not supportive of upward communication (Morrison, 2011) and make speaking up risky. The resultant silence perpetuates dysfunctional behaviours that undermine personal well-being and organisational productivity by reducing innovation and interfering with efforts at organisational change (Morrison and Milliken, 2000). We contend that providing an opportunity for managers to voice what they individually experience in their organisations (their inner dialogue) may serve to uncover mundane, yet pervasive practices shaped by a governmentality of health care. Extending Cunliffe (2002), it may also serve to unsettle individual and organisation-level interpersonal mush that impedes reflection, change and learning. In this way, VID can provide a path to reflection and possibly reflexivity.

VID as relational reflection-on-action and an opportunity for reflexivity

Schön (1983) argues that both reflection-in-action and reflection-on-action are necessary to become an effective practitioner. Jordan (2010) proposes reflection-in-action as necessary for dealing with organisational complexity while suggesting that instituting reflective practice is problematic given webs of social and power relations that surface goal conflicts, identity struggles and ambiguous interpretations of shared values. We extend this argument and contend that in such contexts, where reflection-in-action and reflection-on-action are not fostered, interpersonal mush will impede individual and organisational learning.

While reflection can be viewed as a static state in which one observes one’s own practice, reflexivity has purposeful intent (Bolton, 2010) by exposing and questioning those practices (Hibbert et al., 2010). Reflexivity enables managers to remain open to seeing disconnects in a system, especially disconnects between what is happening and their own values (Moon, 2009). Although managers intuitively sense what it is they wish to achieve, not enough attention is paid to ‘that inner voice’ (Korthagen, 2005: 379). This suggests that, through individual reflection and reflexivity, what may have seemed an individual struggle can sometimes connect with a process taking place on a broader level within the organisation thereby creating ‘… the possibility to (re)discover the alignment of personal and organisational needs’ (Korthagen, 2005: 383).

Reflexivity is driven in conversation with others – a relational or dialogic conversation (Cunliffe, 2003). Corlett (2013) proposes participant-focused reflexivity arguing that in interaction with someone or something, the participant experiences a sticky (Riach, 2009) or striking moment (Cunliffe, 2002) triggering reflection and reflexive questioning of thoughts, actions and being, and leading to different insights (Corlett, 2013; Cunliffe, 2002; Hibbert et al., 2010). Here, we build on Corlett’s (2013) work to offer VID as a subconscious processing that emerges through dialogic conversation – a reflective and reflexive lens through which managers begin to recognise apparently independent and disconnected elements of lived experiences. We extend Corlett’s (2013) work by drawing particular attention to the role of context and interpersonal mush, in impeding reflection and how, through interaction between researcher and participant, participant-focused reflection and reflexivity are an unexpected outcome. Figure 1 depicts how we understand the nexus between context, interpersonal mush, silence, lack of reflection, dialogic conversation and VID as a form of relational reflection-on-action.

Figure 1.

Unsettling interpersonal mush through dialogic conversation: an opportunity for voiced inner dialogue as relational reflection-on-action.

Research design

This research is a part of a wider interpretivist study that took place during 2010 and 2011. Following Cunliffe and Eriksen (2011), we take a relational approach where our emphasis is placed on social constructions of organising. In conversations, participants and researchers engage in shared meaning-making. For the wider study, the authors worked collaboratively with middle managers at the case site to assess LD needs within the organisation.

Data collection

We adopted a qualitative approach, providing an opportunity for participants to re-tell experiences in their own words through rich descriptions. Interviews with 32 middle managers ranged in duration from 42 to 80 minutes and were taped and transcribed. Participants are referred to here by pseudonyms.

In line with our qualitative and interpretivist approach, interviews were semi-structured with both authors working from a common set of 38 questions. Not all questions were addressed in every interview, but all interviews were initiated with questions relating to LD at Horizon (e.g. Why is LD important at Horizon? Does Horizon develop leaders or managers?), followed by questions intended to uncover issues related to organisational climate (learning opportunities, decision making, healthy workplace practices).

Data analysis

For the wider study (on LD needs assessment), we adopted an exploratory approach with each author engaging in initial and interpretative readings (Mason, 2002) and inductive coding. No prescribed codes or themes were established in advance allowing each author the freedom to explore and generate emergent codes. Collaboratively we then engaged in a process of filtering, comparing and refining the initial emergent codes into more meaningful themes. The development of VID for this article emerged later and surfaced from one of the sub-themes of the larger study. The sub-theme, namely, (un)healthy leaders for a (un)healthy workplace, depicted what we interpreted as a paradox of espoused ‘health’ and participants’ lived experiences of ‘unhealthy’. Participants recounted practices and policies that they (and we) felt contradicted a ‘healthy’ workplace and ‘healthy’ leadership (e.g. regularly staying late after working hours, never taking lunch breaks).

We found ourselves engaged in many follow-up discussions around what we perceived as participants’ struggles to enact a ‘healthy workplace’ in a context where ‘health’ was espoused as a part of its vision and mission. Following the completion of the initial LD study, we re-read the data to better understand these struggles. Collaboratively, we interpreted that when the questions moved from discussing organisational practices (e.g. How would you describe/characterise the decision-making model at Horizon? How does Horizon support or prepare middle managers for the complexities of change?) to personal practices (e.g. Do you feel obliged to work at home? Do you feel that Horizon does enough to encourage/create a healthy workplace culture?), participants appeared to exhibit a shift from instrumental rationality (Bourne and Forman, 2014) in ‘performing’ an organisational role to admitting personal struggles and limitations in attempting to live up to that role. To help explain these insights, we went back to the literature and explored several different streams (e.g. interpersonal mush, implicit voice theory, reflexivity). This iterative and collaborative process led to the development of the concept VID.

The first author’s interview with Tara illustrates the shift that we interpreted and the emergent VID that was unsettled through conversation with the researchers. Tara was asked, ‘how would you describe the decision-making process at Horizon’. In response she expressed support for the senior leadership’s desire to ‘make decisions using evidence’ and establish ‘good processes and structures’. Despite her perceived lack of information and help in implementing new technologies and processes, she was not critical of the members of the Executive Management Team (EMT) and was ‘optimistic’ that her team would receive the support needed ‘someday’. When the focus of the interview questions shifted to Tara’s personal practices and how the organisation fosters healthy work practices (e.g. do you take lunch breaks, does the organisation encourage you to do so), disconnect begins to emerge. She acknowledged she rarely took a lunch break and that such a practice was unhealthy (‘[I] eat at my desk and I know that’s not healthy’). As the first author continued to inquire into other specific practices (e.g. ‘would it be a regular occurrence for you to sit down at the computer or Blackberry [at home]’), Tara first rationalises checking her Blackberry at home and that it is ‘easier to take it [messages] as it goes instead of getting a big surprise later’. She also notes that reading and responding to such messages at home do not negatively impact her well-being (‘I don’t get all agitated about things anymore’). We interpreted she was expressing that she is able to manage the various pressures well and that this is part of her subjectification process; it is who she is. When pressed about expectations of senior leaders (e.g. completing work over the weekends), however, she admits to feeling pressure to respond. While noting that she wouldn’t ‘necessarily do it [work]’ and that she ‘doesn’t always feel’ she has to, she states that she usually does do the work. We interpret this as an example of the governance of (self)assuring, well-performing managers. As Tara continues to reflect on these practices in the interview, however, she expresses that it is ‘disrespectful’ to not give middle managers enough time to prepare. Later in the conversation this felt disconnect between espoused and enacted values surfaces more clearly as she releases herself from the responsibility of the organisation’s failures (‘I think I do a pretty good job’) and admits that she is unable to support the organisation’s agenda (‘I can’t even sell it … which is a problem for the organisation’). This indicates a considerable shift from her initial position of empathy, patience and optimism with the processes, practices and senior leadership.

In collaborative coding and subsequent discussions, we agreed that we did not interpret such a shift (or VID), as illustrated in the conversation with Tara, with all 32 participants; however, this shift and the themes we discuss here were salient across most participants’ accounts. In addition to Tara, we include the voices of 15 participants as compelling data to illustrate our findings.

Reflecting upon our interactions with participants we argue that participants’ VID emerged in part because participants were rarely afforded the time to talk reflectively about LD (their needs, struggles) and the context in which they operated (see also Marchildon and Fletcher, 2015). We also suspect that the sequence of questions and type of questions asked (organisational practices then individual practices), as well as the supportive yet challenging coaching style of questioning we used, fostered the emergence of their VID. The semi-structured interview approach allowed us the flexibility within the interview to interpret participants’ responses and relay back to them our sense-making of their experiences. In this way, the dialogic conversations were a shared meaning-making process between researcher and participant. When our interpretations aligned with participants’ views, they offered further supporting points (see conversation with Brian in findings). However, when they disagreed with our interpretation, as they often did, it served as a contrast point for them to clarify their intended meaning (see conversation with Brenda in findings). Participants’ willingness to ‘correct’ us when we ‘got it wrong’ increases the confirmability and thus trustworthiness (Lincoln and Guba, 1985) of our conceptualisation of VID and the findings.

In what follows, we first discuss, through illustrative accounts, how technologies of governmentality were at work in the broader context of the organisation, as well as specifically through LD. We then present three themes that emerged from our re-readings of the interview transcripts through a lens of VID. These include Reacting not Reflecting, Noticing Cracks in Espoused Values and Lived Experiences and Questioning the Implications for Leading and Living. We aim to illuminate how VID emerged through our conversations with participants, how the context informs an interpersonal mush which informs particular subjectivities and impedes reflection, and the implications for learning, leading and well-being. The themes are presented in what appears to be a phase-like manner; however, similar to Corlett (2013) in her re-presentation of research as a dialogic process of learning, we do this for analytical clarity and ‘no ordered sequence … is intended’ (p. 457).

Findings

We interpret that the effects of governmentality surfaced in our conversations with middle managers and that such ‘forms of power, authority, and subjectivity’ (Rose et al., 2006: 101) are developed within ‘mundane practices’ (p. 101). They emerge as an instrumental rationality (Bourne and Forman, 2014) whereby individuals accept unquestioned the privileging of organisational norms and goals. This is vivid in our conversation with Kayla. She takes personal responsibility for working more than 40 hours per week, emphasising that it is ‘her choice’. She normalises these working habits as an expected part of being a manager in this context. While she acknowledges that such a tactic is partly a way to manage the ‘crazy’ workload, she also appears to have internalised that a (good) manager is not ‘resistant’ to such expectations:

Kayla:

It is more of a personal choice trying to manage my own timelines and my own work style … there is a significant amount of work so I don’t think it is reasonable to expect this is a job that only takes 40 hours a week and so it has never been my expectation, I have never been resistant to that.

Researcher:

Around those extra hours, do you come away with a sense of satisfaction from that extra time put in or is it more a case of ‘I’ve got to stay and get this done or tomorrow is going to be crazy’?

Kayla:

Oh it’s both. I think staying until they are done so that tomorrow won’t be crazy and it gives me a sense a satisfaction that knowing that when I come in the morning I have a reasonable workday.

Researcher:

But you don’t think that is a control issue? (chuckle)

Kayla:

I prefer to think of it as managing my work flow (chuckle).

In a similar way, Katherine normalises that there is more work than time for managers, not only in health care but in any organisation, and that managers need to be taught how to ‘balance’ and succeed given those circumstances. We interpret that she illuminates how in this context LD can serve as a technique of governmentality, where managers learn that they have a responsibility to give back to the organisation. We suggest this manifests as a project of the self:

I don’t care what organisation you work in or what management job there is always more work than time and there is more work than energy so it’s really about how do we help – how do we teach managers and leaders to have – to get balance and what are the skills? I don’t think people have the skills to do that.

So it wasn’t enough … to go and say, ‘Oh, well you know I can now balance my life better and I can do this better’ [following a LD program], if you’re not gonna produce a change in the organisation we would not see that as a success and the other thing we wanted people to do was we wanted people to give – to teach what they’ve learned and to give back to the organisation so we felt that your return on investment would come there. (Katherine)

Horizon adopted the LEADS framework in 2011, and as such, discourse around LD was centred on the pivotal role of managers (as leaders) in advancing organisational goals while balancing these with personal development; hence, the initiative’s banner, Healthy Leaders for a Healthy Workplace. The promise inherent in this suggests that, with sufficient effort, managers can balance work demands with continued personal development for the achievement of organisational objectives, as well as personal health and well-being. This responsibilisation was evident in Alexa’s optimism about the adoption of LEADS in that she hoped it would ‘engage employees … in their own personal development’ and ‘help us to define for people … give them some ownership … in terms of their development in leadership’.

We now turn to discuss three themes through which participants’ VID emerged in conversation with us to highlight further how the context informs an interpersonal mush, which in turn has implications for particular subjectivities and reflection.

Reacting not reflecting

Amid a context of normalised crisis, a need for decisiveness and competing demands, we interpret that participants’ VID reveals a vulnerability whereby in trying to lead in such a context, individuals question their competence as effective leaders and managers, internalising responsibility for outcomes in situations where they have little control. Participants express they are unable to do their jobs effectively. We argue that the effects of governmentality can be seen through such self-doubt. This self-doubt emerges through rhetorical questions and self-criticism regarding their ability to plan appropriately and meet imposed deadlines, think strategically, find time for professional development or reflect upon the decisions they make in practice. The context fosters working in reactionary mode, thereby preventing reflection and impeding learning. We interpret Reacting not Reflecting as suggestive of how particular subjectivities are formed and how in this context leaders’ opportunities for reflection and reflexivity are hindered, thereby creating and sustaining both individual and organisation-level interpersonal mush.

In talking about the lived culture, managers acknowledged that the operative mode they had adopted in Horizon’s ‘always on’ culture was reactive, not proactive. Decisiveness and timely responsiveness informed the middle manager professional identity. Rupert suggests that they constantly work to short timelines with little to no advance notice and/or opportunity to negotiate what is perceived as unreasonable deadlines imposed by top management:

We react a lot to what comes our way … suddenly an e-mail will appear and you’ll read it and you say ‘Holy cow!’ [chuckle] That’s what I’m doing for the next three days right? It was never on my agenda … and everything has to be done in ten days. We don’t get anything that says, well we need this by fall. (Rupert)

Time, and lack thereof, was an issue expressed by many. Rather than question and challenge the demands placed on their time or on unreasonable turnaround times, participants took personal responsibility for failing to manage their time. Participants also acknowledged that there was no catching up. Time was always a concern – not enough time for LD, not enough time to meet the demands of the job, not enough time to reflect. This lack of opportunity to reflect emerges in Donna’s account. At the same time, Donna internalises responsibility for not making time, rather than questioning the organisational context (or broader discursive forces):

Donna:

I think you have to make the time to do it [self-evaluation] if you are going to do it … I don’t think it’s your work life (chuckle) but I don’t think – it’s not – we don’t have a separate place to do that. … I wouldn’t say I’m a real reflective person: I’m a go, go, go, go person so I have to force myself if I get overwhelmed and say ‘Okay what are your priorities, what are you doing’.

Researcher:

Do you think with regards to yourself or others, do you think that you are adequately equipped for that self-reflection time?

Donna:

Mmm.

Researcher:

How do you do it? What do you do with what comes out of it – that type of thing?

Donna:

I always think you can get better. I think probably there are better ways to do it – there are probably better systems like mentoring and those types of things: I think that would be a really good thing for new leaders in this organisation. I know when I first took on the job I found it very hard because what you do is try to seek out other people who have similar you know responsibilities but you are really not allowed to talk about a lot of the things because of the confidentiality with staff so you have to be very, very careful.

Donna describes herself as ‘go, go, go’, and we contend in doing so she downplays the organisation’s responsibility to foster reflection and reflective practitioners. She expresses that she is not reflective person; it isn’t who she is. We see here how governmentality works through the governance of the self. We interpret that the self-doubts expressed by Donna denote the pervasiveness of interpersonal mush, shifting responsibility from the ‘organisation’ onto individual middle managers. Drawing from these experiences, we contend that the interpersonal mush in this organisation is characterised, at least in part, by an assumption that effective leaders take control of their circumstances and are able to manage their time and meet deadlines regardless of contextual considerations.

Brenda expresses this responsibilisation in reflecting on the organisational context post-amalgamation:

Probably the first year [post amalgamation] we just felt like we were floating out there that we didn’t – nobody cared and we were just sort of isolated … But basically through that whole period it’s … how you make it better yourself because the organisation wasn’t doing that for you and our leaders didn’t have time to do that for us.

In rationalising her use of technology to manage her time, Brenda insists that the choice is hers. This is despite her admission that she works weekends and late at night, as well as having a work computer at home:

Researcher:

… you mentioned the Blackberry: so you would have it and check your emails in the evenings – is that something that you do every evening or is it if you were expecting an email you might be checking?

Brenda:

If I am expecting an email. Sometimes I use it as my alarm clock so if I’m setting it to get up the next morning I would just look and see what’s come in.

Researcher:

So there is no pressure on you. …

Brenda:

No, no. Sometimes I mean if I have something come in from my boss or VP in the evening – and I feel like it I will respond – depending on what it is but for the most part there is no pressure, I don’t think, I don’t feel it.

Researcher:

Do you feel obligated to work at home?

Brenda:

No and I also have a work PC at home but again if I choose to I choose to.

Similarly, Brian discusses how he ‘chooses’ to come to work an hour before his shift starts and that he is not ‘forced to do it’. He emphasises his agency, thereby shielding the organisation from a responsibility to ensure reasonable workplace conditions and demands. He expresses an acceptance of the new working order, one no longer defined by ‘nine to five’ and as such he adapts and models a particular professional role to meet those changing needs. His conversation also reminds us of the disciplinary power that Foucault (1979) talks about and it could be argued that work supplied mobile devices such as Blackberries serve as a type of Panopticon, a type of surveillance which results in the individual regulating their own behaviour:

Researcher:

Can you leave at the end of the day when your official day ends? Or do you tend to be here longer at the end of the day or do you take work home with you?

Brian:

Both (chuckle) – all three … Yeah I mean generally speaking at the end of the day it’s a time to clean up and get ready for the next day. I don’t always get out of here on time and I’m always in early, you know. I’m always here an hour before the time I start my shift but I choose to do that – that is not something I am forced to do; it’s because I don’t like to come in and have – I like to have one day done before I start another day so to speak.

Researcher:

So to stay on top of things it does require coming in early and staying late.

Brian:

Yeah and the Blackberry helps as well because you can do a lot of your emails after hours you know, clean up on that; but no it’s not something I have an issue with.

Researcher:

Do you resent that intrusion into your private time or your personal time as you say you can catch up on emails on the Blackberry at home – but that means you’re still working?

Brian:

Yeah it’s an issue – it affects your home of course because you’re still doing that type of – you’re still spinning at work but it helps your workday. You’re not in that pressure mode all the time like normally you would be you know.

Researcher:

It’s a matter of keeping it under control and requires that extra time and effort.

Brian:

Yeah we no longer have a nine to five day job anymore – we are not living in that type of world anymore.

Participants expressed a desire to stretch and learn; however, they appeared powerless and stuck in survival mode. A reactive, crisis mode and always-on-call climate inform the background conversation (Ford, 1999) and subconscious mind of the organisation (Bushe, 2009) impeding middle managers’ efforts to be reflective. We argue that an interpersonal mush informed by a governmentality whereby effective managers are able to manage their time and deadlines regardless of context is pervasive. It distracts managers from recognising and challenging these underlying assumptions and impedes opportunities for individual and organisational learning. We contend that the interviews raised participants’ consciousness of their reacting, not reflecting. In so doing, the interviews helped to surface individual background conversations and to voice these in conversation with us, moving the conversations from the subconscious. In the next section, we illustrate how in conversation with us participants’ voices disconnect between a desire (e.g. to learn) and the actuality of achieving it.

Noticing cracks in espoused values and lived experiences

Early in our conversations, middle managers held to the organisation’s espoused rhetoric and we interpret that in doing so they conceal or rationalise their lived experiences, attempting to achieve a balance between their professional and personal well-being. Fragments of narrative self-reflection, however, did emerge offering a lens through which we began to glimpse their growing realisation of disconnect between the organisational rhetoric and their own efforts to enact the expected ethos. Following Corlett (2013), Riach (2009) and Cunliffe (2002), in interaction with us, as participants talk about work they experience a sticky (Riach, 2009) or striking (Cunliffe, 2002) moment which triggers reflexive questions whereby they are Noticing Cracks in Espoused Values and Lived Experiences – a gap between espoused and enacted practices of a healthy workplace. These conversations begin to unsettle the subjectification project of governmentality.

Middle managers indicated that they were empathic to the challenges that members of the EMT faced and they modelled their behaviour. As such, middle managers’ subjectivities were informed by social relations with members of the EMT. Gail implies that she expected members of the EMT to serve as role models for healthy leadership in action: ‘We won’t feel okay until they take care of themselves too. Then we’ll say, Oh yeah okay. Well if they do that then we will too’. Without a clear organisational commitment and performance expectations for workplace wellness in action, managers like Gail quietly acknowledge failed efforts and rationalise these as a ‘no choice’ trade-off at their level and the level above.

At the same time, managers appeared frustrated by what they perceived to be ‘mixed signals’ in this regard. We interpret the mixed signals as an emergent disquiet whereby middle managers begin to acknowledge their assumed responsibilisation. Several expressed feeling supported, respected and valued while acknowledging the fiscal constraints and time-pressured environment within which members of the EMT attempted to move the organisation forward. Yet, they quietly resented the unexpressed but implied ‘24/7’ expectations and cultural norms that condone excessive hours or over time: ‘Defensive reasoning encourages individuals to keep private the premises, inferences, and conclusions that shape their behaviour’ (Argyris, 1991: 103). Among the most frequently cited inconsistencies were unintentional mixed messages, everything from Blackberry protocols to the perceived value placed on work–life balance. We interpreted ‘unhealthy’ practices as those that consciously or subconsciously blurred the lines between work and home: ‘covert catch-ups’ such as arriving at the office an hour early to check voicemail, email and sign papers; continuing to ‘spin’ with thoughts of work while being physically present at home; and waking through the night to check for messages.

As participants talked through what they felt were the expectations of members of the EMT, fragments of narrative self-reflection did emerge through which we interpreted a shift from self-criticism to critically questioning the appropriateness of those expectations and the assumptions that underpinned them. The tone of the conversation changed from ‘towing the organisational line’ to criticism of accepted modes of operating. There is a powerlessness experienced by middle managers, what we interpret as their ‘forced’ silence (i.e. defensive reasoning) and lack of choice in responding to the demands of their work – indirectly told not to work at home but asked to complete work during the weekends or ‘in the middle of the night’ (Douglas). Douglas expresses that he ‘knows’ when to say ‘no’, yet he also indicates there are times when he feels he has to respond:

I know when to say ‘No’ but if there are some things that are pressing like you might get a message in the middle of night ‘Sorry to bother you but I need this information by tomorrow morning because I’m going into a meeting at 10 o’clock’ then you have got to scramble and try to you know – and lucky that using technology again – the Blackberry I’ve got remote connect to the servers here from home that type of thing I can just jump on and do stuff but right now it’s not a healthy culture here because of that. (Douglas)

In talking through their experiences of conflicting messages some participants suggest alternative ways of operating were necessary, recognising a gap between espoused values and their lived experiences. Mavis expresses the need for the organisation and those leading to consistently enact the organisation’s espoused values, thereby challenging the interpersonal mush which contributes to defensive reasoning, sustained silence and impedes individual and organisational reflection and learning:

Sometimes you see that [organisational ethos] in action and then sometimes it’s absent. So what would resonate with me is a focus on our values because as an organisation our focus is on our strategic directions and what every department’s doing in terms of objectives and how are you measuring your progress and indicator, indicator, indicator. Results, results, results. Which is necessary but there needs … to be as much if not more focus on the values and demonstrably living them to build that trust. (Mavis)

Members of the EMT appear to act in ways that stifle voice without realising that is what they are doing. Following Morrison (2011), constraints on time and attention mean that leaders may not listen, may not appear open and may respond brusquely to suggestions and concerns. We extend Morrison’s (2011) argument and contend that such behaviour creates and sustains interpersonal mush, defensive reasoning and silence.

While rationalising the organisational challenges of such a pressured environment, managers (such as Bill) acknowledge that the organisation was not living its values of supporting healthy workplace practices for everyone:

… to move some of that stuff [health as a priority for staff] forward the organisation needs to take responsibility to pay for some of it … whether it’s paying by putting in facilities, whether part of their hourly wage is covered, whether it’s paying gym memberships– we’ve gotta pay to encourage that because we expect a lot out of staff; they work a lot of long, hard hours … even the pieces around healthy workplace in terms of dignity and respect for your friend, for your colleagues and your managers; that’s a big piece that we gotta keep driving home too. (Bill)

As we interpret the accounts of Mavis and Bill, cracks emerge and participants reveal a disconnect between organisational espoused values and what they voice as half-hearted efforts on behalf of the organisation to live out these values. We interpreted these as sticky (Riach, 2009) or striking (Cunliffe, 2002) moments. Moreover, these two participants express how they identify with the espoused values and expect an alignment between espoused and enacted so that ‘dignity and respect’ and ‘wellness’ drive organisational decisions and practices.

While common to the health-care sector, the culture of overwork (Bourne and Forman, 2014) appears paradoxical in relation to Horizon’s espoused values. Responsibilisation (Ferlie et al., 2012) leaves middle managers with the personal responsibility for organising and prioritising individual goals (e.g. work–life balance, health and wellness) and organisational goals (e.g. patient care, quality and safety, cost containment). This occurs against an espoused ethos of healthy leaders for a healthy workplace all the while ensuring an unspoken but clearly implied privileging of organisational goals as enacted at the individual level. Middle managers are effectively silenced by organisationally implied role expectations (Ceci, 2004), unable to voice their experienced conflict. Bushe (2009) contends that interpersonal mush is sustained in organisational cultures where managers do not work at creating interpersonal clarity. ‘Rational discussions in which people make lists of good intentions, create organisational visions, and write values statements soon disappear, swallowed up in the interpersonal mush’ (p. 43). As these participants reveal their previously unvoiced inner dialogue to us, we reflect and ponder that managers cannot create interpersonal clarity without first creating intrapersonal clarity. This process is hindered when they are unable to reconcile their own experiences and practices with organisational rhetoric and goals.

Questioning the implications for leading and living

Participants revealed a sense of torment and dissonance as they talked through their realisation of disconnect between espoused organisational practices, their ‘realities’ of leading in this context and the implications for their own leadership practices and personal well-being. Managers talked of the trade-offs (e.g. no lunches, working late, working at home) in their attempts to meet organisational expectations and found themselves Questioning the Implications for Leading and Living. Here, interviews served as an opportunity for participants to experience ‘being struck’ as a spontaneous sensation (Corlett, 2013: 456), a form of participant-focused reflexivity and learning. Numerous participants talked about eating lunch at their desk while they worked and having meetings during lunchtime. At points in the interviews participants acknowledged the negative impact of the interpersonal mush – the background conversation of ‘always on call’ and ‘self-sacrificing’. Joanne raises concerns about the impact on her own health, and while appearing unable to change her own entrenched ethos, she advocates for others to consider doing it differently:

I don’t think that senior management probably has any idea how much over time is being done by their people because there is no system to track it. It’s like they don’t want to know … So, it’s cultural – you are expected to do it … you know I put in many, many hours of over time. I would describe myself as a workaholic and I realise that my work ethic isn’t healthy and I wouldn’t condone it on anyone. (Joanne)

Managers readily acknowledged their personal compliance in responding to implied expectations and pressures and recognised that they too were sending mixed signals to those they supervise. Carolyn’s comments highlight how reacting and not reflecting has implications for leading and well-being:

Carolyn:

I’m a visionary and I am a go-getter and there’s a whole lot more of us in Horizon very dedicated, hardworking people but it is becoming more and more challenging; we’re change fatigued. I guess that’s the only way to describe things at this point in time. And so you know it is difficult to keep your head above the water and keep the demands on the go. There’s little time to reflect

Researcher:

Mmm.

Carolyn:

Which is in itself … necessary. There is – you’re in reactive mode twenty-four seven … It seems like that and … there’s more and more demands placed on us which is fine but at some point in time people are gonna crash; personally I believe that and … and it’s got to. I mean if I’m feeling it I’m sure my staff are feeling it too.

The pervasiveness of the interpersonal mush was transferred to their leadership practices and affected their relations with their staff. Krista recognises that they are setting the example for their staff:

I find the more I model this go, go, go, go they [subordinates] pick up on it. … I shouldn’t underestimate the barometer that I am because when I’m all wound up they are, so I try really hard … (Krista)

Some talked about trying to make changes that were positive for them and their staff, but it was hard to sustain such practices. Good intentions were frequently side-lined by work pressures and participants confessed that not only were they being short-changed in this balancing act, so too were their families. This penetration of work into the increasingly permeable boundaries of home life worried many middle managers, especially those with young families. They expressed considerable concern in a number of ways such as around needing help in setting priorities; in negotiating reasonable timelines on requests; in finding a balance between seemingly endless work pressures, personal wellness and family commitments; and in finding time to simply reflect and retain some perspective amidst the persistent turmoil. Unable to find a way ‘out of it’, Susan manages the demands by staying late at work or bringing it home and working ‘when the kids are in bed’.

Most participants offered accounts which we interpret as reflection, specifically reflection-on-action, rather than reflexive engagement. We propose that such reflection-on-action may create space for future reflexive thought and action. There was, however, an expressed desire to alter behaviours which we interpret as glimpses of reflexivity in trying to find alternative ways of being and leading in this context.

Discussion

We propose the concept of VID as a form of relational reflection-on-action in which fragments of narrative self-reflection trigger the realisation of disconnect between individual thoughts, actions, beliefs and identities and the organisational rhetoric and mundane practices of governmentality. In this setting, VID reveals a juxtaposition arising in the context of a health-care organisation where the espoused ideals of healthy leadership and a healthy workplace failed to match the reality of middle managers’ lived experiences. One of our key contributions is illuminating how context can inform the creation and maintenance of a backdrop conversation or interpersonal mush at the individual and organisation levels. Such interpersonal mush contributes to silence, defensive routines and unvoiced inner dialogue, impeding reflection. We propose that through dialogic conversations, in our case in relation with the researchers, interpersonal mush might be unsettled. VID therefore opens space for reflection and reflexivity. At the same time, we acknowledge that questions remain around how managers might be able to engage in reflexivity while preventing negative personal consequences (e.g. job loss) given the pervasiveness of governmentality.

In this study, Horizon’s LD initiative of healthy leaders for a healthy workplace can be interpreted as responsibilisation of personal health and well-being: ‘Individuals are addressed on the assumption that they want to be healthy and [are] enjoined to freely seek out the ways of living most likely to promote their own health’ (Rose, 1999: 86–87). Professional identity becomes a process of balancing personal experiences with the expectations of ‘powerful’ others, where identities are performed ‘in context, relating to environmental norms and ideals’ (Bludau, 2014: 877). Personal self-esteem is tied to the identity of the organisation with the individual motivated to uphold the legitimacy of the organisation (Humphreys and Brown, 2002) despite normative workplace practices that undermine individual efforts to be healthy. Healthy practices are constructed discursively as a personal responsibility despite workplace practices that undermine individual ability to be healthy. ‘Individuals are “subjectified” into workers, consumers and citizens who can be entrusted to make the “right” decisions for themselves’ (Martin et al., 2013: 81). An organisational message espousing healthy leaders is all that is required to ‘motivate’ managers to make the ‘right’ decision in prioritising work over personal health and well-being.

Our study supports Moon’s (2009) contention that self-awareness and reflexivity enable managers to remain open to seeing disconnects in a system, especially disconnects between what is happening and their own values. We build on Corlett’s (2013) participant-focused reflexivity for surfacing sticky or striking moments (Cunliffe, 2002; Riach, 2009) by drawing particular attention to the role of context and how it informs an interpersonal mush (Bushe, 2006, 2009) which impedes reflection. In conversation between researcher and participant, a subconscious processing is activated, serving as a reflective lens through which managers begin to connect apparently disconnected elements of lived experiences.

Middle managers play a key strategic role in terms of organisational learning and adaptation (Wooldridge et al., 2008), particularly with increasing organisational complexity (Balogun and Johnson, 2004). Reflection is central to transformative learning (Jordan et al., 2009), but as Keevers and Treleavan (2011) suggest, the complex and dynamic context of health care challenges reflection. It requires a more critical engagement that moves beyond detached reflection to expose the individual and organisation interpersonal mush (Bushe, 2009). ‘In a complex organizational and professional environment, selecting to act solely on individual subjectivity ha[s] limited efficacy’ (Martin et al., 2013: 85). Greig et al. (2012) note the importance of relational practices in accessing such contexts. Participants’ accounts in this study support such a view that in conversation with the researchers, opportunity for reflection emerges.

Jordan (2010) suggests that problems in realising reflective practice in organisations are potentially grounded in goal conflicts and ambiguous interpretations of shared values latent within implicit voice theories (Detert and Edmondson, 2011). ‘Naming and inquiring into dilemmas and inconsistencies is a difficult enterprise … [yet] not discussing them leads members of organizations into a thicket of covering up …’ (Putnam, 1999: 186) and this blocks knowledge sharing and organisational learning.

Horizon middle managers embraced responsibilisation to such an extent that they had effectively dismissed (i.e. buried) their experienced reality. Following from Ceci’s (2004) work also in a health-care setting, we conclude that ‘the effect here was to construct, and then privilege, a specific, albeit contested version of reality, to make one understanding function as real while neutralising or suppressing another’ (p. 1885). Their silence allowed a continued privileging of the organisation’s perspective and priorities. While it would appear that in this particular organisation, action and reaction were privileged over reflection, the opportunity to sit with the authors provided participants with a rare opportunity to engage in reflection in the presence of another. As such, these conversations served as proxies for the kind of ‘interactive routines’ (Jordan et al., 2009) important in organisations for the discovery of the unexpected. The conversations served to trigger managers’ awareness of the ineffectiveness of currently accepted practices in terms of the espoused values and goals of a healthy workplace.

Change entails bringing new conversations into the organisation, shifting what people talk about and making new actions possible (Bohm, 1996). Extending Cunliffe’s (2002) work, we advocate for a critical questioning through reflexive dialogical practice as a means to help managers become aware of how assumptions, ways of talking, theories-in-use (Argyris and Schön, 1974) and defensive routines (Argyris, 1999) help shape and are shaped by responsive interactions with others. Furthermore, we extend Bushe’s (2009) work on organisational learning conversations, as surfaced here through VID, to enable ‘escape from interpersonal mush [to] create interpersonal clarity’ (p. 49). Giving voice through relational dialogue may precipitate a mindful process of moving from simply reflecting-on-action to reflecting-in and transforming actions, thereby opening an opportunity for reflexivity.

We propose that other forms of dialogic conversations similar to that as described here can foster opportunities for reflection-on-action, in-action and reflexivity in such complex environments. Other authors stress the importance of reflective practices such as applied drama and theatre, storytelling, journaling and reflecting on critical incidents in building the social capital necessary for organisational learning (Nakamura and Yorks 2011; Pässilä et al., 2015). Coaching has also been effective in encouraging organisational members to speak up (Edmondson, 2003) and holds potential for fostering reflexivity through incorporation of relational dialogic practices.

While triggering awareness is critical to precipitating change, it is only a first step. Whether, even at the individual level of action, managers can initiate and sustain important changes to support personal health and well-being remains a question. As Cunliffe and Jun (2005) suggest, conscious and unconscious pressures to maintain the status quo are significant and persist unquestioned, particularly in the bottom-line pursuit of rationality and efficiency.

Conclusion

While the wider LD needs assessment process did not include additional opportunities for shared or ‘public’ reflection, a final report on LD needs was presented to Horizon’s Leadership Advisory Council in October 2011. The report recommended mindfulness awareness practice, coaching and mentoring as effective strategies for addressing the challenges of leading in a complex environment. Horizon had, however, shifted its LD focus to implementation of the LEADS competency framework as a performance management system, leaving managers ‘free’ to determine individually how to achieve healthy leadership.

In a subsequent pilot study at Horizon (of which the first author was co-investigator), 400 managers were offered the opportunity to participate in an intensive weekend mindfulness awareness training retreat designed to develop and sustain a personal practice. Only 11 attended the training retreat. Despite the small sample, the study (Wasylkiw et al., 2015) did show significant increases in mindfulness and corresponding decreases in stress that were sustained across 8 weeks post-retreat with corresponding positive changes in leadership effectiveness that were corroborated by peers, supervisors and subordinates. The challenge, however, proved to be sustaining practice. Only one of the participants reported continued practice with others reporting sporadic practice or a tapering off over time. In rationalising their experiences, references were made to Horizon’s culture as a barrier to sustaining practice. In this regard, it is perhaps worth noting that Horizon’s current espoused vision is ‘helping people be healthy’, a vision that may not adequately consider the pressures and challenges facing its own employees. Moreover, it further illuminates the embeddedness of the techniques of governmentality in this context.

Through our development of VID, we conclude that a context of governmentality and responsibilisation can foster silence and impede reflection. We illustrate how it informs the subjectivity of managers in pursuit of intended organisational outcomes by presenting an image of the well-performing employee. Leadership competency is presented as evoking this image with managers prioritising role demands over personal health and well-being, all the while internalising the consequent contradictions as interpersonal mush (Bushe, 2009). VID offers an opportunity for managers stuck in the silence of interpersonal mush to engage in relational reflection-on-action (Schön, 1983). Our final thoughts then also acknowledge the paradox of our own reflexive struggles. We hope organisations find more opportunities for middle managers to express VID and to encourage middle managers to enable others (i.e. their staff) to express their VID as a means of moving both individuals and the organisation towards reflection-in-action and reflexive engagement. At the same time, our own reflexive practice leaves us unsure whether such opportunities offered through dialogic conversations (with researchers, coaches or mentors) and mindfulness training will unsettle the effects of governmentality, or whether they simply serve as another technique of its pervasiveness.

Footnotes

Acknowledgements

We would like to thank Sandra Corlett for her invaluable feedback on earlier versions of this manuscript. We would also like to thank the Editor, Todd Bridgman, and two anonymous reviewers for their constructive feedback during the review process.

Funding

This research is funded by a grant provided by Canadian Institutes of Health Research [Award No. 108986] and Horizon Health Network.

Notes

Author Biographies

Judith A Holton is Associate Professor (Management) with the Ron Joyce Centre for Business Studies at Mount Allison University, Canada. Her research interests include leadership and management of complex systems, organizational change, learning and innovation in knowledge work. She has published in Organizational Research Methods, The Learning Organization, Leadership and Organization Development Journal, Advances in Developing Human Resources and The Grounded Theory Review.

Gina Grandy is Associate Professor (Strategy) in the Paul J. Hill School of Business and Levene Graduate School of Business at the University of Regina located in Saskatchewan, Canada. Her research interests are in leadership, gender, organizational change, stigmatized work and competitive advantage. She has published in such journals as British Journal of Management, Organization, Gender, Work and Organization, Journal of Management Studies, Qualitative Research in Organizations and Management: An International Journal and Gender and Management: An International Journal.

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