Writing in organisations

The reason for my journey to Devon was to hear McGilchrist speaking at the one-day Limbus conference at Dartington Hall.* Since I can’t possibly do justice to his thinking in a short blog post, I’ll just share a few thoughts and phrases that have continued to circulate in my mind since the event:

How we pay attention makes a big difference.
Only living beings can pay attention to the world. (A machine can carry out tasks, but it cannot attend, says McGilchrist.) And the fact that we have a divided brain – as apparently all animals and birds do – means we can pay attention in complementary but very different ways. In essence, the left hemisphere enables us to control and manipulate things, steering our attention to detail, clarity, analysis and a-leads-to-b logic – all very useful for our survival. The right brain, on the other hand, allows us to understand the wider picture and deeper meaning and is at ease with connections, paradox, myth, metaphor implicit meaning and feelings.

The modern world is out of balance.
Symptoms of the dominance of left-brain thinking strike me every day – e.g. public services increasingly ruled by measurement and marketisation; people getting busier and busier, lacking the time for reflection on deeper meaning; and interacting more with their devices than with other humans. And this left brain emphasis can make us blind to many things that matter, such as quality, feelings, context and environment.

The left brain has a close relationship with communication and information technologies (or so it seems to me).
Evidently we invented writing mainly to be better able to control and organise things (the left brain’s preference). But then of course every tool or technology we invent makes new things doable and ends up “acting back on us”. Writing, for instance, made highly-organised societies possible, but it also opened the door to excess bureaucracy. Let’s not forget, though, that technologies are intrinsically neither good nor bad – what matters is how we use them. Nowadays some of us feel overloaded by email and distracted by smart phones, but these newer tools also enable a lot of people to work whenever and wherever they want.

Metaphor is a crucial way of understanding the world...
...and was viewed as such up until the Enlightenment in the 18th century. “A lot depends on what you compare things with,” went on McGilchrist. If you compare them with machines, for instance, it has certain consequences. Today, our language is suffused with the machine metaphor – again and again, I am struck by how unthinkingly people use words like “mechanisms” and “feedback” when talking about human communication. In my view, this sloppy use of language cloaks some deep assumptions. It also makes it harder for us to grasp that human communication involves feelings, is interactive, and is seldom (if ever) unambiguous. McGilchrist used a striking metaphor himself, likening left-brain thinking to clear, translucent water, and right-brain perception to the ocean: deep, dark and mysterious.
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That’s enough for now, but I don’t want to finish without mentioning briefly how struck I was by the quality of McGilchrist’s talk. For a whole hour he spoke in a slow and calm manner, barely consulting his notes. I think this allowed him to stay connected with his surroundings and attentive to the human beings in the room. And he projected just one slide: a picture of the majestic mountain he sees from his home on the Isle of Skye. He used it to illustrate the different ways in which we can perceive the world. We might associate the mountain with history, weather, spirituality and the senses, for instance. Or we can simply say “it’s just a rock”. But that would surely not do it or ourselves justice.
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* I'd like to thank the organisers, Farhad Dalal and Julia Vaughan Smith, for putting so much time and thought into the day.

** Astonishing when you think that our alphabet has just 26 letters and (if I’ve got it right) computer algorithms consist essentially of the same 26 letters, plus 10 numbers (0-9) and some grammatical and mathematical symbols.
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“A desk is a dangerous place from which to view the world.” For me, that sentence, written by John Le Carré, instantly conjured up bureaucrats sitting comfortably in their offices deciding the fate of powerless people. But it also evoked other common habits – managers issuing instructions in emails that won’t engage people, researchers writing reports that will never be read properly, or people creating strategic plans that will never be followed.

There are several problems with these habits, not least of which is the implementation challenge. People may not read the written word (and in my experience, many people are reluctant to follow written instructions); those who are meant to implement the plan may be less rational than the author assumes; and by the time the plan has been completed, the environment will probably have changed.

Of course it is often vital to express ideas in writing to help others understand what we are trying to achieve. And the act of writing can help produce greater clarity, at least for the authors. But having produced a document, the risk lies in thinking that the job has been done, when in fact the work of making a difference has only just begun. This is the moment when we need to get away from our desk – or the boardroom table – and talk to people.

So why do some managers continue to spend so much time at their desks? Why do they remain detached from people on the ground? I suspect that for many the thought of a conversation with anybody other than a few trusted colleagues can seem quite scary. I have been there myself. When I worked for McKinsey as a communications specialist (a kind of writing coach and editor) in the late 1980s, one of my challenges was to convince the busy and brainy consultants about the benefits of working with me (it was optional for them). Sometimes I really had to steel myself to walk up to a table of consultants at lunchtime, seat myself down next to them and open a conversation. 

Conversations with strangers may take both confidence and courage. We never know how others will respond or how the conversation will unfold. That uncertainty can be exciting but it can also be uncomfortable. Sometimes it feels so much easier to put down our thoughts in writing and then just send them off. So let’s keep reminding ourselves that the desk is a dangerous place from which to view the world.

Related reading

Zaid Hassan, ‘The Social Labs Revolution: a new approach to solving our most complex challenges’ (which is where I came across the quote from John Le Carré).

Henry Mintzberg, ‘The Rise and Fall of Strategic Planning’ (also quoted by Hassan). See also @Mintzberg141 on Twitter.

We have created a pretty mad world in some of our larger organisations. I am thinking especially of health and education, where bureaucracy and top-down control seem to have taken over – and that’s not just in the UK. 

Over the Christmas period we had a visit from an old friend of my husband who is a General Practitioner in southern Germany. Prompted by my curious questioning, he began to overflow with stories about documentation gone mad. For example, after every patient visit, he now has to enter his diagnosis into a computer system by selecting from a long list of codes. He is also supposed to note whether each diagnostic code he selects is: (a) certain, (b) suspected or (c) can be excluded. 

This system, he says, not only creates extra work but also encourages doctors to provide “invented” diagnoses. In other words, it distorts how they record a patient’s condition. The system originated in Australia, but “the Germans have perfected it”, he noted with a smile. The computer even offers blocks of text for cutting and pasting.

Documentation is not a bad thing in itself. But when taken to excess, it robs practitioners of time they could otherwise be spending in conversation with people. Our GP friend explained that he has always taken proper patient histories/stories (same word – Geschichte – in German). He also continues to handwrite his notes, as in his view patients prefer their doctor not to be glued to the computer. 

As I reflected on his words, it occurred to me that those who put in place these systems implicitly undervalue health professionals’ experience, memory and ability to make connections and patterns.

How has this madness come about?  As always, there are multiple influences at work. The one I immediately think of, given my interest in uses of writing, is that many people simply do not understand, or stop to think about, how written communication works – and how it can actually hinder communication. Managers and policy makers in particular seem to accept without question the value of detailed documentation. Additionally, they are often remote and disconnected from what is happening on the ground – they don’t and can’t be present to the human exchanges between patients and health professionals, for instance. And of course all the bureaucratic rules and procedures are reinforced and perpetuated by the inevitable power relations among practitioners, and between practitioners and managers or policy makers.

After talking to our doctor friend, I happened to be reading a book called “Wilful Blindness” by Margaret Heffernan. In it, the author describes how most people in organisations – even when they sense or know there is something wrong – tend to stay silent. She provides copious examples (in banking, in the army, in private companies, and also in the NHS) of people following orders, clinging to convictions or submitting to groupthink. And on top of all that, many work long hours and are under relentless pressure to pursue efficiency and cut costs. These conditions make them even more likely to develop tunnel vision and just do what they are told. 

In the face of what he sees as senseless bureaucracy, what does our German GP do? “Resignation” was the word he used. But he did nevertheless point to some small acts of subversion. For example, having handwritten his patient note, he only enters the absolute minimum information (the diagnostic codes) into the computer. Or he refuses to sign what he sees as time-wasting, superfluous documents presented to him by staff in the care home that houses some of his patients. He knows that the nurses there spend hours documenting everything in great detail, and presumably therefore less time really caring for patients. Why should he sign a piece of paper just because the computer system adopted by the home spits out a whole page detailing each patient’s medication? 

These small subversive acts make our friend unpopular with some of his colleagues. But he works in a single-handed practice and only has a few years left before he retires, so he can afford to risk being the odd-one-out. 

No doubt much of what he experiences is equally in evidence here in the UK. 

What would it take for this bureaucratic madness to change – a new generation of doctors willing to challenge and question? So far, according to our friend, junior doctors in Germany show little sign of starting a revolution. If anything they are more compliant than his contemporaries. 

He also regrets that the trainee doctors he comes across are no longer taught how to take proper patient histories and are less likely than their older colleagues to examine patients physically. Instead, they rely on technological scans and tests. People going through medical education today also get fewer opportunities to see patients than he did. This is because (mercifully perhaps) they no longer work such long hours.
 
Perhaps one day the current culture of bureaucratic control will just become outmoded. People may decide it has run its course or that it has simply generated too many distortions. I suspect it will take not only some very obstinate and courageous individuals but also some kind of collective rebellion. 

Related reading
Margaret Heffernan. Wilful Blindness, 2011.

Neil Postman's 1992 book "Technopoly: the surrender of culture to technology" is highly relevant to the subject of writing in organisational life today.

First, Postman lays out how every technology, including writing, alters human thinking. He then goes on to show how bureaucracy has come to be about the pursuit of efficiency above all else:

Problems arise when bureaucratic techniques (e.g. standardised forms, categories and labels, opinion surveys) are applied by "experts" to every problem in society without looking at context or history. This :

Of course, the information explosion that began in the 20th century has only served to reinforce the rule of the bureaucrat.

In case this all sounds too negative, Postman's final chapter includes some suggestions about how to resist technopoly. Most are related to education. For example, he recommends that every subject (including scientific ones) "be taught as history". That way, people can begin to understand that "knowledge is not a fixed thing but a stage in human development, with a past and a future". History, Postman says, teaches that "the world is not created anew each day, that everyone stands on someone else's shoulders." And histories, in a nutshell, are "theories about why change occurs".

All of this speaks to the role of the written word in society today. For me, Postman's book provides a strong argument for (a) restricting the use of bureaucratic techniques to technical problems only, and (b) taking history seriously in every field.

I know a man who has suffered from melancholia of some kind on and off for the past 10 years (he is now 62, diagnosed as 'Bipolar 2'). Today he told me he has managed to get an appointment to see a psychologist next Tuesday. She asked him to "arrive 10 minutes early because there will be some forms to fill out first".

I got the impression his heart sunk on hearing this. He imagines having to tick 'yes', 'no' or 'don't know' boxes. What he actually wants is a conversation.

Presumably the psychologist is following a protocol (written word!) and uses the forms (written word!) to assess the patient's condition and/or to collect important information. Isn't this an example of how modern society has gone too far with its left-brained, bureaucratic processes? Or am I being unfair to the psychologist?