Chapter one

Introducing my inquiry

My never ending story

Introductory framing

The purpose of this first chapter is to both introduce and to provide the reader with a framing within which to view this thesis. This thesis is the result of an intense period of reflection on my practice as a facilitator of healthcare improvement over a period of 6 years. It is a self-reflective inquiry into my practice (Marshall. 2001, 2004) and throughout this period I have been asking myself the question “How can I improve what I do and develop a living theory of my practice?” (Whitehead. 1989). Through my writing I have been able to clarify how my originality of mind is demonstrated through the narrative of my learning and the development of an epistemology of responsive and inclusional practice (Rayner. 2004) as I have engaged with others both creatively and critically.

Engaging in this process of inquiry and reflection into my practice has required a focus on my “lived experience” (Van Manen. 1997) and in particular how a period of illness as a child sowed the seeds of my passion for compassion. It is this ontological commitment to a passion for compassion that not only sustains the work that I do but I now understand that it also influences the way in which I do it. Through this period of reflection in practice this understanding has grown and I have been able to articulate for myself and for others what this means in practice in the following way:-

· I enter into a conscious, dynamic relationship that first of all involves listening to the narrative of others.

· I respond to the narrative in a living and inclusional way allowing the narrative to connect with my ontological value of a passion for compassion.

· My creative response is channeled by our dynamic boundaries which in turn channel and construct a co-created vision of a transformed future.

I have also explored how my practice is continually emergent and transforming as I respond to the needs of the people I am engaging with in a pedagogical relationship. This response communicates my embodied values which are also emergent and transforming and as I have been able to clarify them through my inquiry the act of clarification transforms these values into epistemological standards by which my practice can be judged. I will also show how my emergent methodology, a methodology that synthesises complexity theory and creativity demonstrates an original contribution to an understanding of life in organisations. I have also had to find my own way through the research process in a way that has required an amount of “methodological inventiveness” (Dadds & Hart. 2001).

This methodological inventiveness also includes the creation of a DVD of my practice. The creating of this DVD has enabled me to explore the potential of visual narratives in multi-media accounts for clarifying and communicating the meaning of inclusional values in the course of their emergence in the practice of my inquiry. I will demonstrate how through the creation and communication of this visual narrative the process of clarifying and communicating the meaning of inclusional values which are informed by my ontological commitment to a passion for compassion, has enabled me to transform them into living and communicable epistemological standards of judgement. This also enables the validity of my contribution to educational knowledge to be evaluated.

In the development of my practice I have engaged with and drawn on the work of others who share similar ideas from both the field of complexity theory and that of theatre in education and theatre for development. In particular writers such as Ralph Stacey, Douglas Griffin and Patricia Shaw whose work looks at the theoretical foundations of the ways in which complexity theory is being used to understand organisational change and who also place a particular emphasis on the day- to-day relationships between people in organisations. I have been further influenced in my practice by the ideas of inclusionality from Alan Rayner (2003) and I have also engaged with writers from the world of pedagogical theatre such as Augusto Boal and Bertolt Brecht and educationalists such as Paulo Freire. This thesis will also demonstrate how my engagement with the work and writing of individuals such as those mentioned above has enabled me to both challenge and to develop my own practice thereby creating a living theory of responsive and inclusional practice.

My decision to use narrative in this thesis is an important one because it reflects the emergent nature of the writing of this thesis. In the early days of my writing I was finding it incredibly difficult to find a way to begin. In a conversation with Jack Whitehead, my supervisor, about my writing he suggested that I may find it easier if I had someone in mind who I was writing for. This opened the door for me and enabled me to use my craft, the craft of storytelling, to tell the story of my learning. What is exciting about storytelling is that it is uncertain and unpredictable but essentially people centred. Telling the story of my learning in this way has enabled me to capture complex problems more easily and has helped me to make sense of complex situations.

The Context

With a background in nursing, theatre-in-education and theatre-for development and experience of teaching in higher education, in1992, I returned to the National Health Service and since then have been employed as a facilitator of healthcare improvement. From the period 2000 – 2003 I became a research fellow in a mental health partnership trust in the department of old age psychiatry. In this role I was given the opportunity to undertake a sustained period of self-study whilst leading a programme of change within the department of old age psychiatry. This placed me in a very unique and somewhat privileged position of being involved in the redesign of services at a grass roots level at the same time as being able to influence policy at a strategic level.

I have found the approach to modernising health services adopted by strategists and policy makers throughout this period somewhat challenging for myself and those delivering the services. I began to question the way in which we were being encouraged to improve services, with an emphasis on output and measurement. I began to understand that real transformation requires ownership and engagement by those who are being expected to change. I now know that this understanding came from my embodied knowledge as a practitioner, was based on my experience and was the basis from which to develop my own living theory (Whitehead. 1989).

In this thesis I also reflect on and explore the way in which my inquiry led to a realisation of the way in which so much of what I was experiencing was both interconnected and complex. Marshall (2004) also explores this in a recent paper and comes to the conclusion that from undertaking a self-study inquiry she has learnt, “…that living systemic thinking is long-term, emergent, never-ending activity, with any sense-making always open to re-vision as action, reflection and feedback unfold. Inquiry is key to living systemic thinking and takes many forms, being self reflective but also systemically engaged, and means taking strategic initiatives to learn more and track emerging data, knowing that I will never fully know.”

As I began to apply my growing understanding of systems thinking, learning organisations and complexity theory, I also began to question my application of this understanding. My experience was telling me that even when taking a whole systems or living systems approach to organisational change and development the thinking was still around someone being outside of the system, designing the system, being in control, fixing things. I found difficulty with the notion that organisations are living things, which as Griffin (2002) points out this misses the point and that is that it is the people who are living and not the organisation. My focus in my practice is always concerned with people. For me what is more important is the relationships between the different individuals within the system and this came with a recognition that these relationships were dynamic and emergent in their nature and also had the potential for self-organisation. (Stacey, Griffin and Shaw, 2000; Stacey, 2001; Griffin, 2002; Shaw, 2002 and Stacey 2003.)

I was also beginning to question the desire for traditional management to encourage uncertainty out of the system, to yearn for agreement and consensus when my experience was telling me that tension and conflict and diversity were part of the creative process and were for me a crucial part of any creative process I engage in (Capra 2002).

My exploration and engagement with complexity writers and complexity theory also reinforced my growing understanding of the importance not only of relationship but also with identity. I began the process of reflecting on the work I was engaged in and began to ask myself how I could draw on my embodied knowledge as a theatre practitioner and my growing understanding of complex organisations in order to improve my practice as a facilitator of healthcare improvement.

Emergent Values

In a recent publication Dr Mark Williams (Williams, 2004) asks the following questions:-

How does one realise ones values one lives by?

How does one come to realise the importance of such values?

How does one communicate these values once realised?

How does one really live by such values?

How does one gain the courage to stand up against those who would destroy what you value?

Can one talk of these values in a doctoral thesis and thus join a body of people whose task it is to support such endeavours?

(Williams M.C. and Dick B. 2004.p194).

During the course of this inquiry I believe I have been addressing similar questions and have been trying to clarify my values as they have been emerging in my practice. I have also been reflecting on how the values that underpin my practice are driven by my ontological commitment to my passion for compassion

At this point I want to say something about the process through which I have expressed the meanings of my values. This process is inclusional in the sense that ‘I am because we are’. I will show what I mean by this by explaining how the meanings emerged through my relationships that involved critical and creative responses. Here are my ‘statements’ of value that served the heuristic purpose of engaging the critical and creative capacities of two respondents, Shaun Naidoo and Jack Whitehead. I then responded to their responses in a way which helped me to clarify for myself the process through which I could communicate the meanings of my values.

Here is my first iteration of my values on the 30^th September 2004

1. Ensuring a responsive practice

When I am working in this way I know that I am engaged in a relationship with the people I am working with that enables me to ensure that my practice responds to their needs. This means putting aside prescription and imposition and any preconceived ideas about what I think is needed. Rather I am able to create an environment where I respond to their needs with my embodied knowledge, I need to be fully present in the moment.

2. Developing inclusional relationships

Working in an inclusional way means that I embrace boundaries as places of creativity and connection rather than places that create silos and as a consequence barriers to effective relationships. This is crucial in my work in the health service if I am to contribute to a way of working that brings people together, people who are very often excluded, such as patients and carers, in a process of transforming services.

3. Loving and respecting myself and others

The importance of love and respect for self and for others in my practice can not be emphasised enough. I learnt at a very early age how the pure and non arrogant love of self and of others can help us to develop more meaningful relationships that enable us to challenge and to question unsatisfactory practices. It is by engaging in this way that I intend to show how we can improve relationships and consequently our services.

4. Trusting myself and others

I have learnt how trust is very important not only in the kind of practice I engage in but also in our working lives. Learning to trust is a collaborative process and important in the development of conscious devising actors who are prepared to take creative risks.

5. Living my life creatively

Engaging my imagination both in my practice and in the way I live my life enables me to practice in a much more creative way. This process of knowing my values in order to improve my practice has enabled me to develop a greater understanding of how important this is to me. I believe that I am at my best when I am able to draw on my creativity not only as a way of sustaining myself but also in the way I relate and respond to others.

On the 30^th September 2004 Jack Whitehead responded.

Dear Marian – I’m sitting here with Shaun, both working away on our computers as we respond to your statements about your values. We’ve talked about our tension and feeling of contradiction as we felt the ‘certainty’ of your statements conflicting with your living theory of responsive practice. We wondered if a more dialogical form of expression, involving your responses to our voices and responses to your ideas might be more consistent with the ideas in your thesis. The statements above, as they stand, appear as ‘discrete’ utterances that have become severed from your inclusional awareness and form of life.

We are wondering (I’ve talked this through with Shaun and he is focusing on what it might mean to make your statements more conjectural than their present form as categorical assertions. I said that I’d focus on responding with some ideas about the inclusional process of meaning making that seems consistent with ‘I am because we are’ while acknowledging that our understandings of our values can emerge from our responses to ourselves as living contradictions. I’m feeling this tension between the living and dynamic communication of ensuring, developing, loving & respecting, trusting and living, and what I’m experiencing as the static, lifeless, severing use of ‘certain’ or absolutist language. It’s as if at this point of your thesis where you are framing your values, you have returned to a logic and language that the rest of your thesis has transcended in your living theory of responsive practice.

Shaun has been responding to your statements about your values. I’m wondering if you could find a way of expressing your meanings of your values in a way that is more consistent with your living theory of responsive practice?

My Response to my critical friends

My initial response to these comments was somewhat defensive. I had found the process of articulating my values in this way quite difficult.

As I looked at and reflected on the way in which I had written my values I began to see that I had indeed constructed something that was didactic and static and lacked what is for me fundamental. That is the importance of a dialogic process in enabling me to continually develop my knowledge and my practice. In my anxiety to create a written list of my values I had allowed myself to be intimidated by my assumption of what was required in order to fulfil Academic criteria rather than finding a way to express myself that truly reflected the emergent and inclusional nature of the values that underpin my practice. In this instance I was experiencing myself as a living contradiction as the expression of my values became paradoxical with my practice. This illustrates the importance of the inclusional nature of my practice as I try to communicate the way in which I have transformed my ontological commitment to a passion for compassion to inclusional, relational and living epistemological standards by which my practice may be held accountable.

The following is my second iteration which I believe now communicates my values as they are emerging in my practice.

1. Influencing a responsive practice

When I am working in this way I try to engage in a relationship with the people I am working with that enables my practice to be responsive to their needs. This almost always means putting aside prescription and imposition and any preconceived ideas about what I think is needed and although this is not always achieved, I endeavour to create an environment where I respond to their needs with my embodied knowledge. I do this by trying to be fully present in the moment. Of course I do not always manage to achieve this and on these occasions I experience myself as a living contradiction as I struggle to live this value fully in my practice. I attempt to take moments when working to reflect upon my responses in a way that enables me to try to address my contradictions. Reflecting in this way both in the moment and post delivery is a significant aspect of how I respond to my-self and to others.

2. Working towards the development of inclusional relationships

Working in an inclusional way means that I try to embrace boundaries as places of creativity and connection rather than places that create silos and places of severance and as a consequence creating barriers to effective relationships. This is crucial in my work in the health service if I am to try to contribute to a way of working that brings people together, people who are very often excluded, such as patients and carers, in a process of transforming services. Developing inclusionality in my practice is always my aim but sometimes this way of working is very hard to achieve. This is because it is contrary to our usual day to day practice, particularly within healthcare organisations where we have preferred to develop impositional practices. This manifests itself in top down procedures, standards and protocols and creates hierarchies at an organisational level as well as at a professional level. Inclusionality is something that I am constantly searching to achieve in my dealings with others.

3. Loving and respecting myself and others

The importance of love and respect for my self and for others in my practice can not be emphasised enough. I learnt at a very early age how the pure and non arrogant love of self and of others can help us to develop more meaningful relationships that enable us to challenge and to question unsatisfactory practices. It is by engaging in this way that I intend to show how we can improve relationships and consequently develop the template based on love and respect that can help bring about the changes of our perceptions of self, others and the impact this can have on our services.

4. Trusting myself and others

I have learnt how trust is very important not only in the kind of practice I engage in but also in our working lives. Learning to trust others is usually a collaborative process, trusting self can be both collaborative and reflective and in some cases a process that involves confronting my own living contradictions as they develop and emerge from my interaction with others. The reflection of self and Trust is important in the development of conscious devising actors who are prepared to take creative risks. I also believe that it is -the basis of meaningful and creative relationships between people and can enhance the quality of communications and recognition of identity.

5. Living my life creatively.

Engaging my creative imagination both in my practice and in the way I live my life enables me to practice in a much more creative way. Being sensitised to the engagement of my creative imagination in the way I live is one of the self developed attributes that I have. It is connected with and also enables me to engage in nearly all of the other values identified in this Chapter. This contributes significantly to the process of knowing my values in order to improve my practice and has also enabled me to develop a greater understanding of how important this is to me. It encourages me to displace my ‘self’ in order to relate better to others. Conversely it also encourages me to displace my ‘self’ in order to reflect on my-self and by doing so help me address and reflect on who I am. I believe I am at my best and happiest when I am able to draw on my creativity not only as a way of sustaining myself but also in the way I relate and respond to others.

Also running through this list of my expression of my values is a sixth theme which I have decided to iterate as a theme rather than a value because of its importance throughout all of my values. This process of self study, of undertaking an inquiry in to my own practice in order to improve my practice has enabled me to develop an understanding of the importance I place on my critical and analytical reflection on my practice. This comes from a desire to engage in a process of continual learning and of living my life as inquiry (Marshall.1999),that not only informs my own practice but can also be shared with others.

Communicating my learning

The story of my learning is complex and messy very much in the way that Senge and Scharmer (2001) describe is often the case with the process of knowledge creation. In the final throws of assembling this thesis I found it very difficult to separate the various strands of my learning and my practice. Setting it out in a linear way with chapter numbers was extremely challenging but I also believe that setting it out in this way enables the reader to engage with me in my sense-making process. I also believe, however, that the chapters can be approached in any order and the order that follows is simply the self organising order of my reflections in writing.

Chapter 2 describes the methodology I have used to undertake the research for this thesis. Here I place emphasis on the importance of developing theory from practitioner research (Winter. 1997) and how action research, and in particular living theory, (Whitehead, 1989) is itself an emergent methodology. I reflect on my lived experience as a practitioner / researcher (Van Manen. 1997) and tell the story of my engagement as a new researcher, the problems I have encountered and the way in which I have sought to resolve these problems. This problem solving has required the use of methodological inventiveness (Dadds & Hart. 2001).

Chapter 3 reflects on the process of creating a DVD of my work. I have recorded my practice throughout the period of this inquiry and offer this DVD as evidence of the claims I make in relation to my values and how these values once clarified have become epistemological standards by which my practice can be judged. The making of this DVD was also a creative act and became a process of critical reflection and analysis as I observed myself in practice. Here my intention is also to create an alternative form of representation using the videoed images of me engaging and practicing in order to communicate more clearly how I live my inclusional values in my practice.

In chapter 4 I reflect on the significant events in my life and describe how I believe they have made an impact on the way in which I have developed. I also reflect on how my experience of illness as a small child and my training as a nurse has not only influenced the kind of theatre I became involved in but also how I have brought theatre for development into my work in the health service. I have also paid attention to the past in my inquiry in order to ask myself and to gain clarity as to how the life I have experienced so far, the challenges, the sorrow, the excitement and the joy, have made a contribution and continue to make a contribution to the way I live my life now and the values that I hold. In this way I have been engaged in a process described by Bullough and Pinnegar (2001) of joining history with biography, “When the issue confronted by the self is shown to have relationship to and bearing on the context and ethos of a time, then self-study moves to research.” (Bullough and Pinnegar. 2001, p310, cited in Laboskey, 2004.) Although this may be perceived as a nostalgic process I am in agreement with Mitchell and Weber (1999) that nostalgia can be placed in the context of looking ahead and imagining particular scenarios for the future, in my case imagining scenarios that have the potential to transform our practice.

“We posit that a pedagogy of reinvention through memory has a political agenda that involves a deliberate remembering – one which unconsciously ‘uncovers’ memory – and which implies a relationship to schooling that is anything but nostalgic in the usual sentimental sense. Here we refer to the particular humiliation and pain that individuals might have experienced, and also how these experiences are linked to inequalities based on class, race, sex or religion.”(Mitchell and Weber. 1999. p. 225.)

It is by paying attention to these moments of humiliation in my own inquiry that I have been able to identify the roots of my ontological commitment to a passion for compassion and from this understanding demonstrate how this has now become a living, relational and inclusional epistemological standard by which my work may be judged.

In chapter 5 I show how my engagement with complexity writers has influenced my practice as a facilitator. I also discuss traditional thinking and practice in relation to organisational development and argue for the need for an approach more suited to working in today’s more complex organisations. As I engaged with writers such as Wheatley, Lewin and Rogers, Stacey, Griffin and Shaw, I could see that they were exploring similar ways of working. The issues they were beginning to focus on such as relationship, listening, conversing were very similar to the issues we had addressed in theatre for development. By engaging with this literature I began to develop more confidence in my practice and this confidence in my creative experience encouraged me to begin the exploration of incorporating a creative approach within my practice as a healthcare facilitator.

Chapter 6 focuses on the redesign of services for people with dementia. In this chapter I tell the story of how I develop and engage with others in a process that uses a combination of complexity theory and creativity as part of the redesign process. Here I also aim to show how my embodied knowledge comes to the fore as I begin the process of responding to the needs of those I am working with in a much more creative way.

Chapter 7 continues the story describing an emergent methodology of creative practice. It focuses on the development of a range of workshops that use the creative arts in synthesis with complexity theory.

It also describes how this has been as a result of engaging in an inclusional and responsive process with the participants of the workshops. In order to fully live my value of ‘living my life creatively’ it was important for me to address this within my inquiry as well as within my practice itself. The focus of my narrative is also on myself as a creative arts practitioner. As I began to know myself in practice I was able to draw on and explore in my practice my understanding and experience of creative processes and this was happening in synthesis with my exploration of how complexity theory could apply to organisational development.

I was beginning to explore the possibility that if I was able to engage clinical teams in creative activities it may be possible to see an improvement not only in the way that they work together as a team but also in the way that they focus on the transformation of their services. This would require a different kind of engagement, a different kind of participation and I believed that a focus on creativity could contribute to this.

Chapter 8 describes how a process of responsive practice leads to the development of the inclusion of devised theatre to communicate research. As a creative arts practitioner I must also pay attention to the importance of performance and the educational and developmental potential of performance. I describe the way in which I now also include researched and devised theatre and performance pieces as part of my education and development purpose as well as involving the people I work with in creative processes.

Chapter 9 asks the question – “So what!” what difference has this made to me, my practice and to others. In attempting to answer these questions I realise that my practice is often restless (Murrell. 2203) this is a result of the improvisational nature of spontaneity and creativity (Shaw. 2002), an essential feature of what I do. Although I believe that I am able to live happily with uncertainty it can sometimes result in disquiet amongst those who rely on outcome and closure (Rayner.2000). This inquiry has enabled me to identify how my values inform my practice and how when I am unable to live my values fully in my practice I experience myself as a ‘living contradiction’ (Whitehead, 1993). Whitehead describes how when this happens practitioners imagine a solution and this enables practice to improve and values to be lived more fully. I also recognise that this process is in itself a creative process as I am able to draw on my own creativity and engage others in an ensemble of creativity and improving practice. Working in this way has resulted in me often having to challenge the more traditional approaches to process improvement that are practiced widely within our health services. I believe that I am learning to embrace these challenges in a way that invites people to accompany me as they explore their own potential for transformation in a way that gives us hope for the future of humanity.