In the swampy lowland:

using hypertext to navigate the multiple

meanings of partnership 

Macalpine M. and Marsh M. 2008

‘The Swampy Lowland: Using Hyperlinks to Navigate the Multiple Realities of Partnership’

in McKee L. Ferlie E. Hyde P. 2008 Organizing and reorganising

Basingstoke Palgrave Macmillan>

 

Abstract

‘In the swampy lowland, messy, confusing problems defy technical solution. … in the swamp lie the problems of greatest human concern’ (Schon 1987:3)

Our ‘swampy lowland’ is the complexity of partnership working on the ground within health and social care in the UK public sector. Our multi-layered research project ‘swampy ground’ uses a web based approach to build and communicate many different layers of ‘truth’ within these complex partnerships, that aim to deliver better services, often to people with little power.  We are using multi-voice research to gain access in an ethical way to the perspectives of different actors in these partnerships, often in sensitive situations where much is difficult to make public. (www.swampyground.org ) We are currently updating this study, taking account of a vastly changed external context as well as our own developing ideas.

The paper examines two assumptions underlying this sticky phrase of ‘speaking truth to power’: the first concerning multiple truths and the second concerning ‘power over’ and power/ knowledge. In reflecting on this ‘swampy ground research’, we present four cycles of inquiry: the first gives an account of the research documented on the website comprising the stories of a range of people involved in five areas of partnership working; the second cycle critically reviews the contextual changes which have led us to new areas of study including ‘externalisation’ and user involvement, as well as the related impact of the changed research ethics and governance frameworks. In cycle three we draw on two theoretical domains, policy and discourse, which raise important questions about truth and power for the continuing research. In cycle four we offer an analysis of emerging themes in our updating of the research. We compare these with earlier findings and how they illustrate the kernel of what is involved in working collaboratively: the intensity of the different realities that we construct. The website encapsulates the multiple realities of participants in a hologram of partnership working. We explore the use of the website and its possibilities such as hypertext. We also demonstrate how the multiple layers of meaning can be used in different contexts for learning and involvement. Our work so far suggests an emphasis in our future cycle five on the following in relation to autonomy and agency:

•       how far are participants and their partners recruited to evolving policy discourses at  a national level?
•       or do they co-create shared meanings at a local level?
•       how far do partners act as autonomous actors in a chain of decision makers in policy implementation
•       or do they simply enact top-down policy?

This research represents a body of evidence for policy makers to see the impact on the ground of their policy intentions about partnership. However, given the unknowns of who it is who accesses the multiple layers of the website, we are left with the question of who is speaking to whom - and more importantly, is anyone listening?

Total wordcount: 3,990

In the swampy lowland:

using hypertext to navigate the multiple meanings of partnership 

Macalpine M. and Marsh M. 2008

‘The Swampy Lowland: Using Hyperlinks to Navigate the Multiple Realities of Partnership’

in McKee L. Ferlie E. Hyde P. 2008 Organizing and reorganising

Basingstoke Palgrave Macmillan

‘In the swampy lowland, messy, confusing problems defy technical solution. … in the swamp lie the problems of greatest human concern’ (Schon 1987:3)

Introduction

Our study

Our ‘swampy lowland’ is the complexity of partnership working within health and social care in the UK public sector. Our multi-layered research project ‘swampy ground’ uses a web based approach to build and communicate many different layers of ‘truth’ within these complex partnerships, that aim to deliver better services, often to people with little power.  We are using multi-voice research to gain access in an ethical way to the perspectives of different actors in these partnerships, often in sensitive situations where much is difficult to make public. Our earlier research was completed in 2001, and presents multiple ‘truths’ and ways of seeing and analysing, through the use of web pages and hypertext. (www.swampyground.org ) Over 2005-6 we are updating the study, taking account of a vastly changed external context as well as our own developing ideas.

Conference theme

‘Speaking truth to power’ is a ‘sticky phrase’ (Gladwell 2000) which is used ubiquitously[i], principally to express the idea of people with little power telling their ‘truth’ to those who make policy and have power.  This concept, while attractive, contains at least two assumptions which our work explores.

The first concerns the concept of ‘truth’ as singular and discoverable rather than multiple and/or constructed by the actors involved (Thatchenkery 1996). For us truths are multiple and discursively constructed: not only are there many different perspectives on one reality, as in the ‘Tamara’ effect[ii], but we construct different realities (Law and Urry 2004). The intensity of these different realities contains the kernel of what is involved in working collaboratively and this has informed our interest in multi-vocal research into partnership.

The second concerns the nature of power in the policy/implementation process: is power only at the top, as the phrase seems to assume? In our study, we are interested in a dual notion of power over (for example directives from the Department of Health for local health and social care bodies to engage in partnership) as well as with Foucauldian notions of power/knowledge (Foucault 2002) co-constructed locally and discursively (for example in the construction of professional identities) and the implications of this for how partnerships implement policy.
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This paper

The ‘swampy ground’ study therefore seeks to explore both assumptions through narratives and analyses on practical collaboration on the ground, and explores especially the relationship of leadership and partnership.

This paper represents our reflection on doing this research and disseminating it through the web. We present it as a series of reflexive cycles of inquiry into this research process as we now perceive it, each cycle tracking our thinking, doing, reading, reflecting and sense making (Weick 1995) . The first cycle gives an account of the context of the original research, what we did and our findings. The second cycle reviews the contextual changes which led us to specific new areas of research. In Cycle 3 we take further ideas on ‘speaking truth to power’ through drawing on two theoretical domains that are influencing our study. In Cycle 4 we give an account of what we have found so far, comparing current findings with those of the original study. Clearly this is work in progress: we have further work to do with stakeholders of each partnership, which will lead us to a further cycle of sense making. Here we end with our reflections on these multi-layered truths and their hologrammatic representation and use through the website. Throughout we use hyperlinks to the website to amplify the paper with direct connections to our work: follow the hyperlinks to explore more of the study findings and resources located on the website.

Cycle 1 

At the turn of the millennium, in the context of the spirited New Labour focus on building partnerships across the ‘Berlin Wall’ separating health and social care, we were working with a group of cross-sectoral cross-professional managers in a specific metropolitan area, studying a postgraduate leadership programme[iii].  We used that opportunity to explore what was happening on the ground for those building these partnerships. We worked with managers who were involved in partnerships in the following areas: providing services for adults with learning disabilities; forming an outpatient-focused department across clinical disciplines in an acute hospital; bringing together health and social care inspection units for residential care; developing private residential homes as teaching homes; multi-professional educational policy for a new primary care trust; and cross-sectoral services for older people with mental health problems.

Our intention was to look at partnership at the micro level, gathering the different experiences of people involved, and then to identify key themes. There were 3 stages:

1.  We held meetings with managers interested in participating who each in turn told the story of a key partnership in which they were engaged. Following this the group explored key themes from all the stories. Their stories were taped and agreed by them for display on the website.
2. Each participant contacted their key partners, asking them to tell their story of the partnership; we interviewed those who agreed. These stories were also taped, written up and agreed for display on the website.
3.  We as researchers considered key themes from each ‘case’ and its multiple viewpoints;, then we identified themes and questions across them all.

The methodology was designed to provide a space for the participants to reflect on their work, deeply embedded as they were in their partnerships, and for us all to 'hear' the other voices involved in each partnership. As researchers, we used theoretical perspectives available to us, principally on partnership working: (Webb 1991 on mandated partnerships; Cameron and Cranfield on action, process and learning from partnerships,  Pratt et al 2000 on whole systems; Follett on cooperation and integration (in Graham 1987);  and on power :for example Chambers (1997); Marsh and Macalpine (1999) on paradox and users; and (1995) on the user continuum  Huxham and Vangen 2000 on  democracy

In our findings we were struck by the stark differences in how the same situation was viewed.  We used the Tamara story to express the strength of the multiple perspectives: not only were there many different perspectives on one reality, as in the ‘Tamara’ effect, but partners constructed different realities.(Law and Urry 2004). We were also aware of the impact of mandated partnerships: we found deep conflict and strong emotions:  ‘I ache with hate’ was left written on an office whiteboard following a ‘partnership’ meeting,. Warfare metaphors predominated, such as ‘entrenchment …being in a trench’, ‘ignoring the war’, the ‘seduction of conflict’, having an ‘ally’. Since we were working in the context of leadership education, other key themes arising concerned choices available to managers and leaders within their partnerships, such as engaging the resistors or diluting them by widening the circle; compromise or standing firm on your views.
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Other key issues arising for managers were: achieving clarity in complexity through simple rules such as involving the users to bring order to a highly conflicted inter-sectoral battleground;   maintaining momentum; forging relationships ; and crucially, being aware of others' perceptions of who has power. In particular we noted that perhaps due to the story-telling methodology we used, there was a familiar silence about issues of power/identity, such as ethnicity and gender (Marsh and Macalpine 1998, 2005), and how these impact on partnerships. In our experience silence on ethnicity is common in organisational settings where white people are in a majority. As in these stories, it leaves perceptions of power imbalance due to 'race' unexamined and un-discussable.

We developed the website as a dissemination tool: web technology, both pages and hypertext, enabled us to express the many levels of the research. For example, each viewpoint within a partnership has its own page as well as hyperlinks to issues in the partnership, to themes from the whole study, and to relevant theories or frameworks which illuminate and reflect what the person is saying.

Reflecting on cycle 1, we now see that these partnerships were in the early stages of implementing government policy on partnership. The participants in these were in new situations, setting them up; we found a focus on the internal issues, with raw emotions and feelings; their concerns were focused on the difficulties of carrying out the mandate of forming partnerships.
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Cycle 2   

Cycle 2 of updating the swampy ground case studies arose from the changing external context. By 2005 these were also reflected locally: all our participant managers are now involved in inter-organisational, inter-professional and inter-sectoral partnerships; and along with this there is more cynicism and awareness of the rhetoric of partnership. Indeed Huxham (2002) in her ‘quick tour of some accumulating theory’ advises practitioners: ‘don’t do it unless you have to’ (2002:12).

In addition, ‘partnership’ is increasingly being used in government discourse to include both the independent and voluntary sectors.  This term obscures two very different type of service provider: the corporate for-profit sector e.g. through  the Private Finance Initiative, privately owned Diagnostic and Treatment Centres (Lister 2005, Pollock 2004) and voluntary/community organisations, increasingly recruited into contractual relationships and away from their independent civil society role. The term ‘externalisation’ is used to express this shift in local government. A further shift has been the requirement for user involvement; and ‘user-centred’ services including for children, for older people and in mental health.

In updating the research we wanted to take account of these changes as well as the findings of the earlier research. We have therefore involved participants who manage ‘externalisation’ of services for adults with learning difficulties; a Sure Start project; Intermediate Care; police/mental health liaison; and voluntary sector advocacy. 

A further significant change for us as researchers have been the developments in ethical and governance review. As well as the university’s Research Review Committee which agreed to both phases, we took the updated proposal through the web-based and committee processes of the NHS Central Office for Research Ethics Committees, via a Multi-site Research Ethics Committee. We found that each NHS partner also required research governance agreement, some through the web based processes of the Research and Development Unit (Department of Health 2005).  An early finding in this stage has been that these embedded and necessary institutional processes show little recognition of government policy on partnership working. A research manager wanted to know if parents who are co-chairs of a Sure Start partnership are ‘part of the NHS’; if they ‘step over the boundary into social care’ they are outside her research governance purlieu. As has been documented elsewhere (Norman et.al.2003), some members of the ethics committee had difficulty in stepping outside the positivist paradigm, and taking on board the discursive and often disciplinary construction of truths which is the very subject/topic  of this research.
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Cycle 3   

Concurrent with taking the proposal for updating the study through the research governance processes we have in cycle 3 reflect on two theoretical domains that have influenced us: policy and discourse.

Policy

We have explored an additional thicket within the mixed forest of partnership literature: that deriving from the ‘policy’ discipline which has offered us new perspectives. Bogason (2004) helpfully sets out the range of approaches to public policy development from ‘rational’, top down policy formulation based on a discourse of expertise, to the ‘mutual adjustment’ approach exemplified by Lindblom’s evergreen ‘muddling through’ (1959). Our participants and their partners work in the paradoxical policy context of strong central diktats which nevertheless require increased local autonomy. This central direction encompasses both process and substance. The process of partnership is mandated: this was the substance of the earlier swampy ground findings. The substance concerns specific service philosophies, requirements and targets[iv] which partnerships must achieve. Turning to policy implementation, Heclo draws attention to the ‘networks of interaction’ whereby policies emerge (1972:106 quoted in Bogason 2004:10). Linked to this the notion of autonomous actors in a long chain of decision makers is an intriguing way to explore what happens on the ground (Pressman and Wildavsky 1973 referred to in Bogason 2004:10).  Both ideas helpfully emphasise the multi-organisational aspect of the process and suggest some important questions concerning how the new ‘swampy ground’ partnerships actually carry out policy; and the degree of autonomy that actors in the swamp may have.

Discourse

Bogason also refers to discourse and ‘deliberative policy analysis’ citing Fischer and Forester:

‘Policy-making is a constant discursive struggle over the criteria of social classification, the boundaries of problem categories, the inter-subjective interpretation of common experiences, the conceptual framing of problems, and the definition of ideas that guide the ways that people create the shared meanings which motivate them to act’ (1993:1-2 cited Bogason 2004:18)
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For example ‘parents’ are clearly a ‘problem category’ when the key boundary for the research manager responsible is still that between health and social care. These connected notions of policy and discourse trigger us to explore We are drawn to the idea of the discursive construction not only of policy, but also of consent. We are continually surprised at the speed of enthusiastic adoption initially of the very term ‘partnership’ which now with the addition of ‘choice’; and ‘contestability’ often connotes private sector involvement[v]. Public sector ‘partnership’ is now termed ‘integration’. 

Thus cycle 3 has raised the following questions for our further work:

•      how far are participants and their partners recruited to evolving policy discourses at  a national level?
•      in the field of policy implementation what kinds of autonomy do partners have in working to achieve required goals?
•      how far they co-create shared meanings at a local level?

Cycle 4 

Our updated research is progressing using the same as the earlier research. At the time of writing we have not commenced the interviews with partners but we have held a meeting with the manager participants and we are able to compare the themes arising from this discussion with themes from 5 years go.

The table below shows the key themes from each: It shows especially a move from working to counter entrenched conflict to a confident leadership that accepts complexity and uncertainty. The 2001 managers had to focus on purpose rather than on personal issues and emotions in order to make progress. The later group appear to be using sophisticated approaches such as a focus on ethics, organisational learning, individual development, with users taking key roles. They seem clearer about the degree of autonomy they have in making sense of an unclear remit; they were shaping events by their own action (cf ‘enactment’ in Weick 1980), rather than buffeted by them. Notably structural issues are not only about the instability of top down re-structuring; in 2005/6 there is evidence of more concern with structures intended to achieve joined-up services.

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Theme	2000/01	2005/6
Change process	History persists ‘like families and weddings’ and can slow things down ‘Culture eats strategy for breakfast’ Partnership happens slowly – takes time – when you can see change happening that helps re-energise ‘I came to know’	Acceptance of uncertainty and complexity – recognition there is no guaranteed outcome. Keep momentum going  but time needed – a paradox ‘I don’t know how it is going to end up, been like that all the way through, deciding the next thing’ ‘..need for creativity and leadership’
Personal concerns	Strength of personal feelings and investment Our integrity and how it feels to stand up for it ‘Being in a trench’ the power of two camps but the power to ‘ignore the war’ ‘I ache with hate’	Ethics and responsibilities rather than emotions ‘..the ethical responsibility we are carrying…’
Personal resources	‘Asset base’ ‘Not only go by job titles – what do we each bring to the partnership?’	Action to develop individuals at many levels – staff, users, carers and committee members ‘We’ve all faced a huge learning curve’.
Drivers/  motivations	Energy, momentum, the ‘seduction of conflict’	Explicit aims to develop organisational learning from one context to another. All were influencing wider audiences: cross borough, cross locality, cross organisation, national ‘I’ve gone out of my way to link them together’ i.e. ‘externalisation’ for different client groups
Structures	Structural change in agencies at the same time as developing partnerships didn’t help the process.	Structural change was towards partnership e.g. integrated agencies – matches shift in discursive context
Roles	Notion of ‘risk’, being on the edge, risk for individuals and for projects, both when things go wrong and in raising difficult issues Noticing being stuck in roles and silos – vs ‘freeing self up’ , for example rising above these as leader Helpful to move away from personal issues – whether of blame or adulation – to focus on issues for the group	Leadership: strong and confident Autonomy ‘None of us had very clear remits’ ’Just do it’:  no boundaries on how and ‘not much help’
Power	Power as a negative Professions – the power of expertise and  its role in the interface between professions The centrality of diversity issues to the stories Impact of status on partnership : of users, adults rather than older people or children; of health vs social care; Money as power : power as success for individuals; in the institutional ‘top-down’ sense The challenge of moving from finance-led to service-user based work	Power dynamics : shifts from high power players to less powerful players High level of user involvement ‘You’ve made the committee into something really different from what it was [i.e. involving users] ..organic’

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Where are we now?

This multi-vocal research provides dense, textured material that illuminates the daily experience of people involved in partnership working. It enables us to hear the real concerns, through the power of story, of the different actors. These are concerns that the pressures of working life often forcefully obscure, and which are not often shared in a transparent way. So this material illuminates what we otherwise cannot access in our own partnerships. Managers each immersed in their own singular and intense reality have been exposed not only to others’ perspectives but they have understood how others construct different realities. ‘The shift is from epistemology (where what is known depends on perspective) to ontology (what is known is also being made differently). It is a shift that moves us from a single world to the idea that the world is multiply produced in diverse and contested social relations. The implication is that there is no single ‘world’ (Law and Urry 2004). This in turn has enabled managers to begin to explore the Foucauldian construction of their own professional identities.

The website encapsulates in its own make-up the multiple perspectives of participants as well as the interconnectedness of practice, reflection and theory. It represents a hologram of partnership; it telescopes through hypertext both the different realities and theory with practice through illuminative mutual links. The website had 7500 visits over a year, and has also been well used for case material for teaching on Masters programmes[vi]. Some Masters programme participants have gone on to use the material with staff teams, or with partnership boards and groups on ‘awaydays’ to raise issues of how they see their work.

In cycle 5 we will interview the partners of the managers who are participating in the new round of research. We will further explore how partnerships act to implement policy; how far this is rational or ‘muddling through’. We want to explore further the paradox of top-down diktat which requires local autonomy. The issues here are autonomy/agency and democracy in policy implementation. Our work so far suggests an emphasis on the following in relation to autonomy and agency:

•        how far are participants and their partners recruited to evolving policy discourses at  a national level?
•        or do they co-create shared meanings at a local level?
•        how far do partners act as autonomous actors in a chain of decision makers in policy implementation
•       or do they simply enact top-down policy?

In terms of democracy, it appears the second group have achieved significant user involvement and other shifts of power. Through our interviews we will explore how far users and others perceive this (as) democratisation.
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Speaking truth to power?

The research demonstrates that the kernel of collaborative working is indeed the intensity of different realities which are exposed as multiple truths through the website. Web culture appears to be accessible and democratising; in bringing people together in common cause it can operate powerfully to speak truth to power, for example in the anti-globalisation movement. In our context we are using the web to set out and explore multiple truths; this also helps individuals to deconstruct and become aware of their own reality as different from other people’s.  In addition the ‘swampy ground’ research represents a body of evidence for policy makers to see the impact on the ground of their policy intentions. However, given the unknowns of who it is who accesses the multiple layers of the website, we are left with the question of who is speaking to whom - and more importantly, is anyone listening?

References

Bogason P. 2004 Networks in policy analysis – towards a new pragmatism, Roskilde, Denmark: Centre for Democratic Network Governance http://www.ruc.dk/upload/application/pdf/f51d6748/Working_Paper_2004_8.pdf

accessed 16.1.2006

Cameron M. and Cranfield S.(1998) Unlocking the potential: effective partnership for improving health education NHS Executive, N. Thames accessed 7.2.06 at: http://www.llweb.co.uk/documents/LSM_Cohort2/unlomain.pdf

Chambers R. 1997 Whose Reality Counts? London Intermediate Technology Publications

Department of Health 2005 Research Governance Framework for Health and Social Care second edition.

El Ansari W. Phillips C. and Hammick M. 2001 Collaboration and partnerships: developing the evidence base, Health and Social Care in the Community 9(4), 215¡V227

Ferguson K 1994 On bringing more theory, more voices, more politics to the study of organisation in Organisation 1 (1) 81-100

Foucault M 2002 Power: Essential Works of Foucault 1954-84  vol 3,  Faubian J (ed), London: Penguin Group

Gladwell M 2000 TheTipping Point: How Little Things Can Make a Big Difference, New York: Little Brown

Graham P. 1987 Dynamic Managing the Follett Way London Professional Publishing  and BIM

Heclo, H. (1972) Review article: Policy analysis. British Journal of Political Science, 2; 106  quoted in Bogason 2004 opcit :10

Huxham C. and Vangen S. 1996 Working together: Key themes in the management of relationship between public and non-profit organisations  in International Journal of Public Sector Management Vol 9 No 7

Huxham C. and Vangen, S. 2000 Leadership in the shaping and implementation of collaboration agendas: How things happen in a (not quite) joined-up world, Academy of Management Journal,Mississippi State University, December

Huxham Chris 2002 Theorising collaboration practice: a quick tour of some accumulating theory. Accessed 4.2.06 at http://www.gsb.strath.ac.uk/research/workingpapers/default.asp?curpage=9

Law J. and Urry J.2004 Enacting the Social Economy and Society 33, Number 3:390 - 410

Lindblom 1959 The Science of muddling through Public Administration Review 19:79-88

Lister J 2005 Health Policy reform: driving the wrong way? London: Middlesex University

Marsh S and Macalpine M 1995 Our Own Capabilities: clinical nurse managers achieving strategic change London The King's Fund, republished  London Hodder 1999

Marsh S and Macalpine M 1998 Negotiating a ‘borderland: nursing, gender and management Health Services Management Research 11:221-227

Marsh S. & Macalpine M. 1999The search for reconciling insights: a ‘really useful’ tool for managingparadox  Journal of Management Development vol 18<

Macalpine M and Marsh 2005 On Being White: There's Nothing I Can Say’ Management Learning, 36, 4: 429-450

Normand, C., Meyer, J. and Bentley, J. 2003. Research ethics and complex studies, Nursing Times Research, 8, 1, 17–26

Pollock A 2004 NHS PLC London: Verso;

Pratt J., Plamping D. and Gordon P. 2000 Whole Systems Thinking, Working Papers series London: Kings Fund

Schon  D.1987  Educating the Reflective Practitioner  San Francisco Jossey Bass

Thatchenkery  T. and Upadhyaya P. 1996 Organisations as a play of multiple and dynamic discourses in Boje D. Gephart R., & Thatchenkery T. Eds. 1996 Postmodern Management and Organisation Theory London Sage

Webb A 1991 Co-ordination: a problem in public sector management, Policy and Politics 19 (4) 229:241

Weick K 1980 The Social Psychology of Organizing London: McGraw-Hill Publishing

Weick K.1995 Sense-making in Organisations London Sage
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[i]  An interesting search has led us to the Quakers and an ongoing debate about the first usage of the term.  A pamphlet published in 1955 by the American Friends Service Committee (AFSC) called ‘Speaking Truth to Power’ suggested  it was ‘taken from a charge given to eighteenth century Friends.’ However, that appears not be authenticated. It was first heard at an AFSC  meeting in July 1954 where Milton Mayer came up with the phrase, saying he thought it was an old Quaker phrase’, but Quaker historians have not been able to identify the source. (Bailey S 1993 Peace is a Process’ London Society of Friends Swarthmore lecture). Thanks to Sally Maxwell for following through this enquiry.

[ii] In ‘Tamara’ the longest running play in San Francisco, both actors and audience move around the many rooms of the building following and building their own stories and understandings. This play vividly demonstrates for its audiences what in organisations and in partnerships is a truism: that there are many different ‘realities’ being experienced, many perspectives at play.

[iii] The MA in Leading, Managing and Partnership Working at Thames Valley University

[iv] There are a variety of mechanisms used to implement these, notably the NHS Plan, National Service Frameworks (see www.dh.gov.uk) as well as legal requirements (eg The Community Care (Delayed Discharges etc.) Act 2003)

[v] For example Prime Minister Blair in his press conference of  23 January 2006talked about schools having ‘external partners’ as positive, without mentioning this meant the involvement of private firms in the running of schools.

[vi] The material is extensively used on leadership masters programmes, typically through participants reading one person’s perspective, then discussing it with others who have each read one of the other perspectives in the partnership ‘story’.
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