Making sense of change in primary health care : a complex responsive processes perspective
Abstract
This research arose from my curiosity about change, and my dissatisfaction with models and tools
which do not explain my real life, messy, and sometimes disappointing, experiences of trying to
instigate change. My aim, therefore, has been to explore what is it like to experience and make
sense of change as it is happening in my working life as a Nurse Practitioner and Primary Care
Trust Board member, in primary health care in the National Health Service.
Essentially I argue that the dominant way of thinking about change assumes it is a "thing" to be
planned and then applied. I believe the error is in thinking we can produce change as if we are in
control of a system. An alternative way of thinking about change arising from my experiences is
that it can only express our intention for the future but is not controllable in the way often implied.
I also suggest change is experienced as movement in the present where, often with hindsight, we
experience a shift in patterns of how we speak about or experience something.
Early on, my search was for a way of explaining my experience of change by initially drawing on
the theories of complexity, which point to emergent pattern which arises spontaneously from local
interaction, without any external blueprint or plan. I then turn to the theory of complex responsive
processes of human relating (Stacey et al, 2000) which views human interaction as itself inherently
pattern forming and therefore ordinary everyday interaction as the source of change. I take the
theory of complex responsive processes as the foundational theory for my research by asking
"What is it like to experience change in primary health care from a complex responsive processes
perspective? " My methodology, which is consistent with this perspective, focuses on my own
experiences, as emergent exploration of experience (Stacey and Griffin, 2005). In other words I am
reflexively exploring my own experience by using narratives, stories and analysis intertwined, to
reflect as closely as possible the messy reality of the way we are continuously making sense of
experience and change.
My experience seeing patients in primary health care; managing a nursing team; and sitting on the
Board of a Primary Care Trust highlights the emotional, fantasy laden aspects of experience which
are often disregarded or viewed as common knowledge. Similarly, there are feelings of anxiety
surrounding any change where my identity feels threatened and there are changes in power relating
between people (Elias, 1939). I argue that tools, models and labels serve to relieve feelings of
anxiety, by providing an illusion of control, but may in themselves also increase anxiety and block
the potential for change.
During the research, my own practice has changed by becoming more reflexive as I focus on my
own participation, whilst adding further dimensions to the theory. Firstly, I argue that focusing
attention in this way implies a heightened awareness of responsibility and potential for one's own
actions. I cannot know the result of my actions but know that they may have some effect, large or
small. Secondly, I argue that the dominant discourse may perpetuate the way change is viewed as a
"thing" external to every day experience. Rather than focusing on control, process thinking
conveys a different reality of continuous sensemaking. Lastly, I argue that focusing attention on
feelings, emotions and the environment as simultaneous rather than separate aspects of experience
becomes important when experiencing and making sense of change from this perspective. I argue,
therefore, that a complex responsive processes perspective challenges the dominant perspective on
change by providing a way of understanding which resonates with my experiences, has significant
implications for my own practice, and validates paying attention to ordinary everyday experience
in which change is continually emerging.
Publication date
2006Published version
https://doi.org/10.18745/th.14347https://doi.org/10.18745/th.14347