“I will exercise my art solely for the cure of my patients … in uprightness and honor …. Into whatsoever house I enter, it shall be for the good of the sick to the utmost of my power, holding myself far aloof from wrong, from corruption, from the tempting of others into vice …. I count my life and art as holy.”
Those are sentences taken from the Hippocratic oath, upon which the model image of the physician has rested through the centuries. They are quoted in Meeting the Shadow, a book edited by Connie Zweig and Jeremiah Abrams (1991:110). The editors go on to talk about the dark side of the work of the model physician—portrayed through a story in another book: “Dr. Knock has no altruistic desire to heal. He uses his medical knowledge for his own personal profit. He does not even hesitate to make healthy people sick. He is a quack—the swindler, who at best deceives himself along with his patients—at worst, deceives only his patients…these medical practitioners are not interested in the medical aspect of their activity; they are false to the Oath and work only for themselves.”
The quack is the shadow which forever accompanies the medical man. It is a shadow which may live in him or outside him. His own patients exert great pressure on him to forego the Hippocratic model and imitate the caricature of Dr. Knock.
The allure and challenges of the quick fix
In the middle of February 2017 myself and a colleague at EASUN were assigned the role of facilitating a staff assessment process for a civil society organization based in Arusha, Tanzania. We will call this organization RESET. The essence of the intervention was to observe, document and report the results of the assessment to the board.
In the clarification process it soon became clear that the Director of the organization was under pressure to convince the board that the secretariat has always been authentic in reporting their performance, achievements and remaining or new questions emerging. He went on to make our work sound extremely simple, i.e., attend the two days of the participatory assessment, which was being conducted by the organization itself, and collect the assessment papers for safe keeping. In addition, we were to make a summary of what was said in the assessments of various individuals and make a presentation to the board.
The RESET Director himself confessed to not being clear about what the board wanted from the assessment exercise, and particularly did not know how we were expected to design or prepare both the report and presentation. As we continued to clarify, I was haunted by the feeling that my colleague and I were being set-up for scapegoating, in a complicated scenario where even the board itself did not seem to know where its boundaries lie in terms of assessment of personnel.
On the other hand, it all seemed like the easiest consultancy ever. I was even slightly disturbed by the fact that we were being asked ‘simply’ to collect forms—and do the clerical task of typing the results of the assessment in summary form. Is this all that what we were to present to the board? I “smelt a rat”.
Yet we did our best to listen carefully, both to our own questions and doubts, as well as those of the client. We struggled to remain empathic even as they themselves hesitated, and therefore irritated us with their own anxiety and lack of clarity about the kind of support they needed from us.
On the specific day that we were to make the presentation to the board, the ED requested an urgent meeting with us. By this time, we had already gone through over one thousand pieces of papers from the assessment and had nicely arranged the results in a table. We still were not sure about what was to be the scope of the presentation—but suddenly, the ED had a bright idea. At this very last minute, he was full of advice on how we should prepare the report and what to say to the board. “Please include your own views of what the assessment results mean for the organizational development of RESET”, he said, with a lot of optimism. By that time we had only 2 hours remaining, including lunch time, before the start of the board meeting, and we had already been paid 50% of the consultancy fee.
Facilitating responsibility-taking through meaning-making
We couldn’t tell the ED that his request was impossible, even though that is what it seemed like. We quickly went back to the chart that we had formulated and looked at what seemed to be going well in terms of strengths demonstrated by RESET staff, as well what was not going so well. We put that information on the organizational levels of complexity tool, which offers 8 organizational levels, from the physical and formal to the social, spiritual and strategic aspects. This gave us a framework that enabled us to give our own assessment based on the understanding that an organization is a complex system of interacting levels that influence occurrence of the symptoms we may see in any particular place within a given time. Performance of staff perceived through the physical/ formal levels alone, therefore raised further questions and opportunities for potential performance of the organization as a whole. It was some relief for us to be able to transfer this headache to the Board of RESET, now that they were aware of the complex nature of organizations, and therefore could see their organizational development alongside project level performance issues that had been surfaced.
In the end it was fulfilling to note that the intervention had helped broaden the rationale for assessment from a purely physical level management of performance issues, i.e., a focus on stated rules, rituals, skills and practices that help people organize their activities. Through use of action learning at the end of the assessment day, we were able to facilitate RESET staff members to review their experiences of the assessment process itself. This enabled them to raise important issues from the emotional aspects that were not necessarily stated in organizational guidelines and were also not inherent in the performance assessment questions that they had to respond to. What was shared by staff members in the brief evaluation included 1) appreciation of their empowered participation in the assessment; 2) valuing the opportunity to get to know one another better; 3) they had increased their awareness of the work and purpose of their organization; 4) increased openness and confidence due to the challenge of participatory assessment of one another.
Additional experiences shared seemed to have their real source from the darker side of the psyche as shaped by the organizational context. These included
The evaluation of the assessment by staff members was made available to the leadership of the organization. This is an opportunity for RESET to recognize that the emotional side does play a role in influencing the quality of performance on the physical and formal sides of organizational life.
It will be interesting to see the extent to which RESET is willing to work with this new understanding in developing their organizational development plan.