Chapter 12
Navigating organisational change: being a person-centred facilitator
Famke van Lieshout
Fontys University of Applied Sciences, Eindhoven, The Netherlands
Worldwide, health-care practice is facing societal and political changes and challenges. Initiatives for organisational change alternate rapidly to respond to these developments. There is an ever increasing number of initiatives in which the human dimension of caring gains explicit attention; the development of person-centred care is illustrative of this. Facilitation is vital in effective implementation of person-centred care in health-care practice (McCormack & McCance 2010); this could be performed by management, team leaders, advanced nurse practitioners or consultants. Also, by practitioner (action) researchers, who aim to develop practice and to study this development simultaneously (Kemmis et al. 2014).
Each of these professionals can choose from a wide variety of facilitation approaches. Deciding on a certain approach is guided by the value system a person holds, which often also characterises them as facilitators. In my doctoral study, I facilitated the development of an effective workplace culture in clinical practice through participatory action research. In order to achieve congruency between my facilitation, the research topic and methodology, I adopted an holistic and emancipatory/enabling facilitation approach that was supported by humanistic and person-centred values. However, realising this in practice was no mean feat. Four themes, identified in this study, will be presented in this chapter and could help when working with the person-centred framework (McCormack & McCance 2010) in order to be and to become a person-centred facilitator.
Person-centred facilitation
Person-centredness is a normative-value approach to relationships and is characterised by values of respect, mutual respect, understanding and the right to self-determination. These values can, metaphorically speaking, be a rudder for decision-making, consciously or pre-consciously, in the development of relationships. Person-centredness is often associated with care relationships. However, Rogers (1980) defines it also as any helping relationship aimed at growth: ‘person-centredness is a philosophy, an approach to life, a way of being, which fits any situation in which growth – of a person, group or community – is part of the goal’ (p. xvii). Facilitation is most simply regarded as ‘the helping of others to change their current situation’ (Harvey et al. 2002) and as a holistic means of enabling practitioner emancipation, development of self and effective workplace cultures. Combining these concepts of person-centredness and facilitation results in ‘person-centred facilitation’ as a specific type of relationship where person-centred values are lived and (personal) connectedness and reciprocity foster mutual growth (van Lieshout & Cardiff 2015). This mutual growth can both liberate people from restrictive views, traditions and practices that inhibit their flourishing, and enhance commitment for developing and sustaining ethical organisational change. Participation in the change process and in person-centred relationships is essential for such ethical change.
Although humanistic and person-centred values were embodied in my daily actions, these were challenged when I engaged with individuals, teams and contexts in the study. I experienced that my value system and my interrelated philosophical stance and facilitation approach, were continuously subjected to intra-personal, inter-personal and contextual influences and therefore were in a constant state of change. Values supportive of being person-centred were alternated with values that were less supportive of being person-centred. Hence, remaining person-centred in the many relationships I engaged in, as a practice development facilitator, could not be taken for granted and became a main focus for reflection and action.
The person-centred framework of McCormack and McCance (2010), although it has a focus on nursing relationships, is also perceived to be helpful in reflecting on relationships in the facilitation of change. It emphasises those key concepts that are relevant for engaging in person-centred relationships, helps to understand person-centredness and guides action. The framework, however, does not prescribe specific actions that could be taken when facing complexity as a person-centred facilitator in practice. For this reason, I will focus on four specific themes in this chapter, which I will argue can help when working with the framework to develop and sustain person-centred relationships, in particular when involved in facilitating organisational change.
Working with the person-centred framework
This idea of linking new themes to the framework is drawn from my doctoral study, in which the central focus was an extensive reflexive analysis of my lived experience as a person-centred facilitator in developing practice through participatory action research (van Lieshout 2013). Themes were identified from storied data, which were collected in a 2-year period of facilitating practice development, and considered in relation to existing literature. The themes that were identified in the analysis were central in the development of a mid-range theory on essential conditions for facilitating organisational change. The themes are:
- knowing the context;
- balancing being and doing;
- creating a system of support;
- achieving synchronicity.
These will be described and linked to relevant elements of the person-centred framework.
Theme: knowing the context
It is argued that the ability to use a person-centred approach is heavily influenced by the care environment (McCabe 2004) – that is, the context. Context is complex and dynamic as it concerns the interplay of culture, leadership, behaviours, relationships and evidence. Culture in particular is considered to shape the dynamics and to have an impact on relationships. Culture holds a set of values and beliefs that become noticeable in collaborative working, and impact on the way people do things in their context.
The culture I worked in during my study indicated issues of hierarchy and the valuing of a more traditional stance in research. For instance, when I presented my study proposal to higher management, to gain permission to work with a selected unit, they wanted to know in advance what my actions would be, whilst this could not be answered as the study had an emerging design. Also, in my engagement with the unit leader I experienced a constant struggle in working together with the team to reflect on practice and to identify issues for action. The leader was suspicious of my role as an external facilitator and often withheld initiatives for collaborative action and for exchanging information. In sharing some preliminary findings on workplace culture to management, they felt offended and doubted my competencies. Signs of a blame culture were evident here.
Practitioners were disappointed in the organisation. They felt they were ‘marionettes in the game of change’ and their individual talents were not seen. Also, the formation of teams was constantly changed by management, which required practitioners to constantly fine-tune with others. All these issues and values that were characteristic for an overall culture in context, made practitioners hold back from engaging in a relationship with me in order to change their practice. These hindered the realisation of person-centred processes – those of shared decision-making and working with the team’s values and beliefs. Specific preparatory action in building relationships was required for these processes to be realised.
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