Health at Work

Critical Perspectives

Leah Tomkins, Katrina Pritchard

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781351205177
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Engaging with some of the most debated topics in contemporary organizations, Health at Work: Critical Perspectives presents a critical, contingent view of the healthy employee and the very notion of organizational health. Drawing on expressions such as 'blowing a fuse', 'cracking under pressure' or 'health MOT', this book suggests that meanings of workplace health vary depending on how we frame the underlying purpose and function of organization.

Health at Work takes some of the most powerful and taken-for-granted discourses of organization and explores what each might mean for the construction of the healthy employee. Not only does it offer a fresh and challenging approach to the topic of health at work, it also examines several core topics at the heart of contemporary research and practice, including technology, innovation, ageing and emotions.

This book makes a timely contribution to debates about well-being at work, relevant to practitioners, policy-makers and designers of workplace health interventions, as well as academics and students. This book will be illuminating reading for students and scholars across management studies, occupational health and organizational psychology.

1

EFFICIENCY AND HEALTH

Discourses of the machine

In this chapter, we focus on the first of the two most dominant metaphors of institution, namely the organization-as-machine. We consider some of the ways in which mechanistic constructions of organizational experience have a powerful, often taken-for-granted influence on our assumptions and understandings of health and well-being. Specifically, we:

• Reflect on how notions of the well-functioning organization and the well-functioning employee have been shaped by the qualities of the well-functioning machine, so much so that human experience and performance are shot through with issues of efficiency, reliability, predictability and consistency.
• Consider the resulting construction of organizational health as an implicitly mechanistic injunction to ‘fix it!’, with binary assumptions of health/unhealth akin to the on/off switch on a machine.
• Propose that much of the mainstream literature on occupational health, in particular, operates with such mechanistic underpinnings, with a resultant focus on fixing physical and/or psychological breakdown, rather than actively promoting well-being.
• Argue that mechanistic constructions of both organization and the human body in post-Enlightenment Western thought imply that all problems are fixable with the right diagnostic expertise and efforts of re-engineering.
• Share some personal reflections from our own corporate experiences as diagnosticians, fixers and re-engineers.
• Suggest some of the ways in which the machine can be resisted or subverted, thereby paving the way towards other metaphors in the remainder of the book which set themselves up in direct opposition to mechanistic constructions of both individual and organizational health.

The organization-as-machine

As we outlined in the Introduction, there are multiple ways of understanding and approaching organization through discourse and metaphor (Alvesson and Karreman, 2000; Alvesson and Spicer, 2010; Cornelissen et al., 2008). Morgan’s (2007) seminal work on the images of organization is a useful point of departure for us here, because the first two of his eight metaphors – the machine (this chapter) and the organism (Chapter 2) – are arguably the master discourses of organization (Grant and Oswick, 1996). They both represent and reveal the most firmly embedded assumptions about the purpose and dynamics of organization and their effects on the constitution of individual and organizational health.

The contrasting notions of organization-as-machine and organization-as-organism have dominated organizational theory and practice over the past century or so. Each has very different implications for how we understand what it means for organizations and the people who work for them to be and stay healthy, and for the difficult, but crucial, question of who is responsible for this health. These differences can be crystallised as the distinction between efficiency and effectiveness – a pairing that comes extremely easily, almost automatically, in organizational conversations when we look for ways to summarise what successful organizational functioning comprises. To unpack the effects of these taken-for-granted assumptions on health, we focus in this chapter on the notion of efficiency and discourses of the machine.

Mechanistic assumptions underpin a great deal of classic management theory, such as Taylor’s principles of scientific management and the notion of ‘one best way’ of organizing (Taylor, 1914). Mechanisation infuses Weber’s (1946) discussion of bureaucracy, where bureaucracy standardises and regulates the business of administration in the same way that the machine standardises and regulates the business of production. Both the well-oiled bureaucracy and the well-oiled machine have specific components allocated to specific tasks, and their success is measured primarily against criteria of efficiency, reliability, predictability and consistency. As Morgan (2007) (p.13) suggests,

The mechanistic mode of thought has shaped our most basic conceptions of what organization is all about. For example, when we talk about organization we usually have in mind a state of orderly relations between clearly defined parts that have some determinate order. Although the image may not be explicit, we are talking about a set of mechanical relations. We talk about organizations as if they were machines, and as a consequence we tend to expect them to operate as machines: in a routinized, efficient, reliable and predictable way.

Many of the things we take for granted about organization have elements of this mechanistic approach, such as the standard depiction of a business in the shape of an organization chart, showing hierarchy, reporting relationships and specialisations, in which everyone has an allocated place, purpose and set of interfaces. Indeed, bureaucracy is proving remarkably resilient as the default organization type. In response to those who claim that the death of bureaucracy with all its ‘red tape’ is nigh (e.g., Bennis, 1967; Hamel, 2014), other scholars argue that bureaucracy persists as the base model for organization because it protects us from arbitrary power and patronage (Du Gay, 2000) and has adapted well to the demands of contemporary neo-liberalism (Graeber, 2015; Hanlon, 2016).

In the mechanistic mode of organization, there is little interest in the outside environment, whether it be customers, clients, consumers or any other external stakeholders. Instead, design and management effort is directed towards how well the machine runs internally. In a sense, therefore, any theory of the workplace which emphasises endogenous qualities of efficiency, reliability, consistency, etc., reveals the influence of the underlying metaphor of the organization-as-machine. The machine metaphor gives us a view of organization as a largely closed system, in which the organizational dynamic revolves around qualities of autonomy, self-reliance and self-reference (Morgan, 2007). Several influential theories derive from this depiction of organization as closed system, including models based on notions of autopoiesis or self-generation (Maturana and Varela, 1980) and self-organization (Ostrom, 1990).

From this perspective, it is not just the organization itself which is seen as machine-like. Mechanistic qualities and values spread to the organization’s employees, too. In other words, human beings are expected to behave as if they were component parts of the machine. Thus, the individual employee is measured and assessed in terms of performance, productivity and reliability, and these expectations are laid out in contracts, systems and standards of performance management and professional development, which are designed to be applied consistently across all members of a function or department, adjusted for the specifics of individual grades or seniorities. In other words, the ‘perfect employee’ is maximally productive and efficient, but also relatively easily replaced – the perfectly-tuned cog in the wheel. There is no room for inconsistencies or idiosyncrasies, for each employee-cog needs to comply with the machine design and align perfectly with the other cogs in the machine apparatus – a little like fitting in as a piece in a jigsaw puzzle.

It is not just the ‘perfect employee’ who is seen in machine-like terms, for mechanisation has infused notions of the ideal leader, too. For instance, the metaphor of the leader as cyborg shines a spotlight on the type of leader who is characterised by almost super-human dedication, perfectionism, reliability and an absolutely tireless energy. As Muhr (2011) (p.153) puts it, ‘a cyborg leader holds the ability to keep working on a continuous basis, almost like a machine that does not need breaks … It is almost as if they have an unlimited source of battery power, which never reaches low levels’. Cyborgs – both real and metaphorical – embody many of the ideas and qualities of the base metaphor of the machine and, in the process, come to blur the boundaries between human and machine (Nyberg, 2009; Parker, 1998). Moreover, their presence is not limited to the realm of science fiction; Muhr (2011) argues that the effects of the cyborg can be felt in many popular organization and management works, especially those which emphasise superiority, excellence and a succeed-at-all-costs mentality. By associating the qualities of Duracell bunny-style energy with business success, the metaphor of the cyborg creates a virtue out of humans behaving like long-life batteries. Such associations extend beyond the corporate world and enter the political realm, too. For instance, it is interesting to reflect on US president Donald Trump’s persistent accusations that his Democrat rival, Hillary Clinton, lacked stamina and energy, whereas his own health and ability to push through was considered to be ‘astonishingly excellent’ (McCartney, 2016; McGranahan, 2017). Consciously or otherwise, Trump seems to have made very canny use of the leader as cyborg.

As we outlined in the Introduction, discourses exert not just a top-down, managerialist influence on how people behave in organizational life; they also exert their influence on how people feel about their work and their role in an organization, becoming absorbed into the employees’ ways of being and sense of self. With the machine metaphor, in particular, mechanistic expressions such as ‘blowing a fuse’, being ‘a little rusty’ and ‘running out of steam’ have a forcible and enduring impact because they seem to equate to how people actually feel about their relationship with the organization and working life. Thus, discourses shape and regulate people’s ‘insides’, not just their external actions and behaviour (Alvesson and Willmott, 2002; Collinson, 2003; Ezzamel et al., 2001; Knights and Willmott, 1989).

Mechanistic constructions of the healthy employee: ‘Fix it!’

When we apply these mechanistic constructions of organization to the domain of health, we find what we call the ‘fix it!’ mentality, with the organization cast as ‘corporeal garage’ (McGillivray, 2005). If the ideal employee is healthy in the sense of the perfectly functioning cog, then the undesirable, i.e., unhealthy, employee is the broken or malfunctioning machine part which needs to be fixed or, if it cannot be fixed, replaced. There is a simple binary divide between the healthy and the unhealthy employee; one is either ‘fit for work’ or not, just as the switch on a machine is either on or off. As the vignette below suggests (Box 1.1), the binary nature of such constructions of fitness can affect how they are perceived and received in practice.

BOX 1.1 VIGNETTE: FAILURE OF ‘FIT FOR WORK’

In 2014, the UK government’s Department for Work and Pensions introduced legislation under the heading ‘Fit for Work’. This initiative was designed to support employers to manage sickness absence in the workplace through a range of measures, including free referral for occupational health assessments for employees who had reached, or whose General Practitioners (GPs) expected them to reach, four continuous weeks of sickness absence.

In 2018, the service was scrapped because of low referral rates, amid apparent scepticism amongst employers, employee representative bodies and health professionals about its viability and usefulness. Whilst not changing their assessment that levels of sickness absence are a serious problem for UK organizations, the British government has now pledged to explore other ways to tackle the issue, including considering how changes to the ways in which doctors fill out ‘sick notes’ – now refashioned as ‘fit notes’ – might support more effective return-to-work conversations with patients.

There are, of course, many possible explanations for the failure of the UK government’s ‘Fit for Work’ initiative. Commentators have highlighted a chronic shortage of qualified occupational health assessors, and a failure to invest enough resources in publicity for the new service. Adding to this list of very feasible explanations, we would suggest that this binary ‘fit’ versus ‘not fit’ construction simply does not resonate with most people’s subjective experiences of health – whether their own health or that of others whom they encounter as patients, clients or other kinds of referral. Unlike the industrial machinery from which this language and symbolism derives, our health does not usually operate with an on/off switch.

In passing, we note that the notion of ‘fit’ versus ‘not fit’ for work is reminiscent of another popular piece of organizational rhetoric, the idea that something or someone is (or is not) ‘fit for purpose’. This has become one of the most frequently heard organizational excuses to crystallise and simplify why something has gone wrong, inviting a radical, all-or-nothing kind of organizational recovery. If something is deemed ‘not fit for purpose’, it is simply beyond the scope of what can be repaired. The fact that it is also increasingly mocked by comedians and political commentators suggests a level of awareness, we would suggest, that it merits exposure for the tensions of its construction. There is something dehumanising indeed about the idea that a human being is ‘not fit for purpose’ (Cutcliffe, 2000; Nolan, 2015).

Health scholars argue that such mechanistic, binary assumptions reveal the origins of the occupational and organizational health literature in the fields of preventative medicine, epidemiology and engineering, in which the emphasis is on preventing and repairing breakages and breakdowns (Quick et al., 2007). Within this mechanistic paradigm, a great deal of the occupational health literature focuses on how to maximise employee productivity; manage absenteeism and other sources of non-productivity; avoid risks, mistakes, accidents and hazards; and comply with health and safety and employment legislation (Schultz and Edington, 2007; Smedley et al., 2013). It is mechanistic in orientation, in part because it relies on creating clear and discrete health ‘issues’ so that specialist interventions can be targeted, effectively ‘chunking up’ employees’ lived experience. Much of it examines the down-side of organizational life, such as burn-out, psychiatric disorder, bullying, substance abuse, etc. It also tends to be orientated towards ‘quick fixes’, that is, towards providing enough repair to allow employees to get back to work, but without really focusing on any longer term change or health reorientation. The focus is not so much on health, but on avoiding and managing unhealth, because unhealth is inimical to successful organizational functioning (Macik-Frey et al., 2007).

We referred in the Introduction to important parallels between discourses of organization and the social, cultural and ideological construction of health, selfhood and the body. Perhaps the most striking of these parallels is this connection between the organization-as-machine and the notion of the body-as-machine. A mechanistic approach has dominated understandings of embodiment over the past couple of hundred years, and is often traced back to Descartes’ comparison of the human body to a clock, which works without a mind (Descartes, 1641). With the rise of Enlightenment thinking, mechanistic understandings of health and medicine became entwined with a broader mechanistic, scientific and positivist outlook on life itself, summarised as ‘emphasising the search for invisible (to the senses) causative mechanisms, an analysis of phenomena into their component parts, the use of quantitative methods and physical measurement in research, and an objective stance toward phenomena’ (Osherson and AmaraSingham, 1981) (p.223).

With this mechanistic understanding comes an assumption that all problems can be fixed if we apply the right combination of cause and effect, and allocate the right specialists to their treatment. As Sontag (1978) argues, we live in an era when medicine’s central premise is that all diseases can be cured, and anything which is not fully and scientifically understood, and therefore fixable, is ‘felt to be morally, if not literally, contagious’ (Sontag, 1978) (p.6). In the parallel track of constructions of organization, we find a similar and powerful set of assumptions about the workplace: all (or at least, most) problems can be fixed, just as long as we diagnose them accurately and apply the right kinds of expertise to their resolution. And if we fail to fix them, the organization will eventually break down or become obsolete with a not-dissimilar sense of professional, even moral, failure.

The army of consultants, coaches and other kinds of professional expert we find in the contemporary organization speaks to the residual power of the machine discourse, and its emphasis on compartmentalisation, specialisation and repair. It is interesting to reflect on how, and with what effect, the language and practice of ‘organizational diagnosis’ has come to be taken-for-granted as a crystallisation of what it is that these experts and consultants actually do (Kahn, 2015; Lucas, 1987). Both body and organization are analysed into their component parts and engineered towards improved functioning. With such causal and compartmentalising ideas at work, no wonder the dominant injunction in organizational and occupational health is ‘fix it!’. As the vignette below illustrates (Box 1.2), our own professional experiences have been heavily infused by such assumptions, imagery and analogy.

BOX 1.2 PERSONAL REFLECTIONS: CONSULTANTS AS DIAGNOSTICIANS AND FIXERS

As we have worked on this book, the two of us have been revisiting our own experiences in our former careers as management consultants. When looking through examples of presentations and reports given to clients, we have been struck by how often – and how unconsciously – we used to draw on the language of ‘diagnosis’ to describe a default process of deconstructing the client organization into its component parts, usually into some combination of so-called ‘hard’ and ‘soft’ factors, such as Weisbord’s (1976) ‘purposes, relationships, leadership, structure, mechanisms, rewards’ or the famous McKinsey (see Bryan, 2008) 7-S framework of ‘strategy, structure, systems, shared values, skills, style, staff’.

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Table of contents

• Cover
• Half Title
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Series Editor Preface
• Introduction: Constructions of health at work
• 1. Efficiency and health: Discourses of the machine
• 2. Effectiveness and health: Discourses of organism
• 3. Care and health: Discourses of family
• 4. Age and health: Discourses of competition
• 5. Learning and health: Discourses of reinvention
• 6. Technology and health: Discourses of cyberspace
• 7. Politics and health: Discourses of power
• 8. Conclusions and consequences
• References
• Index