![\"\"](\"https:\/\/stg-blogs.bmj.com\/medical-humanities\/files\/2017\/01\/True-Tales-of-Organisational-Life-2-201x300.jpeg\")
<\/p>\n<\/p>\n
<\/p>\n
True Tales of Organisational Life<\/em><\/strong><\/p>\n Barbara-Anne Wren<\/strong><\/p>\n Karnac Books Ltd, 2016<\/strong><\/p>\n ISBN-13: 978-1-78220-189-2<\/strong><\/p>\n <\/p>\n Reviewed by Dr Andrew Schuman<\/p>\n <\/p>\n It\u2019s stories<\/em>, the psychologist Barbara-Anne Wren reminds us, \u201cthat will hold us when nothing else can\u201d. They are humankind\u2019s most effective way of making sense of the world \u2013 of organising and giving \u201ca shape to experience\u201d.<\/p>\n The organisation in question, both in the title and at the heart of the book, is the National Health Service (NHS): a gargantuan body employing around two million people. The individuals, working within the service in these straitened times, are facing unprecedented challenges. Relentless waves of financial cuts, along with breathtakingly costly systems of regulation and inspection, have left a workforce more disillusioned and more demoralised than ever before.<\/p>\n Wren\u2019s work as a psychologist and organisational consultant, in a busy London teaching hospital over the past seven years, has been ground-breaking. Rather than seeking the impossible, of\u00a0 \u201cbanishing\u201d emotion and distress at an individual level, her remit has been to \u201cmanage meaning and complexity, understand emotional life at both an organisational and individual level, and create spaces in which the unique challenges of healthcare work could be observed and understood.\u201d Some remit.<\/p>\n The strength of Wren\u2019s book lies in her first-hand account of setting up this therapeutic space \u2013 in the form of Schwartz Rounds. Originating in America, they consist of a monthly meeting of health professionals, in a forum that is non-hierarchical and deliberately organisation-wide. Their primary focus is on the human <\/em>dimensions of providing care. Rather than chasing action-points and outcomes, the emphasis in these meetings is on quiet reflection and stillness \u2013 storytelling without a means or an end, where \u201crational and emotional experience have equal permission to emerge\u201d.<\/p>\n At their core is the work of Kenneth Schwartz, a US lawyer, who died of lung cancer in his forties. His own story of diagnosis and treatment was, he writes, \u201cpunctuated by moments of exquisite compassion\u201d, [that] \u201cmade the unbearable bearable\u201d. \u00a0The article he wrote, shortly before he died, serves as a rallying-call:<\/p>\n I cannot emphasize enough how meaningful it was to me when caregivers revealed something about themselves that made a personal connection to my plight. It made me feel much less lonely. The rule-books, I\u2019m sure, frown on such intimate engagement between caregiver and patient. But maybe it\u2019s time to rewrite them\u2026<\/p>\n Our response to his plea must be to support and enable those working in the front-line of the health service \u2013 and to encourage and inspire a greater emotional engagement with our patients. As Wren reminds us, psychology\u2019s modus operandi<\/em> is in \u201crelationship\u201d: \u201cit is dynamic\u2026 It works because it moves.\u201d<\/p>\n The protected time and head space of the Schwartz Round give participants permission to open up about the very things that really move them \u2013 \u201cwhat they were proud of, exhausted from\u201d, but also \u201cwhat saddened and puzzled, infuriated and frightened, humbled and inspired them.\u201d<\/p>\n Two-thirds of the way through the book, we get to its raison d\u2019etre<\/em>: a collection of seven stories, garnered from the many Schwartz Rounds that Wren has facilitated. These \u201ctrue tales\u201d (of the title) illustrate the limitless ways in which a particular story is able to \u201cmove\u201d, in all senses of the word. They tell a tale, but they show us a greater truth: that stories \u201cwill hold us when nothing else can\u201d. With their beginnings, middles and ends, they can bring order and sense \u2013 and \u201csustain us\u201d. Some of the stories arise from clinical issues, others from tensions that can occur between our personal and professional lives; still more concern conflicts at an organisational level.<\/p>\n One of them concerns a \u201cmacho\u201d transplant surgeon, who needed to travel to another hospital in order to harvest an organ, before returning gung-ho, aware only of \u201cthe happy anticipation of the expectant, hopeful patient\u201d whose life he would be saving \u2013 and \u201cready to demonstrate his skill and authority\u201d. As the successful retrieval surgery came to an end, and the surgical drapes were removed, there was a rustle of paper below the body of the child donating the organs \u2013 and a teddy bear tumbled to the floor. The teddy bear was the very first thing the child had been given when he was born; the paper some pages on which family members had imprinted their hands, so that the child would die \u201cin their arms\u201d.<\/p>\n As soon as this was explained to the transplant surgeon, \u201ca ring of steel around his emotions was broken\u201d. By the time of the Schwartz round, the surgeon succeeded (only just) in \u201cgather[ing] up all his energy\u201d, and recounted his experience \u2013 including the detail of the teddy bear.<\/p>\n Reading this stopped me short. It also brought to mind the words of the American writer, Maya Angelou: \u201cThere is no greater agony than bearing an untold story inside you\u201d. The surgeon\u2019s burden had been made lighter by the telling of his tale, while those listening, bearers of this confessional, could respond only with silence.<\/p>\n Wren unpacks each of the stories she gives us \u2013 in this particular case, reflecting on the challenge for clinicians of balancing feelings of sadness and grief with \u201cthe business of living\u201d. We need to know, in order to function for the good of all of our patients, when to block each of them out. Both feelings are, of course, essential.<\/p>\n Another tale looks at the case of an abusive patient \u2013 but from the perspective of the staff looking after her. As Wren points out, the focus of the Schwartz Round is more on effects<\/em> than causes: here, the focus was on the impact of the abuse on the individual staff members, and the \u201creality of what they have to withstand\u201d. Faced with this situation, we can sometimes summon up compassion and creativity; at other times, we\u2019re all too aware of the limits of our compassion. But Wren gets the participants to \u201cquestion the balance between what is being required of them, what they have left to give, and the containment and support they are being offered\u201d \u2013 while appreciating, and exploring, the ways within the group of dealing with such abuse.<\/p>\n The book is not without faults. The editing could have been a little tighter. At times, Wren\u2019s prose tends towards the mystical. Elsewhere, her generalisations can seem weak. \u201cEveryone\u201d, she tells us, \u201cwants to be a psychologist, or is one, or knows one\u201d. Her statement, that patients in hospital \u201c[a]ll have families who want them back\u201d seems, sadly, a tall tale.<\/p>\n But<\/em> True Tales<\/em> is good on the practicalities of voicing disharmony in the workplace, and of seeking ways to resolve these conflicts through the timeless alchemy of stories and story telling. \u201cEver since we were little, the stories have kept the darkness at bay. That and each other will get us through.\u201d<\/p>\n <\/p>\n Dr Andrew Schuman<\/p>\n Dr Kenyon & Partners,<\/p>\n 19 Beaumont St., Oxford, OX1 2NA<\/p>\n <\/p>\n