Metaforer vi leder efter: Et felteksperiment om agency i primær sundhedstjeneste

Jakob Bovin

Student thesis: Master executive thesis


Aim and scope: The production of welfare has transformed itself from the production of service to a production of participatory possibilities. This transformation produces new forms of organisational tension and paradox that may surface in several shapes. In the present thesis, tension and paradox are addressed as and through narratives. According to cognitive linguistics, we live largely by metaphors and the metaphor is consider-ed especially potent in the construction, preservation and reconstruction of narratives. The aim and scope of the present thesis is therefore to explore the potential of deliberate metaphoric leadership as a means for developing agency in the present day tension and paradox of public management. The thesis is further narrowed down to the empirical field of primary health care with the strategic manager as observation point. Three strategic managers of primary health care have been involved as both study objects and co-researchers in designing, conducting and documenting experiments with metaphoric intervention during a period of one month. The theoretical focal point has been Klaus Majgaard’s division of management into simple, reflected and transformative management combined with a scope of theoretical frames of reference for understanding the effects, the embeddedness, the life and the narrative potential of metaphor. The main research question is: How can deliberate metaphorics catalyse a development of agency in primary health care? The main findings are: Three Danish strategic health care managers have conducted each a metapho-ric intervention. One re-frames a management dialogue on coordination, in order to achieve a higher level of functional efficiency, in a context that was otherwise bureaucratically paralysed. Another re-frames rehabilitation to enhance a sense of professional coherence over simple linear efficiency. The third re-frames welfare technology with intentions of establishing both a positive attitude and an orientation towards cross-organisational collaboration. All three metaphoric interventions entail elements of both simple-, reflected and transformative rationality. A metaphor is an instrument of representation. In the perspective of three strategic managers, metaphors can produce visibility, overcome organisational distance and establish remote control. It does so by means of simplification, displacement and fixation of complexities. The original tension or paradox is thus not dispersed but transformed into new tension or paradox. In the case of the managers involved, this has been a productive process in itself, but the process of strategic re-configuration is not brought to an end. Metaphors are easily communicated when they tap in to existing metaphorically structured schemata. In the three experiments providing the empirical foundation of the thesis this seems to have the advantage of efficiency in communicating complexity in a simple way. Thus it seems that metaphors that are highly ‘metaphorically true’, prior to an intervention, is a suitable means of simple management. But this kind of communication is efficient at the expense of entangling the communication in the very same foundations of the pre-established schemata that one would sometimes like to renew. A metaphor has a life circle. If a new metaphor is well chosen, the experiments suggest that it can be brought to life by a creative and/or persistent pedagogic effort. It can thereafter live out a re-organising potential in a period of vitality. There are some empirical indications that such an innova-tive metaphor will tend to progress towards becoming a truism and thus in time also progress towards its own death. A dead metaphor is a metaphor that is no longer seen as a metaphor, but instead as a more or less literal expression. The birth and the initial nurturing of a metaphor seems to be an example of reflective leadership and the vitality of a living metaphor an indicator of organisational transformativity. In the present study there are examples of both effective simple management by metaphor, reflective production of self-awareness of managers, and transformative facilitation of practical implementations – all catalysed by metaphoric framing. Metaphors can carry meaning, but to some extent the meaning must also be carried by a broader communicative context. Innovative metaphoric intervention is therefore seen as an element amongst others in a complex process of organisational re-narration. For instance a strong metaphor can help distill a desirable component in an existing narrative of the past from an undesirable component. In such a case the metaphor functions as a catalyst for the establishment of plots by intertwining future, past and present in strategic ways. A new story of the future can be told by metaphoric reframing of the past in a metaphoric effort in the present. In conclusion a metaphor can be seen as a powerful catalytic instrument of agency in primary health care. It can be so (1) in a relevant degree; (2) in ways, that produces both simple-, reflective-, transfor-mative- and integrated agency depending on context and approach; (3) the developed agency addres-ses both spatial and temporal tension and (4) metaphoric intervention can be seen as an always tem-porary and intermediary remedy, -but (therefore) also as a relevant and productive catalytic of agency. One of the outcomes is, that public managers who are aware of the life cycles of metaphors might strengthen the capacity for embracing, designing and potentialising the organisation respon-sibly in the image of futures of the future.

EducationsMaster of Public Administration, (Executive Master Programme) Final Thesis
Publication date2016
Number of pages105