Bad Science

A good colleague of mine, Robert MacIntosh, has just created a blog for PhD students in management. He's developing it as a resource site for them and has included a number of books that might help those people learn about what consitutes good research. I'm going to suggest he recommends Bad Science by Ben Goldacre, a wonderfully funny and well written book with serious messages on what comprises knowledge in the field of healthcare, nutrition and much of the nonsense that gets acres of press coverage by all branches of the media.

Goldacre, a medical doctor, writer and columnist in the Guardian, has brought together ideas from his website to do a demolition job on popular treatments such as Homeopathy, Brain Gym, much of Nutritional 'Science', Pills that solve social problems such as Omega - 3, etc., and people who promote them, including Gillian McKeith and Professor Sir Robert Winston. He does so from the perspective of a trained experimental scientist, used to applying the rigours of controls, placebos, probablity sampling, etc to the evaluation of research. For the most part, these are not the kinds of rigours that some PhD students in management are used to, nor are they necessarily sympathetic to the positivist assumptions underlying this form of knowledge production - at least in the UK. However, it's probably best that they learn about them, if only to defend their methodologies and methods against those examiners with a scientific disposition - and I've come across a no more amusing nor sharply intelligent way of doing so than by dipping into this book.

Reading it has helped me understand where my class of surgeons, physicians and dentists are coming from when they looked at us with some astonishment when introducing them to the 'rigours' of action research in clinical leadership. It's a world away from their world, though as the author frequently mentions, what is often the most interesting aspects of the findings are the complex social issues that often have the greatest impact on treatments.

The book has also taking me down another path to explore the metaphor of 'leadership as placebo'. This is not a new idea: it was first 'discovered' nearly a century ago during the Hawthorne studies when productivity progressively increased during the so-called experimental stages even when benefits given to the girls in the Relay Assembly Test Room were removed (at least that's the myth). Mayo, the father of Organizational Behaviour at Harvard, explained these findings in terms of the bad science of the Hawthorne effect, sympathetic leadership and the development of 'appropriate norms' rather than the treatment (increased lighting, rest breaks, etc) - itself an explanation that was based on bad science. Nevertheless, placebos in the form of sugary coated pills (read leadership) can produce some extraordinary effects because people want to believe in their efficacy, as Goldacre points out in a stunning set of findings by Braithwaite and Cooper in 1981 on research into headaches. 835 women were given either aspirin or placebo pills, packed in either bland boxes or flashy, brand name packaging. They found that aspirin did have a positive effect on treating headaches, but more than that they found the packaging enhanced both the effects of the aspirin and placebo pills.

Just like some nutritional and pharmacological treatments, the evidence on leader impact on performance isn't strong, yet the belief in leaders is high, especially when they come well packaged and branded. Goldacre argues his medical case in the context of the highly dubious claims that fish-oil pills improve childrens intelligence, which are accorded no support by good science. Yet belief in these pills is widespread and the main reason for this state of affairs lies not just with the hucksters and snake oil salesman but with the media in the form of the news values of journalists and how stories are pushed. What is also evident is the invention by pill salesmen and some unethical pharmaceutical companies of new diseases because they cannot find new treatments for the diseases we already have. A parallel exists in the business field, because power lies in the ability of leaders, according to the leader-centric explanations of business performance, not because the facts support this explanation but because of the media's need for celebrity and their search for heros (and more recently villains). And because some leaders become almost deified by the business and popular media, they are encouraged to search for new problems (or diseases) to solve, often in contexts for which they have no previous nor relevant experiences. Such is the case with the system of pantouflage in France, whereby public sector leaders can easily transfer to positions in the private sector because of who they are, not what they know. It also occurs in the reverse direction in Anglo-Saxon countries such as the USA and UK. Leadership as craft it seems is not important, where leaders learn to lead with followers; instead it is the art of leaders and their charisma that dominates popular imagination and the expectations of many followers.

It is just such an unhealthy view that has led to the problems we currently face in many of our companies. Am I onto something here with this metaphor, and can our PhD students learn more from reading serious 'airport books' like this one on medical research than some of the material we pass off as knowledge about management?

Branding and Reputations: the Needs for Equivocality, Flexibility and Adaptability

It’s been my week for working on reputation management and employer branding. Along with colleagues in the Centre, I’ve just finished off a couple of draft reports on employer branding and reputation management for two of the largest health boards in Scotland, given a presentation on the topic to the senior executive team of another health board, and about to give a presentation on corporate reputations to a specialist conference on the subject in Rome in a few hours. So it was extremely helpful to have received a mail from a good colleague of mine, Kerry Griggs, from Charles Sturt University in Australia, who is working with me in this field. Kerry pointed me in the direction of an insightful academic piece in the Journal of Management Inquiry by Kirstin Price, Dennis Gioia and Kevin Corley from the USA entitled ‘Reconciling Scattered Images’, which has helped me make sense of the scattered images we have unearthed in our own health service research and revise some of our model building on employer branding, coming out in two books early next year by Ron Burke and Cary Cooper and by Paul Sparrow.

Price et al discuss organizational images from three perspectives. These are projected organizational images (self presentation), refracted images (how outsiders read specific aspects of an organizational image) and intercepted images (how particular employees and leaders interpret images, often based on the way insiders think outsiders see them). So far, nothing much new here, aside from new terms. However, it is what they make of these, often competing, images that help me make sense of organizations such as the NHS. They argue that these images are ‘best seen as ‘virtual commodities modified and exchanged’ in a marketplace for ideas about an organisation. Thus people hold multiple images of organisations, often at odds with the official one that organisations such as the NHS would like to dominate the marketplace for ideas about health providers. As an example, our research (on, in their terms, projected, refracted and intercepted images) has unearthed four competing and complementary images among health service employees in rank order of the 'volume' (a measure of frequency and intensity with which they were expressed during group interviews): as organisations dominated by financial governance, power and politics; as professional bureaucracies structured along strong clinical identities, as employers of choice; and as a patient-centred, caring organisations. Interestingly, while the first two images dominated, the last two were not widely held or consistently expressed during our interviews.

Price et al's key insight is that organisations such as the NHS need to be flexible and adaptable in identity management to cope with the dynamic environments in which they operate. In this way they become sustainable in the long run – the dynamic capabilities argument. Organisational image architects (and academics) need to think in terms of ‘image equivocality’ to mitigate the scattered images problem. Roughly translated this means they need to build in flexibility (relevant to time and context), consistency (non-contradictory images) and inclusivity (relevant and authentic to most employees and users). How organisations such as specific health care providers achieve this is dependent on their ability to create images that maintain employees’ appreciation of its needs for adaptability (say in moving care towards the community and away from hospitals, and in meeting ever stringent financial resourcing) while not producing cynicism and mistrust through projected duplicitous images (e.g. those emphasising patient care that health service workers sometimes find difficulty in buying into, given their perceptions of senior management's main concerns). Such projections have an awful tendency to come back to haunt them.

Political science tells us this is best achieved by creating images that constituents can write what they want into them, while still remaining consistent with their overall mission and values. Which is why we are advocating public value as a equivocal image for health services providers. This notion, part of another of our research programmes on healthcare discussed on this blog, seems to fulfil the criteria of flexibility, consistency and inclusivity because it is ‘what the public values’, an idea broad enough to be flexible,consistent and inclusive but also a compelling one. What the public values may change over time with ratcheted expectations of healthcare providers; it may also change over time to incorporate an economic as well as caring mission. However, it remains a consistent goal for many healthcare employees seeking to gain meaning from their work while being fairly rewarded and provided for, and being allowed to hone and utilise their professional skills. For example, new public sector financial stringencies will lead to investment problems for all healthcare providers in the UK, while demographic trends point to major problems in recruiting clinical and non-clinical staff from traditional labour markets. A public value image allows healthcare to reflect these environmental changes by being at the heart of economic development as well as a caring society - providing good knowledge-intensive jobs in regions that need them and in providing employment for disadvantaged groups who are often those most in need to healthcare as a consequence of their marginalisation (see the results between unemployment and health). These economic goals are easily reconcilable with a healthcare and prevention mission, and place Scotland’s healthcare providers at the heart of economic growth.

Is this a projected image that we can all write into it what we want to, while remaining consistent with the traditional values of the NHS?