Motivating our nurses – give them freedom.

What gets you up in the morning?

 An old myth about nursing is that is a vocation, a calling based on the desire to help and care for each other. Currently nurses are being criticised for being too educated to care, that they have lost their compassion. I don’t think these things are true. Nurses come to work for a variety of reasons, chief among them of course is paid employment. However, pay itself is not the issue either. Managers and governments need to address more fundamental issues if they want nurses in the NHS to fulfil their mission to provide high quality complex care.

 The first thing to do is to dump old ways of thinking regarding motivation. The theory that if you reward good performance then you will get more if it and the converse that punishment of poor performance reduces it, is flawed. Daniel Pink (2009) reviewed the science and based on a good deal of research in both private sector and public sector organisations, criticises the carrot and stick approach.

First the pay issue, the carrot and stick method works when the task is mechanical in nature needing little or no thought. Then rewards for good performance works. Tasks requiring more than rudimentary cognition are different. The globally replicated research indicates that staff who were extremely well remunerated actually performed poorly which might explain why the global finance sector crashed. High pay does not lead to high performance. Pay has to be set, though, to remove it from the table as an issue, so there is a baseline to be achieved where staff no longer worry about their salary. Beyond that level there are there are three other factors at work: Autonomy, Mastery and Purpose.

We need Autonomy to perform well and to be creative.  Second we like Mastery. It appears that we like to get better at things, we like to practice to master our skills and finally we need Purpose (or vision) over and above the profit motive. If profit (or cost cutting) is the only goal things go pear shaped. Successful organisations want to make a difference and they develop a transcendental purpose.

The lesson for the NHS is clear. Calls for more nursing leadership to address poor care will fail unless nurses are given or allowed to develop these three things: Autonomy, Mastery and Purpose…that is what will get the nurse leaders of tomorrow really making a difference. Are our organisations up to the task of setting staff free or will they not take the risk and do more of the same? Bureaucracy, managerialism and petty fogging quality processes will kill this initiative. Identify your key members of staff and then give them autonomy to be creative and to master their skills and knowledge, ‘sell’ to them a higher purpose, let them develop their own purpose, and if you don’t know what that is you have work to do. Hands up those of you who can clearly articulate that these three things are your daily experience?

Pink, D.  Drive. (2009) The surprising Truth about what motivates us. Canongate. Edinburgh.

One Dimensional Man

 

Photo by NeONBRAND on Unsplash

Marcuse: ‘One Dimensional Man’ (1964) (Critical theory)

 

Herbert Marcuse’s One Dimensional Man will not be known by the majority of people. Its continued, and renewed relevance derives from that fact that his work is a fundamental challenge to taken for granted modes of thought which applies to understanding the relationship between the individual and society. Central to his argument is the role of culture, of patterns of thinking, in the narrowing of analysis of our current social positions, edifices and structures. This results in the loss of freedom to develop into alternative, if not our full, potentials as human beings.

As he argued: 

“Freedom is on the retreat – in the realm of thought as well as in that of society” (Marcuse 1954 p433).

When politicians not only lie, but get away with lying and deliberately tell half truths and falsehoods; when CEO’s and their apologists in the media, use self serving justifications for obscene levels of pay despite no correlation at all between reward and results; when great swathes of the 99% are persuaded that precarity in work, wage stagnation and withdrawal of vital services are not only in their interests (the latter) but are the fault of immigrants (the former); when white supremacists rail against loss of white identity…freedom is on the retreat.

Political lying, elite self justification, populace distraction and racist xenophobia all pre date Industrial Capitalism. This is not therefore a simple cause-effect discussion. It is a consideration of how modern forms of capitalism (US Industrial Capitalism for Marcuse) distort thinking into overly reductionist and a one dimensional frame of reference. It does so in order to reproduce itself with the consent of the masses.

By ‘it’ I actually mean actual living people who are members of a capitalist class, or its apologists, who benefit from the current political economic order or who aspire to benefit from it. If this class wishes to continue to engage in capital accumulation, the primary dynamic of capitalism, then they can only do so if everyone else plays their role willingly or by force.

Marcuse was instrumental in analysing capitalism in affluent America to address the role of culture in human affairs. After Hitler’s rise to power in 1933, the Institute for Social Research in Frankfurt (of which Marcuse was a member) moved to the USA. This group of scholars (The ‘Frankfurt School’) wished to understand the continuing development of capitalism basing their ideas on Marx’s overlooked philosophical works. The continuing position of the working class in the USA (specifically why they were acquiescent in the face of such issues as the Great Depression) needed some explanation. This has resonance today in the light of relative acquiescence by various publics to the fallout from the Financial crash of 2008.  From this perspective, society in its growing affluence in the USA, was increasingly ‘one dimensional’, i.e. had only way of knowing/thinking: it was an increasingly uncritical acceptance of the ideology of capitalism.

Marcuse’s work suggests we deal with two conflicting hypotheses:

  1. industrial capitalism is capable of containing qualitative change for the foreseeable future.
  2. forces and tendencies exist which may break this containment and explode the society.

Thus there is a need to study containment and stabilization as well as contestation and struggle. In three other works (Eros and Civilization, Essay on Liberation and Counter Revolution and Revolt) he focuses on ‘what could be’. ‘One dimensional Man’ discusses the what is, i.e. the forces of containment.

Multidimensional discourse posits possibilities that may transcend the current. The human subject is then free to perceive possibilities in the world that do not yet exist. ‘One Dimensionality’, then, is a mode of thought that conforms to existing action, behaviour and world view. It lacks a critical dimension which would seek to explore alternatives and potentialities. Thus, one dimensionality accepts current norms, values and structures without being able to envision any alternative. It is not able to discover liberating possibilities, or engage in transformative practices. One dimensionality is a state of being, it is a description, an adjective of ‘what is’ in opposition to ‘what could be’.

Countervailing forces do exist but have to struggle against the dominance of the prevailing control. Marcuse does not reject the idea that contradiction, conflict, revolt or alternative action exists, rather that capitalism is increasingly one dimensional in its application of technical rationality to social and economic life and this leads populations into uncritical ways of thinking outside the capitalist frame of reference.

This can be seen in the HE sector in the UK. HEFCE’s outline of ‘strategically important subjects’ (HEFCE 2008) is suggestive of the idea that the main role for HE is to provide education for economic purposes. The frame of reference of (notably Western) capitalism can be seen in the emphasis on STEM and ‘a skills based economy’ (OECD 2008), and the reduction of teaching budgets for what may be seen as non essential subjects. There is debate within the community of sociologists in the UK (British Sociological Association 2011) about the cultural value of sociology. The fact that they deem it necessary to defend this notion exemplifies a countervailing force against the one dimensionality of much of HE thinking and practice.

One dimensionality in health may be seen in the fixation on obesity as a largely food and individual choice issue, despite Andrew Lansley’s ‘Responsibility deal’ (Dept of Health 2011) which implicitly invokes nudge theory (Thaler and Sunstein 2008). A more critical stance understands obesity as a global and social problem in the obesogeneic environment,  related to the use of fossil fuels, food manufacture and marketing, employment, social inequalities, social networks, fast food outlets and many other factors. However, even this critique does not challenge the fundamental ideology of consumer capitalism. An ideology  which is devoid of critical self reflection on the purpose of life other than to produce as efficiently and economically as possible (technical rationality) goods and services for consumption.

For Marcuse, ‘Organized’ capitalism results in a totally administered society and the decline of the individual, a society without opposition. In this world the ‘metaphysics’ of the human subject is superseded by technology. The metaphysical subject (man/woman) who is free to act and face controllable objects is lost within a one dimensional technical world in which the answers have been found within a pre existing universe characterised by the application of ‘Technical Rationality’ to address means and ends. What dominates is instrumentality and efficacy within a means/ends taken for granted existence.

Technical Rationality (TR) suggests that it is rational to do something, to produce something, as efficiently as possible through the application of scientific theory and technique. Marcuse suggests that technical rationality within modern culture is dominant but that it is irrational when it becomes an administrative, managerial process of capitalism that enslaves and prevents original thought. ‘Technology’ is not merely ‘gadgets’; it is also the social process of production, distribution and exchange, the totality of how we construct a society.

How is TR played out? The economy is organised around calculations about resource inputs and outputs, the triumph of the bottom line, and the operation of a ‘free’ market. Human needs are subservient to this rational process. So, phenomena that cannot be measured may not appear in rational accounting. Human relationships are reduced to that which can be observed, measured, predicted, accounted for in efficiency terms. If the UK cannot support an industry (coal mining) because it is too expensive, then the rational thing to do is to close it. If a rational assessment (e.g. “they will go elsewhere”, or “we have to attract the best”) of exacting high levies on financial transactions results in not regulating the financial sector, then that is the efficient thing to do (regardless of the health and social outcomes of vulnerable groups). However TR may also be used as a screen to prevent examination of ideological positions or the defence of vested interests.

Marcuse’s key ideas were thus a critique of industrial, consumer capitalism in which there had been integration of the proletariat into the mainstream so that they no longer protested against the system itself.  This resulted in the stabilization of capitalism, the bureaucratisation of socialism, the demise of the revolutionary left and an absence of viable forces for progressive change. New modes of social control are exercised through technology, consumerism, media, rationality, administration and bureaucracy.

One dimensional manis losing individuality, freedom and the ability to dissent or control one’s destiny, the self is whittled away by a society that shapes aspirations, hopes, fears and values and manipulates vital needs. The surrender of individuality and freedom is the price paid for satisfaction. One’s true needs cannot be met because one does not know what true needs are, as they are not one’s own. Needs are manufactured by a society to serve other ends. Administration and control take over from autonomy, domination cannot be resisted. We are then unable to distinguish between our:

·          existence and essence.

·          fact and potential.

·          appearance and reality.

This occurs through reification and repressive desublimation. The process of reification (‘to give life to’) occurs when one thinks that something abstract actually exists rather than being a product of social relationships. So the capitalist ‘system’ is no more than the sum of a particular set of historical human relationships. When we talk about for example  ‘the system’ as if the system has a life of its own we reify it, we take it for granted  and forget that ‘the system’ only exists because humans interact in a particular way. If we chose to act differently, the system would cease to exist.

The sublimation of desires (libido) in Freudian terms means to place into the subconscious impulses and desires, and to control them into something socially useful. To desublimate is to release one’s impulses, to bring them out into the open. Capitalism encourages this desublimation, encouraging the production and satisfaction of desires and impulses through marketing, media and consumer society. However this desublimation is actually repressive because the mode of social relationships thus encouraged, closes down alternative world views as it is played out in the stage set by consumer capitalism. Consumerism gives us a framework in which to indulge our impulses and desires in particular forms, it fosters a false consciousness around what constitutes our true selves, it negates alternatives and through the act of consumption we lose the ability to think and act differently.

We then fool ourselves onto thinking that which makes us happy ought to make us happy and are the only things that can make us happy.  We think that because as we feel this is the best of all possible worlds, then this world is the best of all possible worlds (we cannot see an alternative). If we do this we then become one dimensional in our thinking:

“This society is irrational as a whole. Its productivity is destructive of the free development of human needs and faculties…its growth dependent on the repression of the real possibilities for pacifying the struggle for existence – individual, national and international” (p xl).

Like capitalism, health (as well as having objective existence to some degree) is a social product, i.e. social relationships under capitalism produce particular health and disease patterns. We become one dimensional if we are unable to think that health may be constructed differently, if we are unable to consider that a different form of social relationships, different modes of production, distribution and exchange, and technology would have different effects on patterns of health and well being. So in a one dimensional (capitalist) society:

  1. Individuals are integrated into society, content with their lot and unable to perceive possibilities for a happier and freer life, unaware that their illness is political and social in origin and instead largely rely on biological and genetic interpretation for illness.
  2. Society’s progress and affluence is based on waste and destruction, fuelled by exploitation and repression and that this then effects the health and well being of populations in negative ways.
  3. Freedom and democracy are based on manipulation, thus making it very hard to come up with alternative political action to address the social determinants of health because facts are distorted or not shared.
  4. The opulence and affluence of technological capitalism dehumanises and alienates, there is slavery in its labour system, ideology and indoctrination in its culture, fetishism in its consumerism, danger and insanity in its military industrial complex.
  5. Commodification and consumption. When everything has a price (becomes a commodity to be bought and sold on the market), when our prime social function is centred on buying ‘stuff’ we become disempowered and distracted by bright shiny things to challenge the roots of dis-ease.

What is needed is to engage in the ‘Great Refusal’action and thought to challenge the dominant and controlling modes of existence, to criticise and negate the taken for granted, to hold ‘power’ accountable, to withdraw from advertising, marketing, consuming, to develop intellectually and culturally non repressive forms of social relationships, through active citizenship, political discourse culture and Art.

Marcuse’s analysis, based on the conditions of the post war United States, may result in an over emphasis on the stability of capitalism and its ability to close down critique, but One Dimensionality does accept the existence of countervailing forces. This is not a one dimensional theory as he explicitly addresses the two conflicting hypotheses above regarding capitalism’s ability for containment and explosion from within. Currently there are countervailing forces trying to address the current global pattern of disease which is based in inequitable distribution of income and resources, political instabilities, hegemonic arguments for ‘there is no alternative’ and the negative consequences of capitalist globalisation in its variant forms.

 

References

British Sociological Association (2011) Sociology and the cuts. Response and debates http://sociologyandthecuts.wordpress.com/

Great Britain Department of Health (2011) The Public Health Responsibility Deal. March. http://tinyurl.com/publichealthresponsibility

HEFCE (2008) Strategically Important and Vulnerable Subjects. Final report of the 2008 Advisory group. http://www.hefce.ac.uk/aboutus/sis/ October 2008/38

Morrall, P. (2009). Sociology of Health. Routledge.

OECD (2008) More than just jobs. Workforce development in a skills based economy.  http://tinyurl.com/oecdskillsbased

Roberts, I. and Edwards, P. (2009) The Energy Glut. The politics of fatness in an overheating world. Zen.

Thaler, R and Sunstein, C. (2008) Nudge. Improving decisions about health, wealth and happiness. Yale University Press.

Marcuse. H. (1964) One Dimensional Man. Routledge. London.

Marcuse, H. (1954) Epilogue: Reason and Revolution. 2e New York Humanities Press pp 433.

Wilkinson, R. and Marmot, M. (2003) Social Determinants of Health. The solid facts. WHO.