From the Editors' desk. All is change

Hi everyone. I can't wait for my vacation from this blog!! Not that I don't love weekly blogging!! When it goes well there is immediate inspiration to articulate something that has been simmering beneath the conscious surface. And that may well be important.
I find myself thinking about change....”all is change” said Heraclitus and the Buddha said something similar a little beforehand too (it is possible that there was knowledge transfer between these very high cultures of northern India and Southern Greece at around 500 BCE --but I do not wish to digress...)
If “all is change” then what possessed Kurt Lewin to suggest a three phase change model that has been very influential in organizational action research and indeed even in organizational conventional research?! His model went something like: unfreeze the system, make the change, refreeze. It still forms the underlying basis of many change management theories models and strategies for managing change. It still informs much action research.
His premise is that the organization (or any system) is frozen in place - hence we seek to unfreeze things just to begin to make change. More rigorous understanding of reality (a la physics) suggests that all systems are, in fact, extraordinarily dynamic. From the microscopic level up, electrons are whirring around at unimaginable rates, configuring themselves over and over...and in apparently the same way as they just were! Who’d have thunk? Isn't that odd how it all comes together so nicely just the way it was?! Well what if we took scientific insight more seriously as action researchers and allowed ourselves experience that things are, in fact, exactly what they are, namely in profound flux. As such we could imagine how reality can become reconfigured much more easily than we secretly fear. Indeed, a revolution continues to spread across the Middle East, and simultaneously, yes, the Israelis and Palestinians are still at each other’s throats. Both facts are true, change and stubborn stasis. I think about this today as I spent the morning in a faculty meeting and listened to how much all faculty learn from our students about the degree of suffering there is in the workplace. For many our workplaces are simply toxic. This is especially troubling when we consider that the faculty I interact with most spend their time teaching people who work inside healthcare systems. Healthcare systems that make their own employees sick. Hmm.
When I consider that “all is change” then, and I work and teach as an action researcher, I can get in touch with actually how much capacity there is for improving things, after all. “It’s all good” as we say in LA and it could use a lot of improvement. I decide that the insistent reemergence of the status quo comes from fragmentation. There are just too many disconnects among us. However if we can combine our intrinsic capacity for change we'd get, well, change! And that means assuming we can align interests. OK, that is a hard part. But for now at least I have established for myself that acceptance of change as the foundation of how things are means that the spring board from which i invite others to jump with me (toward alignment of interests) is one that is right there -doesn't need to be created - it is how the universe actually is. Einstein is said to have said that the most important question to ask of someone is whether they think the universe is friendly or indifferent. I experience it as friendly. I believe the universe may actually even support non toxic work situations - ones more pleasing (psychologically and socially) to natural systems - we just have to get aligned. Now that’s where action research comes in!

Hilary Bradbury-Huang,
Editor ARJ
Portlandia, USA.

From the Editors' desk: Welcome Svante Lifvergren to the Associate Editor board at ARJ

I am pleased to announce that Svante Lifvergren, MD., who leads the Centre for Healthcare Improvement (CHI), Chalmers University of Technology, Gothenburg in Sweden has agreed to join us at ARJ. Svante will be part of the ARJ journal's associate editor board. He will lead the growing healthcare domain. I speak for all of my colleagues on the AE board -- Drs. Mary Brydon-Miller, Victor Friedman, Patricia Gaya Wicks, Davydd Greenwood, Meghna Guhathakurta, Marianne Kristiansen and Ernie Stringer-- in offering welcome to Svante.
Svante is both a scholar and practitioner. In leading CHI, he says the main idea behind the Center is to enhance quality improvement work in healthcare from a patient point of view, by facilitating learning about improvement across boundaries. In this way the action is toward a creative rather than reactive approach to health and wellbeing. Healthcare PAR is therefore very much alive and thriving in this arena. A large measure of the work is also educational - with Masters level courses offered to Healthcare leaders. Svante’s background as a physician and hospital administrator allows him bring practice and scholarship together. The education is designed to help these specialists think beyond technical excellence and toward greater systems alignment. That this all happening with strong government support in Sweden, one of the world's most advanced countries in terms of quality of life, women's activity in society and with little healthcare disparity across social and ethnic lines. Doesn’t that make us silently wonder if it's even relevant to other countries whose deep struggles with healthcare are only increasing? In fact to write of there being so little healthcare disparity across class and ethnicities makes me wonder if Sweden is somehow in a parallel universe! Nonetheless there too people who are living so long and using costly therapies pose problems. Problems like these have not really been addressed by healthcare and it seems that a more behavioral, humanistic approach is well placed to address resource allocation in an ethical way –action researchers working with health care consumers to acknowledge our human fear of death and even greater fear of incapacitation in old, old age. What does the future portend for all of us?! But I digress – even as I encourage action researchers to consider study designs on these complex issues…”dying well, dying participatively,” anyone? Besides where best to pose the difficult questions than in places that resource intelligent systems approaches to change.
Like all good action researchers Svante takes a networking approach to learning among hospital leaders across nations and continents. This is important given our commitment to being in dialogue with our colleagues in the developing world. We are lucky to have Svante join us. We also look forward to some more health focused special issues in the future. Welcome Svante.

From the Editor's desk: Students Against Nicotine

As I consider the papers of 9 (1), issues of inter-subjectivity leap to mind. By inter-subjectivity I mean the ways in which we as researchers interact, later I will use the word “commune,” with research subjects. Conventional research training prompts us to treat research subjects as passive, albeit, respected objects of data collection. Action research acknowledges the subjectivity of the research subjects, which in interaction with ourselves, becomes inter-subjective inquiry.  Our engagement as persons first and foremost allows for knowledge to be shared that otherwise might have gotten lost.

Consider the Tai Mendenhall, Peter Harper, Heather Stephenson, and G. Santo Haas paper, entitled: “The SANTA Project (Students Against Nicotine and Tobacco Addiction): Using community-based participatory research to reduce smoking in a high-risk young adult population.”  This is another excellent example of potential partnership between medical and action research approaches that together can tackle chronic illness or contributors to chronic illness as with the smoking cessation program described here.  Thus we see efforts at systems modification rather than solely disease modification.  Systems change starts, ironically, at the interpersonal level - by having ordinary citizens activated as co-producers of their own health.  Once again we see an integrative, inter-subjective and successful systems change.  One system at a time.


Read for yourself: http://arj.sagepub.com/



Hilary Bradbury-Huang, Ph.D.
Editor, ARJ
Oregon Health Sciences University
Portland.

From the Editors' desk: Hanson and Hanson on Welfare recipients

As I consider the papers of 9 (1), issues of inter-subjectivity leap to mind. By inter-subjectivity I mean the ways in which we as researchers interact, later I will use the word “commune,” with research subjects. Conventional research training prompts us to treat research subjects as passive, albeit, respected objects of data collection. Action research acknowledges the subjectivity of the research subjects, which in interaction with ourselves, becomes inter-subjective inquiry.  Our engagement as persons first and foremost allows for knowledge to be shared that otherwise might have gotten lost.

Consider: Cindy Hanson and Lori Hanson offer “Unpaid work and social policy: Engaging research with mothers on social assistance.” In the USA we might call it social welfare and be surprised the Canada too is also rationalizing benefits to the poor.  In fact, however, all industrialized countries seem to be doing this – even over the strikes of French workers.  Again, in that theme we see throughout the papers so far, taking an inter-subjective approach better humanizes those who are seen as passive recipients of charity.  The humanization allows a deeper understanding to emerge. We understand better why a work ethic is not so present when a woman may end up with less money when she gives up assistance to take a job, plus then is burdened by having to pay for child care that in most cases will not be the type of child care any of us would wish for our children. The authors remind us also that the concern for health and physical/material security is so much greater for mothers on assistance – a reminder that prompts compassion. Importantly this study also involved the participation of decision makers, so that the findings and insights were translated into positive impact.

Read for yourself: http://arj.sagepub.com/


Hilary Bradbury-Huang, Ph.D.
Editor, ARJ
Oregon Health Sciences University
Portland.