Holding Fast: The Struggle to Create Resilient Caregiving Organizations

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Psychology Press, 2005 - Medical - 242 pages
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How can caregivers remain both caring and strong enough to withstand the stress of their work?
How can caregiving organizations effectively improve their management and practice?

Increasing pressure on caregiving organizations to serve more people with fewer resources means that epidemics of burnout, high staff turnover, dissatisfaction and internal conflict often appear inevitable. Holding Fast focuses on the particular stress of caregiving work, its influences on the people and organizations who do that work, and what they can do about it.

Illustrated by case studies based on extensive research in schools, hospitals, social work agencies, health care centres and religious institutions, Holding Fast identifies the problems faced by caregiving organizations, and outlines appropriate strategies for tackling these to create a resilient, effective organization. The book is divided into clear sections covering:

* an introduction to the nature of caregiving organizations

* the disturbances that can occur within them

*the skills required to effectively lead them.

Holding Fast offers a portrait of how organizations become, or are prevented from becoming, systems of caregiving. It will help leaders of caregiving organizations and their staff gain a better understanding of the difficulties encountered by their organizations, leading to improved management and practice.
  

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Contents

The nature of caregiving organizations
1
Caregiving organizations defined
3
Primary tasks
5
The primacy of relationships
6
The nature of caregiving
8
Implications for organizing
14
Insistent questions
19
The stress of caregiving work
21
The costly construction of safe havens
112
Greenvale Residential Treatment Center
113
Compelling distractions
120
Failures to collaborate
122
Teams real and imaginary
126
Fissures
127
Casualties
129
Sudbury Hospital emergency room
130

The strain of technique
22
The strain of absorption
23
The strain of relationship Part I
25
The strain of relationship Part II
29
Contextual strains
33
Holding on letting go
35
Resilience under stress
36
Pressing toward integration
38
Holding environments at work
42
Resilient cultures
45
The creation of capacity
49
System breakdowns
52
The underlying logic of system breakdowns
53
Social defenses
55
Antitask boundaries
57
Organizational fault lines
58
Primary splits
60
The paradox of resilience
67
Disturbances in caregiving organizations
69
Caregivers and casualties
71
Relational systems
72
Project Home
73
Dysfunctions served
83
Reclaiming the casualties
86
Authority at work
89
Pulls toward irrational authority patterns
90
The choice of dependence
93
New Hope Childrens Hospital
94
Codependency
103
The courage of selfauthorization
105
Divided they fall
108
Archipelagos
109
Team defenses
139
From scarcity to safety
141
Politics
143
Social anxiety
145
Thurston High School
147
Care versus control
155
Inside out
158
Running in place
160
Organizational trauma
161
Maple Hospital surgical unit
163
Principles of movement
171
Letting go moving on
176
Leading caregiving organizations
177
The leadership task
179
Creating conditions for engagement
180
Convening for resilience
184
Holding the fort
191
Negotiating dependency
194
Pulls toward dependence
196
Immature dependence
198
Mature dependence
204
The mature leaders stance
205
Playing for keeps
209
Leadership and change
211
Organizational maturation
213
Engaging change
219
Holding authority
226
Final reflections
230
References
232
Index
239
Copyright

Common terms and phrases

Popular passages

Page 232 - Kahn, WA (1995) Organizational change and the provision of a secure base: Lessons from the field. Human Relations 48: 489515.
Page 233 - Powell, L. (1994). Interpreting social defenses: Family groups in an urban setting. In M. Fine (Ed.), Chartering urban school reform: Reflections on public high schools in the midst of change (pp. 112-121). New York: Teachers College Press. Powell, L. (1997). The achievement (k)not: Whiteness and Black underachievement.
Page 232 - E. (1974). Social systems as a defense against persecutory and depressive anxiety. In GS Gibbard, JJ Hartman, & RD Mann (Eds.), Analysis of groups. San Francisco: Jossey-Bass.
Page 232 - Kahn, WA (1998) Relational systems at work. Research in Organizational Behavior 20: 39-76. Kahneman, D., Slovic, P., and Tversky, A. ( 1982) Judgment Under Uncertainty: Heuristics and Biases. Cambridge, UK: Cambridge University Press. Kallifatides, M. (2001) The tough ones. In S.-E.

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About the author (2005)

William A. Kahn is Associate Professor and Chairman of the Department of Organizational Behaviour at Boston University's School of Management.

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