Competition and Coherence: Creating a New Balance between Economic Change and Organizational Identity in Mental Health Care Organizations

Rapid changes in the basic economic conditions of the health care system have, over the years, led to a generally apprehensive climate in health care organizations: the endeavour to provide high quality therapy conflicts with economic dictates to reduce costs and ensure a good rate of return.

Looking at the recent development in Germany, this article tries to analyse how the health care system has to tackle these contradictory demands. It uses for this purpose the central dimensions of competition, which is one of the basic moving forces of market economy, and of coherence, which highlights one of the central necessities of the work of dealing with mentally ill individuals.

Competition demands rapid change, which in turn collides with the distinct need for stability in health care organizations; this corresponds to a structural dilemma: because of the nature of work in helping professions, which may be defined as ‘stabilization of destabilized systems’, and because of many helping professionals' personal history and psychological structure, we can frequently observe that the prevailing values in health care teams are continuity, stability, and orientation within the organization. This relates to the fact that people working in organizations have a basic need for coherence: to identify sufficiently with their own role, task, and organization. Primarily, they may try to fulfil this need by maintaining the stability of familiar structures and processes. However, they often underestimate the necessity of orientation to the demands of the environment, that is, to context and change.

The institution's economic context, the mechanisms of the market, and the increasing influence of competition, on the other hand, appear to be an annoying and irritating factor in the face of the ‘real’ helping activity. A onesided economic orientation, which does not take into account the specific way of working in ‘helping professions’, has an equally destructive effect by breaking up meaningful work coherence.

An earlier version of this paper was first presented at the ISPSO-Symposium in Amsterdam in 2006.

Yet, when an organization succeeds in balancing the necessity of developments driven by competition with the need for coherence and social identity, and in bringing both together in a shared vision, taking financial concerns as well as its own tradition into account; that is, keeping both the client and the staff in mind, then a new balance for the dilemma described above can be achieved.

This paper outlines the conditions for such an integrative organizational attitude, which tries to balance the various factors at play. The shift of values within society and its influence on the culture of organizations is discussed in a historical perspective. A case study from the author's consultation work with mental health care organizations illustrates the working hypotheses of the paper.