Inside Voice: Change-Making Inside your Organization

It was the early 2000s. I was a young social worker at the psychiatric rehab facility on the campus of San Francisco General Hospital. We were charged with de-institutionalizing hundreds of people with serious and persistent mental illness. Think highly disorganized schizophrenia and life-threatening depression and bipolar disorder. Our patients needed a high level of clinical and logistical support to navigate life. Most had either been living in a traditional long-term mental hospital or been homeless or marginally housed. It was an expensive program in a new and expensive building.

We were seeing some successes with people moving to lower levels of structure and support in the community. Then one day: My boss announced budget cuts that would end the rehabilitation model and move the people with the most complex needs to long-term locked nursing homes. And cut lots of staff.

The budget cut process was moving fast, so I did too.  I wrote letters to my boss’s boss’s bosses. I gave an impassioned speech at a special hearing. I helped one of the facility residents testify. She was brilliant. I was young and righteous and amped up and very worried about my patients. This was Advocacy. It felt good. It was also very stressful. My boyfriend, now husband, was worried about me and wanted me to just quit. But I couldn’t walk away.

I made my boss nervous: “You should be careful what you say. Think about your career.”  My boss’s boss’s boss wanted me to stop. I learned that several senior managers spent hours crafting a response to a strongly-worded letter I wrote. And they did not appreciate having to do that. I kept going. I was confident that I was doing the right thing. I stayed focused on the facility’s patients and what I thought was best for them.

The discomfort I was creating in the managers told me I was making progress. What I didn’t see, in my blinding righteousness, was how their discomfort was placing me on the other side of the table, creating a Me versus Them dynamic that risked undermining my goal, and even my ability to do my job.

I wish junior me had known the concepts of Advocacy and Inquiry as two ways to engage in communication. As I shared in my last blog (about activism for change on behalf of your organization in the external world), Advocacy is stating your view or making a demand. Inquiry is seeking solutions in a collaborative process.

In my work to “save the facility!” from budget cuts, I was all-Advocacy-all-the-time. This was in part because I sat at the bottom of the org chart. I was far from the decision-making. But looking back now, there were opportunities to participate in Inquiry and help steer the decision to the best possible solution. I was not savvy enough to realize it. I was also too attached to the righteousness of being the Advocate.

Here’s what those opportunities to shift to Inquiry looked like: My boss asked me for ideas a couple times during her attempts to manage me in those days. And, magically, there was one side conversation in the parking lot after the big hearing with her boss’s boss, the head of the whole Department of Public Health, where I was offered a chance to contribute ideas for how to preserve services in the facility while also balancing a very out-of-whack budget. Why didn’t I jump on those chances? I think it was too much of a shift for me to make, and I knew I didn’t have enough knowledge of the budget and the process to jump in.

Inquiry also requires trust. And there was a lack of trust between me and the bosses. The bosses lacked trust towards me, a previously well-regarded social worker, because I had been outspoken and borderline confrontational. My colleagues and I lacked trust toward the bosses, because of this seeming attack on our hard work and on the needs of these mentally ill people living in the facility.


That’s the dance of creating change within your organization:

How do you create the discomfort with the status quo that is required for change to happen, without creating a Me versus Them division that will undermine trust and stand in the way of the change you seek?

Try this: Stop to think about the right ways and the right moments to employ Advocacy and Inquiry, and how to use them together, to make change happen over time within your organization.

P.S. What happened at the psychiatric hospital, you ask? The budget cuts were not as severe as threatened. I left that job, burned out after the drama and maybe a little embarrassed. The facility stayed open with the same level of services, then cuts were made later. A couple years later, in a job interview at another social work program downtown, the hiring manager asked me why I was a social worker and not an attorney. I did not get that job, but I did get a great position back on the hospital campus with patients living in the community and on the streets.