Suchergebnisse

AbstractThe predictions of Max Weber's "iron cage" of bureaucracy and Michels's "iron law of oligarchy" failed to materialize in Alcoholics Anonymous. AA has maintained an alternative form of collectivistic‐democratic voluntary organization for more than seventy years. Its organizational form was developed within its first five years and articulated in its foundational text, Alcoholics Anonymous, published in 1939. Based on detailed histories of its early years, an analysis of AA's crucial ingredients suggests that six factors interacted to avoid the temptations of power, money, and professionalization that would have resulted in a bureaucratic form of organization or oligarchic leadership. In order to avoid death and to obtain or maintain abstinence, the desperate cofounders stumbled on the essential method: egalitarian peers share their lived experiences, conveying hope and strength to one another. In the context of the essential method, the two cofounders, from the Midwest and New York City, held similar spiritual beliefs and practiced a self‐re?exive mode of social experiential learning gained from the Oxford Group, a nondenominational group that advocated healing through personal spiritual change; they downplayed their charismatic authority in favor of consulting with and abiding by the consensus of the group.

Based on a case study of Alcoholics Anonymous (AA), the authors argue that some self-help organizations are able to translate their tradition of group-level experiential learning into unique organization-wide learning cultures. The underlying premise of such learning cultures is that organization-level structures and processes evolve in response to group-level experiences. Instead of adopting a rigidly centralized, top-down approach, some self-help organizations appear to be driven by the collective needs and experiences of their member groups. In some cases, the most critical role of the central organizing body is to create a context within which multiple, diverse local groups are allowed to organize themselves according to their unique circumstances, opportunities, and challenges. The article uses a perspective in which it is possible to understand AA's approach to organization as the enactment of a self-organizing, emergent design process that is driven byanorganizationalcultureofexperientiallearningandexplorestherelevance of this to other self-help organizations.

Background
This article charts the relationships between the model of evidence-based practice (EBP), healthcare markets where providers are increasingly competing through the adoption of EBP-certified interventions, and the cultivation of experiential knowledge within self-help and mutual aid groups (MAGs). After 35 years of neoliberal reform, service user involvement in research, service provision and evaluation, and patient-centered care has been operationalised in increasingly measurable ways. In seeking to value and incorporate service user experiences, current models of EBP do not unpack the heterogeneity within experiential knowledge.


Aims
This article explores a more meaningful use of experiential knowledge than the cursory and tokenistic treatment it is often given.


Objectives

Propose, illustrate and theorise the concept of 'deep experiential knowledge' (DEK)
Identify ways that the acknowledgement of DEK are useful in healthcare policy, governance and the clinical encounter


Methods
Drawing upon case study vignettes, we analyse MAGs as epistemic communities of problem solvers.


Findings
Deep experiential knowledge is a robust and collective form of knowledge, generated over time in the long-term members ('old-timers') and collective knowledge of MAGs. Five characteristics of deep experiential knowledge are proposed.


Discussion
By rendering DEK amenable to the logic of EBP, we outline potential benefits of foregrounding DEK in the conduct of healthcare research, policy and governance, and the clinical encounter.


Conclusions
DEK constitutes an authority that distinguishes different degrees of experiential knowledge of healthcare problems. Attending to DEK helps untangle some of the challenges posed by EBP for and to successful service user involvement.