CARCINOMA DE MAMA
5. TRATAMIENTO DEL CARCINOMA DE MAMA
5.2 TRATAMIENTO RADIANTE EN CARCINOMA DE MAMA
The notion of children as stakeholders is embedded in the United Nations Convention on the Rights of the Child (UNCRC, 1989) with a commitment not only to the safety, well-being and access to opportunities for all children, but also meaningful involvement in all aspects of decision-making that may affect their lives. While the extent of their social capital and the real value given to children’s voices all over the world, including the UK is contested (Hinton, 2008), the participants child-centred value base - referred to frequently in interviews, sees children as stakeholders in this context.
Look, in the end the whole purpose of us being here, of doing this job is they [children] are the stakeholders who matter. It should feel like building a legacy with them, and I use “with them” very deliberately. My whole sense of what I’m about is vested in children. They won’t know who I am. My status means jack to them - I’m another children’s worker out there and that’s fine by me. (Billie)
Writing about stakeholders in education, Gross and Godwin, (2005), define them as
“individuals or entities who stand to gain or lose from the success or failure of a system or an organization” (p. 4). Applying this more widely, and recognising the dual character
of society which connects the influences on, and of, people in systems and structures (Giddens,1991; Archer, 1995; Layder, 1997), Morgan’s observation offers an insight into how reminding herself children are the key stakeholders, brings her back to purpose.
Sometimes you lose a sense of what it’s all about, but being with children – spending a little time with them, well it grounds me. It also helps me be more creative in my work … makes me think ‘how can we do things differently?’ I am in a position to make things happen, even in this climate. That refocusing definitely stops me losing sight of what actually makes me feel anchored. The whole point of this is to improve things for kids. (Morgan)
Identity construction remains precarious and uncertain in the messy, uncertain world DCSs inhabit. In dealing with competing demands and conditions, it was possible to see participants attempt to ‘anchor’ themselves by drawing on their agency as the most senior leader of children’s services, with access to organisational resources and some influence over systems. Meaning and direction, and efforts to allay insecurity (Alvesson, 2010), are seen to come full circle, realised in “the values and principles by which
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We worked with a little boy with special needs who went from being a baby who only ate yoghurt and literally screamed all day to being able to go to mainstream school at five - with support and still with lots of issues, but he got there. I have a poem his mum wrote about what that meant to them as a family. I keep it in my office because it reminds me that my job is about children and sometimes that can be quite difficult to remember as a DCS. That’s where my sense of credibility really lies. (Chandra)
Our priorities for outcomes we need to achieve are predicated on ‘what’s it like being a child or young person growing up in this city?’ What part the kids play in terms of voice and influence in negotiating those priorities is very important to me. (Charlie)
Many accounts of the social interactions with frontline staff, other senior leaders, chief executives and Lead Members evoke the dramaturgical notions of Goffman’s (1959) frontstage and backstage performance being enacted, as situated activity takes place in a range of social settings. When DCSs spoke about their interactions with children there was no sense of them feeling they have to ‘perform’, to ‘be another’ to secure status and credibility. Perhaps because as Ali wryly observes:
At the end of the day, children can see right through you better than anyone else (Ali)
This final section explored participants’ accounts of some key social interactions in the complex, often turbulent political and organisational contexts of children’s services; particularly focused on perceptions of their status and credibility with others. This offered insights into the DCSs domains of contextual resources (Layder, 2006) where cultural and material features have built historical ‘ways of doing’, value-bases and discursive practices which influence, and are influenced by, those encountering and drawing on these largely structural forces in situated activity. As DCSs attempt to make sense of their professional selves, they remain vulnerable to the affirmation or condemnation of powerful ‘others’ such as their chief executive and Lead Member for children’s services, and the unique challenge of establishing credibility with their own multi-disciplinary teams, and other professionals outside their management.
7.6 Chapter Summary and Conclusion
This chapter presented and discussed some of the empirical findings documenting identity struggles encountered by DCSs in the context of their own internal readings of
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identity (Ybema et al., 2009), and some of the institutional and organisational forces and social dynamics they are both part of, and exposed to.
Strong images of children’s services leaders driven by shared personal and occupational child-centred values emerged, seen to create a discursive resource which gave purpose and form to their work lives. Protestations against what was largely viewed as government ideology and policy agendas incongruent with their own, revealed a discourse of resistance which found strength in reaffirmation of guiding principles and values to help mobilise some identity salience. It is interesting to consider the extent to which the DCSs in this study may have been displaying a socially accepted (and expected?) ‘face’ in exalting virtuous child-centred values in the storying of themselves (McAdams et al., 2006). Yet, time and again, in interviews at different points, the same claim to child-centred values was made; the same passion and conviction was expressed in the commitment to these values on a personal and professional level. Critically, participants suggested that there was still enough influence and potential in the role to ‘make a difference to children’s lives’. This sense of agency enabled them to reconcile some of the vulnerability and risk they carried as a DCS.
It is no surprise given the occupational backgrounds of my participants, that their language is steeped in discourse around ‘making a difference for children’ and placing value on the importance of child-centred practice. In their professional training and in the social and discursive contexts that they operate in, this narrative runs deeply through their occupational and organisational ideology. Critical perspectives help to reveal and disrupt this, and what becomes clear is that participants draw on this dominant narrative to both align themselves with a view of social reality if it ‘fits’ with their self-view as a values-based leader, or to resist it if it is seen to be in conflict, and this forms an integral part of their identity struggle and work.
In articulating a particular leader image capable of bearing this risk and the weight of statutory responsibility for safeguarding - while effectively leading children’s services delivery through complex multi-agency and multi-disciplinary arrangements, the DCSs were keen to emphasise how the role was special and distinctive, requiring particular personal qualities, strengths, skills and leadership approaches. Similar character and behaviour-based images and messages are also evident in dominant leadership
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models, institutional discourses and collective professional DCS discourse. Together these encourage an ideal leader identity construct (Schwartz, 1987) which in reality, some found hard to live up to. Even for those who actively promote these images in self-identity narratives, in the final analysis, it subjects all DCSs to idealised expectations and “close and constant scrutiny” of their leadership behaviours and performance (Knights & Clarke, 2014, p. 338).
An interesting perspective on leading hybrid organisations is that the realities of practice and social encounters do not measure up to ideals about unbounded human capacity and scope for professional autonomy (Frost, 2011; Trodd, 2011). So, rather than creating what could be perceived as a superhuman construct with very prescribed skills, qualities and behaviours, determining ‘who’ and ‘what’ a DCS is, a more productive approach is to accept identity as always unfinished (Corlett & McInnes, 2012): in constant ‘dialogical relationships’ with others (Rinaldi, 2005). Viewing identity in this more open way - which sees uncertainty as a quality rather than a limitation, has implications for ontological security (Archer, 2003; Giddens 1991) but given the vulnerability of identity in contemporary organisations, this could bring new insights and resources to identity work. Indeed, it may better equip these senior professional public leaders to deal with the harsh realities of a hostile and critical media and damning political rhetoric. In the accounts shared, this dimension of their professional lives clearly causes significant anxiety and feelings of insecurity for most participants. Naturally, much work is needed to influence and change the perceptions and reactions of these powerful external forces to engender a better understanding of the complexities of the role and the fact that risk cannot simply be managed away (Blyth, 2014).
The chapter ended with a critical exploration of the DCSs perceptions of their status and credibility with others - including practitioners on the frontline of their service area, who may share the same occupational training and background as them, or come from a different discipline. This offered some insights into the hybrid nature of DCS identity as participants found themselves quite comfortably straddling both identities, or feeling inadequate and lacking in credibility in situated activity with other professionals. Encounters with senior leaders from other organisations suggested similar dilemmas. Negotiating the fragile nature of these social interactions reveals some of the struggles involved in identity work, none more so than the energy invested in trying to maintain
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positive relationships, status and credibility with chief executives and elected Lead Members for Children’s Services who had the organisational power to significantly affect a participant’s standing in the organisation, including the ‘ultimate horror’ of standing back and allowing or facilitiatng a DCSs’ public shaming and dismissal as the sacrificial lamb for the council if a serious incident, or death involving a child in their area reached the media. The potential for ontological insecurity and feelings of vulnerability in this context are substantial, but there is little doubt that esteeming children as their key stakeholders, and returning to their child-centred value base - and the potential to effect positive change for children in the role, demonstrated some salient identity positions and stability, even if these remain fleeting and temporal (Sveningsson & Alvesson, 2003).
The next chapter more deeply considers how DCSs are seeking to make sense of their identity as hybrid professional public managers (Noordegraaf, 2007) in the ambiguous organisational domain of children’s services. The extent to which influences of structure, and of human agency, are contributing to leader identity-identities constructs and how these are enacted in the context of individual understanding, and institutional and discursive forces is examined. Claims to professionalism from DCSs themselves as a form of occupational control, and the experiences and impact of external attempts at control, regulation and discipline (Evetts, 2003) form a key part of the chapter.
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