Observing organisations Anxiety, defence and culture in healthcare Edited by RD Hinshelwood and W Skogstad Routledge 175 pages £15.99

Anyone who has worked in an institution knows that there is something called 'atmosphere'which, although difficult to describe, marks some places out as good places to be and some others as bad.

But how can we learn from this perception, if we are not really aware of what is going on? One way is to use a method here described as participant observation where healthcare staff regularly observe a part of the organisation for a fixed period recording not only what they saw but how they themselves felt.

The book uses eight accounts by separate participants (most of them with some allegiance to the Cassel Hospital, Richmond) of life on psychiatric and general wards, day units, a hostel and a hospice. Readers should be warned that most contributors have overdosed on Isobel Menzie's seminal work in the 1950s which maintained that nurses develop strategies to defend themselves against anxieties induced by their work. Obviously this perception has much to recommend it but there is also a danger in that to challenge it may just be seen as another example of defence.

This limited perspective leads to some frustration. It could equally, and perhaps less judgmentally, be argued that people involved in what Hochschild (not mentioned here) has called 'emotional labour', need to dramatise their work in order that the actors (themselves) and the audience (others) can tolerate both what is going on and their reflections on it. However, with this major proviso there is much to think about.

Donati observed a psychiatric long-stay ward staffed entirely by men. This in itself dates it and so does her somewhat stereotyped observations about male and female roles.

Rees' observation of a patient canteen is altogether more telling for managers whose response to the organisational problem was to introduce measures that were likely to make the overall unease greater.

By far the most interesting to me was Morris' study of a social services hostel for people with mental illness. He unflinchingly questions the politically correct view that an egalitarian culture aimed at abolishing traditional social structures based on hierarchy and rules is more therapeutic.

He observes that this allowed a far more pernicious tyranny to develop based on pecking order.

Of all the contributors, he alone faces the consequences of his own observations and daringly suggests that the often espoused anti-medical model might make matters worse.

After all, what makes mentally ill people unhappy may not be their environment so much as their illness.

Overall, the book has an old-fashioned feel. The case material is up to 15 years old.

The observation method poses unresolved issues of legitimacy. If the main object, as stated, is to increase the sensitivity of healthcare staff, this book seems a laborious method. To describe experiential learning is not to experience it.