The organization’s synaptic mode of existence: How a hospital merger is many things at once

Abstract

Different perspectives on organizations have alternatively sorted them on the side of the social / human / linguistic or that of the material / non-human / technical, reducing the question of what an organization may be to attempts to (re)connect these two realms. Literature adopting a relational view, however, has offered a way out of this opposition, by embracing the multiplicity of beings that may make up organizations. We extend this approach by engaging with French philosopher Étienne Souriau’s discussion of modes of existence to suggest that organizations are “synaptic,” which means they exist in the passages between modes, as they articulate the actions of entities existing under different modalities. By analyzing the case of a hospital merger in Denmark, we show that this work of articulation amounts to organizing, and that viewing organizations as synaptic recognizes not only their ontic pluralism, but also their existential pluralism. By doing so, our study contributes to relational understandings of what organizing means and provides a sensitivity to the politics involved in deciding who or what may exist within organizations.

Introduction

How does an organization exist? In answering this question, literature has suggested that “organizations are many things at once” (Morgan, 1986: 337), which, however, raises a new question: how to detect the many beings and things that jointly make up the organization, and especially interactions between them? Attempts to answer such questions have led organization scholars to draw attention either to people’s understanding of these many elements (Martin, 2001; Putnam and Pacanowsky, 1983), thus locating the organization on the side of meanings, language and culture that people produce together and that guide their interactions with others and their collective. Alternatively, attention has been drawn to the material facet of organizations, including bodies, technologies and space (Ashcraft, 2008; Bansal and Knox-Hayes, 2013; Kornberger and Clegg, 2004; Leonardi, 2012).

These two poles—to which we can refer as the social and the material, or the human and the non-human—have been theorized as being in a dialectical tension (Putnam, 2015). While studies adopting either perspective have the merit of expanding our views of organizations to include more than just human beings, they only recognize two possible keys to the organizational equation. Organizations thus often continue to be considered as social entities whose relationship with materiality is the intriguing problem: each pole “stands for itself, by itself, and has to be (causally) re-linked, which takes a major theoretical effort” (Weik, 2011: 658). Indeed, despite acknowledging that materiality is integral to organizational life, research still deploys much effort attempting to theorize the connection between the social and the material within organizations, especially under the rubric of sociomateriality (Orlikowski and Scott, 2008; Scott and Orlikowski, 2013), and still considers them as only two realms whose “entanglement” must be explained (Orlikowski, 2007). These proposals invite us to rethink the relationship between “the social and the material” (Dale, 2005: 655), but restrain from “radically questioning this dualism” (Lorino, 2018: 51). As such, these proposals, on the one hand, reproduce, perhaps unwantedly, an artificial “bifurcation of nature” into a social and a material realm (Cooren, 2015) and, on the other hand, implicitly take for granted that organizations are first and foremost “social” in nature, thus making their connection with materiality a secondary problem rather than a core ontological consideration.

Some authors have suggested that “[m]aterials – and so realities [. . .] do not exist in and of themselves” (Law, 2004: 42), and, as we will argue, exist thanks to the assistance of multiple modes of existence, which cannot be reduced to the social or material. This view is consistent with the recognition that organizations emerge from relations that are established between or through entities, irrespective of their nature, as “each implies the other so that they exist in a relationship of betweenness rather than as separate terms” (Cooper, 2005). In other words, rather than define organizations as a collection of material and social items, we should look for it in the interstices (Debaise, 2013) and embrace their “monstrous” (Thanem, 2006) and “inhuman” nature (Hietanen et al., 2020).

Considering organizations as the outcome of relations raises the question of what the “act of relating” may concretely look like (Cooper, 2005: 1689). We must ask why and how beings reach out to others, desire them, and how their encounters in turn give rise to new beings (Linstead and Brewis, 2007). In order to answer this question and extend the relational view on organization, we turn to the philosophy of modes of existence as it was formulated by Etienne Souriau. The French philosopher has had an important influence on actor-network theory, in particular on the writings of Latour (1986, 2011), and can be seen as the precursor to ANT’s suggestion to observe the “work of connection and collection” among heterogeneous beings (Latour, 2005). However, studies in organizational studies adopting actor-network have yet to fully explore the notion of modes of existence, which was only explicitly acknowledged by Latour (2013a) later in his career.

Building on this, we may say that current organizational research readily recognizes ontic pluralism—the existence of multiple beings in organizations—but has yet to explore existential pluralism—the idea that each being exists under multiple modes at once (see Souriau, 2015: 99). Organizing, then, consists in helping each being move from one mode to another. As we will suggest, though, returning to Souriau’s own work allows us to specify the organization’s mode of existence as articulating between other modes. Of particular interest to us, Souriau (2015) suggested that one of these modes is the “synaptic,” which describes that which exists as an articulation mechanism for other modes. The notion of articulation refers to the toil of finding out how one being’s actions may continue into another, which may exist under another mode, and therefore provide it more existence. For instance, a research lab may exist as a room on a campus, as a line on the university’s budget, as an annual workshop it organizes, as an administrative unit in the organizational chart, etc. All of these modes are articulated, say, on the lab’s website and in its annual report, where passages between physical space, money, events and bureaucracy are made explicit and shown to support its existence. This articulation is not intrinsically good or bad. For instance, while it may be “good” from the perspective of a being that now exists through more ways, it may also interrupt or interfere with some other being’s existence—for example, the same budget for the research lab was perhaps coveted by a fellow professor, whose projects and existence as a researcher may not find their way into other modes of existence, and therefore not materialize. In this paper, we will expand on this notion of a synaptic mode of existence to show that it corresponds to organizational reality. Indeed, organizations exist as a connection hub for other modes of existence, including people, buildings, artefacts, abstractions, and budgets. We suggest that paying attention to how the synaptic mode deploys in empirical settings may help answer the question: “how can an organization be many things at once?”

We respond to this question by reviewing current theorizing of organizations as comprising entities of several natures, we consider how these different entities may co-exist and how synaptic passages can be conceived between them. Using empirical data from our ethnographic observation of two consultants helping a department through a hospital merger in Denmark, we show that synaptic articulation between modes of existence may be concretely observed when buildings, numbers and abstractions take up each other. Consultants often act at the crossroads of various forms of knowledge, materials, groups and tasks and making these different beings converge and the merger situation vividly showed this (see Bourgoin and Muniesa, 2016). This analysis allows us to develop an analytical apparatus that not only accounts for the many “things” that make up organizational life—which corresponds to ontic pluralism, as in the case of several existing theoretical proposals—but also highlights that each being exists in many ways and that organizations exist precisely as the articulation of those many modes of existence—which corresponds to existential pluralism. This allows us to recognize that diversity is not only the collection of different people and things within organizations, but rather that diversity is their defining feature and that the more or less harmonious interaction of existentially diverse entities is organizing. We can therefore specify current literature’s general recognition of the organization’s “hybridity” (e.g. Castor and Cooren, 2006), which advance our understanding of what organization are and mean, the politics they implicate, and how to study them.

The social, material and relational ontologies of organization

What an organization is has been a key concern for decades and different proposals have been formulated in that sense. Yet, Taylor and Van Every’s (2000: x) finding, that “the closer one looks at literature on organization the less evident the answer to the question becomes,” still seems to hold true (see du Gay and Vikkelsø, 2016: 2). Indeed, it seems difficult for organizational scholars to move past habitual forms of theorizing. For instance, over 60 years ago, March and Simon (1958) already argued that “snatches of organization theory” could be “assembled from a wide range of sources”, but when they tentatively defined organizations, they still reduced them to “assemblages of interacting human beings” (1958: 4). Focusing solely on human beings, we argue, provides a limited view of how organizing takes place. While they admit that organizations comprise more than just human beings, scholars exploring the articulation of organizations diverse nature have tended to prioritize either the social or the material pole. Alternatively, some have taken up the question differently, and have embraced a relational ontology (e.g. Cooper, 2005; Kuhn et al., 2017; Wilhoit and Kisselburgh, 2019).

The social and the material as prisms into organizational multiplicity

A key answer as to the way organizations could articulate elements of a different nature has come from the “interpretive turn” (Pacanowsky and O’Donnell-Trujillo, 1983; Putnam and Pacanowsky, 1983). This orientation has proposed that organizational reality is shaped by the shared understandings individuals produce together. Grasping the relationships between the elements making up the organization, then, equates to grasping our understandings of them, thus making them largely a matter of human interaction and sociality. What elements become salient, how these elements are connected to each other, and what sort of organization emerges from those relations, may not so much be dependent on the “truth” of the organization, as on the metaphors we use to understand it (Morgan, 1986; Schoeneborn et al., 2016; Smith and Eisenberg, 1987). These understandings can be shared using “sensegiving” devices (Corvellec and Risberg, 2007; Gioia and Chittipeddi, 1991), including narratives (Boje, 2003), visual tools (de Vaujany and Vaast, 2016), meetings (Jarzabkowski and Seidl, 2008; Teulier and Rouleau, 2013) and other opportunities for sensemaking (Rouleau and Balogun, 2011; Wright, 2005). What is shared on those occasions, therefore, is not only one meaning or another, but also a particular way of weaving elements of reality together, which sediment into a culture (Martin, 2001; Schein, 1996). Shared interpretations, then, play a part in the way that people collectively engage with these elements and integrate them into their sociability, in agreement with Weick’s (1995) insight that sensemaking and organizing are related processes.

As an alternative to considering the organization as existing in people’s understanding of relations between elements, some authors have also drawn attention to the part that technology, artifacts and other physical elements play in organizations. While most attention in that line of thinking was dedicated to technology (Faraj and Azad, 2012; Leonardi, 2012), some authors have also considered how bodies—gendered, ageing, and variously abled—participate in the constitution of organizations (Ashcraft, 2008; Trethewey, 1999). Others have studied the contribution of architecture and space (Knox et al., 2008; Kornberger and Clegg, 2004; de Vaujany and Vaast, 2016), as well as that of tools and equipment (Anteby, 2008). These authors insist on the important role of materiality in establishing organization. For instance, Kornberger and Clegg (2004) stress how architecture is characterized by concrete generative spatial arrangements that order social organization (see also Cnossen and Bencherki, 2018). Attention has also been drawn to the properties of technology that allow it to transcend space and time, collectively designated as its materiality (Leonardi, 2012). Researchers concerned with the relation between individuals and technology tend to either suppose that one pole can be reduced to the other, or to consider that one pole controls the other, as either social or technological determinism (Leonardi and Barley, 2008). For instance, materiality’s role in organizing may be seen as socially constructed, thus tilting to the side of social determinism (Leonardi and Barley, 2010), or human behavior may be understood as constrained by material structures, which “require users to cope with the things that they perceive it can and cannot control them to do” (Leonardi et al., 2019: 668). Indeed, whether one pole has precedence over the other raises the question of control, since, as Dale (2005: 651) notes, organizational control is a “combined social and material construction.”

However, while a good proportion of research is concerned with disentangling the part the social and the material respectively play in their encounter, the studies focusing on linking the social or the material restrain from rethinking the dualism of the relationship between the two. In response, authors have pointed out that the relationship may also be viewed “via a relational ontology focused on constitutive entanglement” (Faraj and Azad, 2012: 249). Overemphasizing the social realm would indeed “cheat matter out of the fullness of its capacity” (Barad, 2003: 810), and the opposite is also true. There is therefore a need to make the familiar categories of the social and material strange again to discover that they are themselves already made up of many things (Beyes and Steyaert, 2013).

Starting in-between things: Relationality

While much empirical work proposing to take a “relational” stance has in fact used this term to refer to relationships between human individuals (e.g. Kellogg, 2009; Montanari et al., 2016), some studies use the term in a stronger sense. These studies, rather than reducing organizations to one type of being, refute that there was ever a “bifurcation of nature” (Whitehead, 1920), and suggest that registering the many beings that populate society and organizations is more complex than it appears. Humans are social beings but they are also natural to begin with (Rosset, 1973) and any attempt to “purify” the social and the material into neat realms is a fabrication (Latour, 1993). More than duality, we must think in terms of multiplicity (Linstead and Thanem, 2007; Styhre, 2002). Organizations are monstrosities given that they exist as multiple things at once and always exceed attempts to reduce them to any simple categorization (Thanem, 2006). Even the human self is punctuated with breaks and discontinuities, rather than being a homogeneous and coherent material (Driver, 2014). Otherness constantly encroaches on efforts to define organizations and subverts them from the inside (Bloomfield and Vurdubakis, 1999). Organizations are also monstrous as they may fail to record or even permit the existence of others, for instance because their numerical or bureaucratic practices may limit the forms by which beings can account for themselves (Munro, 2001).

From the moment we acknowledge that organizations exist not only with other beings, but through them, the question is raised as to how beings engage in relations with each other to constitute organizational assemblages. Scholars attempting to answer this question have adopted a relational ontology to understand how people and events or things relate to constitute organizations (Cooper, 2005; Munro and Jordan, 2013) as well as abstractions such as authority (Bourgoin et al., 2019) and resistance (Wilhoit and Kisselburgh, 2019). This question has been particularly posed in terms of desire, which is not so much a want for something lacking, as if each component being was incomplete without others. Instead, desire is an autonomous process, an urge, towards no particular object (Linstead and Brewis, 2007). This appetitive movement could be better described as a thirst for more existence, aiming for its own proliferation and trying to reach it by connecting to other, similarly oriented processes (Hietanen et al., 2020). A relational stance stresses the in-between, thereby challenging the common understanding of organization in terms of the categories of the social and the material, and encouraging a sensitivity to the act of relating or connecting a multiplicity of beings (Cooper, 2005: 1689).

To further elaborate this strong version of the argument, we turn to French philosopher Souriau (2015, originally published in 1943). Souriau suggested that any given thing exists in many different ways at once, which he refers to as modes of existence. For him, existence itself is a matter of degree, depending on how many modes take up the thing’s action. An important element of Souriau’s theory is that one of the modes he identifies is what he refers to as the “synaptic” mode, which corresponds to that which exists inasmuch as it allows passage between other modes of existence. It is, in a sense, a mode which articulates other modes, and which as such combines elements of what we understand as relationality with aspects of organizing.

Finding “passages” between modes of existence

The notion of modes of existence finds its roots in Spinoza’s (1994) Ethics, where the Dutch thinker suggests that reality is made up of a single substance expressed through different “modes.” These modes correspond to “that which exists in, and is conceived through, something other than itself” (Spinoza, 1994: 1), pointing to the fact that existence must be continued through uptake in other beings. In other words, to exist, a being must find others that can continue its action through their own, taking it up and continuing it; hence, existence is inherently relational. For instance, a person exists physically as matter in space, biologically as flesh and blood, but also politically as a citizen, fictionally as a character in their friend’s short story, legally as a party to a contract, and so forth. This entails that the social and the material are not the only two modes of existence. Most importantly, the relation between modes of existence is not external, as if something existing under one mode tried to get in touch with something existing under another mode, but rather internal: the very existence of one being depends on its ability to continue its existence otherwise.

Souriau’s notion of modes of existence, including the synaptic, makes it possible to devise an empirically viable approach to the study of how elements existing under diverse modes of existence may play a crucial part in constituting organizational reality. It allows extending current understandings of relationality and materiality by recognizing that the organization lies in the articulation between modes of existence. That articulation is not abstract but relies each time on a concrete mode of existence that provisionally plays the part of an articulating “meta-mode.”

Thinking in terms of synapses highlights the importance of considering organizations at the intersection of several modes of existence. As Souriau (2015: 182) unequivocally states regarding modes of existence, “considering one as having priority over the rest, is therefore a gross mistake and an abyss of error.” Instead, existence must be understood in the conjunction between modes. Souriau lists “intensive” modes of existence (degrees, levels, distances, etc.) and specific modes (phenomenon, thing, identity, universals, psychical, solicitudinary, virtual, etc.), and notes that they transition into one another and that a being is always scattered across modes. This means that any being exists through the actions of others. That is why, as Latour (2005: 24) notes when commenting on Souriau’s notion of modes of existence, the term is “clearly linked to the expression of alternative ontologies” since most beings exist as many others, and may be said to exist politically, legally, economically, etc., depending on who or what continues their action.

Those crossings are made possible by the synaptic mode, which may take a different empirical form depending on the situation—for instance, how a biological being becomes a fictional character depends on the apparatuses of writing and publishing. A synapse is defined by its function: “the very nature of a synapse is to ‘bring together’” (Stengers and Latour, 2015: 72). In the same way as a synapse, the junction of two nerve cells, is where an electrical signal becomes a chemical one and back again, the synaptic mode of existence ensures that the action that takes place under one mode continues on under another one, although it also expresses itself fully in each one of them. As he explains, “Existence is all the existences, it is each mode of existing [. . .] it is cloven in and through its modal diversity [. . . it] resides and accomplishes itself integrally in them all, in each taken on its own” (Souriau, 2015: 187).

In that sense, synaptic existence is not merely the addition of modes of existence. Indeed, for Souriau, modes of existence do not simply co-exist, but also support each other’s existence as they take it up and continue it. He refers to the synaptic mode of existence as the “anaphoric” mode, referring to the anaphora, the stylistic device that consists in emphasizing an idea by repeating the same group of words. To exist, then, is also to be repeated, like an anaphora, through the same or through different modes of existence, as an author exists as a body, as a name on the cover of her books, as a character in a literary critic’s work, and so forth, while always maintaining some recognizable equivalence through those repetitions. For clarity, we will from now on simplify this vocabulary by speaking of one mode “taking up” the other and of “uptakes” and “passages.”

We therefore propose that organizational existence involves a form of uptake of one mode into the next, an uptake that corresponds to the synaptic mode. To understand organizations, we must understand how to move from one mode to the next and recognize that each being participates in the constitution of the organization’s common reality because “the part hopes for existence together, it hungers after a different mode; it wants to be transposed into that mode” (Souriau, 2015: 188). This hunger is a driver for existence, as the different modes, as feeble as they may be, “are then ‘calling us’ because they need to be sustained to get ‘more’ existence” (Hennion, 2017: 78). Indeed, Stengers and Latour (2015) note, in their presentation of Souriau, that he redefines the notion of intention or desire: the driving force is not so much the volition to do one thing or another, but rather the appetitive movement towards the Other as an outlet to continue one’s own existence (see also Debaise, 2008; Thanem, 2004). In that sense, the synaptic mode does not correspond to a collection of beings existing under different modes (this would be ontic pluralism), but to entities that exist to the extent that they facilitate, channel or guide other existences’ appetitions.

The organization’s existence as a synapse can be observed in the work of articulation between modes of existence and their appetitions. This work, in its turn, is observable because it is rooted in action, in the “‘what is done’, which is itself the true existent” (Souriau, 2015: 176). This action-based view of existence means that “the event becomes the true substance, and the connection between all beings becomes exclusively transitive and situated or constituted in the action itself, and according to its mode” (p. 178). This action is therefore the action of passing, of moving from one mode to the next, and of preserving a form of agentive equivalence through those modal changes. It also means, and perhaps especially in organizational contexts, that equivalences may be contested, as the “threshold of identity” may not be agreed upon. Furthermore, some of these passages are reversible, but others not so, which means that passing from one mode to the other also shapes existence in a more or less durable way (Callon, 1991).

Such passages between modes are not rare, esoteric occurrences. On the contrary, they are routine accomplishments that allow us, human beings, to embrace the richness and complexity of the world. They are at the heart of what we usually mean by the term communication. Indeed, communication is not only about human’s use of language, but also the transformation and transfer of action from one being to the next. Communication, therefore, also takes place when a movement of the foot on a pedal ultimately leads to the car moving faster (Bencherki, 2016; Cooren, 2015). This more generous definition of communication allows accounting not only for transactions between individuals exchanging signs, but for all acts by which action is moved from one entity to the next, irrespective of their mode of existence. Insisting on the way communication performs an assemblage or arrangement of beings and articulates action among them shows that the synaptic mode of existence is at least as common and as constitutive of organizational reality as communication is. It also gives a hint as to the sort of empirical phenomena we may be interested in observing to look for modes of existence and their articulation: we must look for how modes of existence can “speak” to each other to convey action (Bencherki, 2017; Bencherki and Iliadis, 2019).

Research setting: Preparing to merge

The importance of passages between modes of existence and the notion that the organization consists in the articulation of those passages emerged while we studied a hospital merger in Denmark. This merger consisted of several hospitals combining into a single large public university hospital. As part of preparing for the merger, a leadership development initiative took shape where consultants from the hospital’s HR consultancy unit, in collaboration with external counterparts, were assigned by the hospital top management to coach department managers and leaders through the merger process, and to encourage cross-departmental collaboration to improve continuity of care. In this article, we narrow our focus to a specific medical department, which we call department H. This department was to merge three geographical sites into a single one over the following 3 to 4 years, and the goal was to reduce the number of patient beds by 20%, by treating more cases on an outpatient basis. Like the rest of the hospital, department H was preparing for the merger while also facing broader challenges, such as an aging population and fast-paced technological change. At department H, the consultants’ role became both to help implement the strategic initiative that followed the mandate entrusted to them by the hospital’s top management, moreover, to assist the local team at department H in preparing for the merger and transform the initiative to fit the department’s own reality.

Our observations at department H spanned from spring 2013 to summer 2014. The material we collected consisted of about 200 hours of observation, including a number of informal conversations or ethnographic interviews (Spradley, 1979), as well as 37 formal semi-structured interviews. We also shadowed (McDonald, 2005; Meunier and Vásquez, 2008) two consultants from the HR consultancy unit, Anne and Karen, as they worked with the department’s management team (consisting in a head doctor and a head nurse) and with department “leaders” who were doctors and other professionals (mainly nurses) with administrative roles. Because of the consultants’ developmental approach, they collaborated mostly with those leaders and worked with them through interviews, meetings, and a series of three-day seminars at a conference facility. We also observed the clinical leaders in their everyday work and conducted interviews with them related to the upcoming merger. Hence, we adopted a multi-sited approach to the consultants’ work and to department H’s preparation for the merger (Marcus, 1995), yet what we observed was not a coherent view of the merger (see also Ratner and Gad, 2019). Rather, what we witnessed were series of crisscrossing agential lines corresponding to uptakes of one action into another existing under a different mode, until the department became something else while remaining department H. Our analysis attempts to reveal how these uptakes precisely took place and how they were articulated.

In the next section, we explore the details of these passages by looking at department H’s daily work and the consultants’ work in supporting the transition. The case of the merger allows us to expect a concentration of such passages. We focus our analysis on interview and observation excerpts where the consultants and leaders were especially concerned by how pieces of the puzzle would fit together, thus making explicit apparent inconsistencies and breakdowns in the way action would move from one part of the department’s organization to another. Karen and Anne, the two consultants, as well as the department leaders, found themselves having to actively deal with desultory existences and tie them back to others. Our analysis followed an abductive reasoning (Klag and Langley, 2013) and, having Souriau’s modes of existence—phenomenon, virtuality, thing, solicitudinary, synapse, and so forth—in mind, we carefully analyzed interview transcripts and field notes in search of the many elements that were at play and attempted to identify under what mode they exist. We found that elements such as physical objects, abstract concepts and finances and budgets were all ways through which department H came to exist. Yet, a crucial part of the work related to the merger consisted in these beings existing together rather than as separate parts. The organizing feature of the synaptic mode of existence was therefore explanatory to us in revealing how Department H exist as more things at once. Through our analysis, we noted that some modes were more often than others involved in action moving across them. We thus inferred four broad categories of intermodal passages, which were critical in our empirical material. These four passages show how actions of entities existing under different modalities were articulated.

As we concentrate on the synaptic mode of existence in this article, we decided to avoid unnecessarily conceptual vocabulary and use ordinary terms to refer to the elements involved, that is, materialities, numbers and abstractions. The first passage we identified was that materialities, that is, some physical objects, took up the action of other physical objects, such as a building being large enough to allow the presence of several beds. The second was that numbers, which we consider to encapsulate accounting procedures, budgets and funds, would be written down in such a way that they were more or less able to allow materialities like beds and buildings, for instance, to be taken up and exist in a particular way. Thirdly, abstractions, such as consulting principles and managerial responsibility in our case, more or less successfully accounted for materialities such as the buildings in the new merged Department H. Finally, abstractions were themselves taken up by numbers, which again allowed the abstract beings to exist more or less successfully. We organize our analysis along these four passages between modes of existence, which are not easily separated out analytically:

• (1) materialities taking up materialities,

• (2) numbers taking up materialities,

• (3) abstractions taking up materialities,

• (4) numbers taking up abstractions.

Of course, we recognize our analysis is only partial and could be done otherwise, as is widely recognized in ethnographic research (Watson, 2011). Also, while we name these categories using “positive” terms, in fact, they mostly showed themselves negatively, in hesitations and breakdowns. In analyzing each of the interview quotes and meeting excerpts, we follow the trajectory of beings existing under one mode of existence attempting to pursue their existence into another mode, by ensuring their action is taken up and continued into it. Positively, this materializes as the uptake of a being into another mode. Negatively, this appears as frustration when this uptake is denied or made difficult. These passages reveal how the organization exists as more modes at once and these existences may enable or diminish each other’s existence. In this particular case, the stakes are important as failing to be taken up into new modes of existence may mean, in the context of a major hospital merger, that some people, projects, ways of working and other concerns may be left behind.

Following a hospital department’s synaptic existence

The merger was demanding to all departments at the hospital and Department H was no exception. The government required the hospital to make savings of 8% on its budget following the merger, and indeed, the hospital management recognized that all staff groups would be affected, and several efficiency initiatives were drafted in preparing for the merger. In what follows we will focus on the four different intermodal passages, which we inferred through our analysis. The move into a new building, the reduction of the number of beds, and shifting treatments outside the hospital, and thus outside the hospital’s budgets, all became critical projects, as we will see below; they implicate various modes of being, including materialities, numbers, and abstractions.

Materialities taking up materialities

Department H spanned three different geographical sites corresponding to three different ward sections. Each of the current buildings was old and posed its own organizing difficulties that were widely recognized by department personnel. For instance, patients would often be moved from one site to the other, encountering new staff along the way. The most crucial information would circulate thanks to the electronic patient record, but the different geographical locations still created challenges to organizing continuity of care. Its scattered premises had been improved—for instance, tables had been replaced—but the increasing number of patients being treated on an outpatient basis put great pressure on continuity of care across the current buildings. These issues were to be resolved with the new building, where department H would be unified “under the same roof,” but the relocation could also cause some difficulties of its own. The merger would mean that department H’s three different geographical sites were going to join into one, with the consequence of reducing the physical space available for beds and requiring the three wards to combine into only two sections. As Karen, one of the consultants, explained, “it is a matter of the new physical surroundings—there simply is no room for more beds.” Similarly, one clinical leader noted that “the physical buildings are critical for our ability to collaborate . . . you cannot just move a wall if you want to” (Interview, March 2014). Consequently, more treatment would have to be carried out on an outpatient basis instead, making the building design complicit of the management’s goals to reduce costs. This understanding also became illustrated in an interview with the head nurse at department H. While looking at the blueprints of the new building, she explained how the new location mattered to the department’s organization:

[. . .] the issue is that the lines are made by the architects, we cannot change the drawings, but we will have to adjust to the surroundings. We need to adjust our organization to less beds but probably not less patients. . . The first two beds are to be closed by the end of this year, next year we will close three other beds, and in two years we will close one more bed. We have two large bed sections and one transplant section, which must move into two sections after the merger. . . This also means that we need to find out if there should be fewer leaders and if our way of organizing the department in specialized team divisions also must be adjusted (Interview, October 2013).

The head nurse notices how the building, in its existence as a blueprint, cannot accommodate the existence of as many beds as the department used to have. This means that there is no other option but to merge different sections, leading also to possibly fewer leadership positions. As she notices this, the head nurse is taking up the drawing’s action into her own speech. This articulates a passage from drawings to buildings to beds to the organization of patient treatment. Through this passage, these actions are moving across one another and changing each other’s existence. An inconsistency reveals itself in the articulation between the biological existence of patients and their other forms of material existence: as bedridden bodies and as patients under the care of the appropriate section. Health professionals were very aware that they were dealing with bodies that exist precariously: “. . . it is very difficult illnesses, life-threatening, where people can die within half a day or so [. . . it] does not respect the holidays, it doesn’t care if it is Christmas or New Year’s Eve” (Interview, November 2013). To ensure the continued existence of patients—almost literally, since their lives may be at stake—they must be channeled elsewhere: to outpatient care. As outpatients, they would be getting the care they need and then return home. Therefore, their existence would not need to be taken up by beds or other aspects of the department’s physical disposition.

As we also will see later, the passage from the existence of the new buildings to beds implicated in turn that the existence of patients also articulated a new organizational configuration, with fewer leaders and greater reliance on outpatient care. This new articulation channeled (bodily and medical) action towards a different form of material existence, the home rather than the hospital bed. As such, the organizational existence of department H required much more treatment on an outpatient basis, with a lesser focus on the individual patient.

Numbers taking up materialities

Another important issue that department H members faced was finances, especially in the context of the cost cuts that are demanded from them. To begin with, the new financial situation the government imposed on the hospital meant it could not continue existing on several sites and had to merge into a single one offering less total space to the department. Numbers affected the space available for beds (as we saw above), but they also directly impacted the availability of beds, as the head nurse described it:

Another difficulty related to the merger is that our staffing is equivalent to beds, and that it depends on budget reductions. We are told that we need to cut costs by 8% in total. This department has a budget of roughly 200 million DKK, and we have also been told that, in addition, we need to reduce 10% of our medical secretaries, but cuts also concern doctors and nurses (Interview, October 2013).

The head nurse’s commentary can be understood as showing that less money entails having to let go of personnel, which in turn—given organizational and medical standards—affect the number of beds that can remain open. Finances, thus, do not allow beds to continue their existence through them. However, just as in the case of the building, this also means that members had to find other ways of channeling patient bodies, or risk finding themselves in a contradictory situation. This was illustrated by Karen, one of the consultants:

Each time you remove a bed, you subtract some costs. The beds are what matters in the accounts [. . .] they [the leaders] argue this is an accounting maneuver, since the patients are still there, and they are still overbooked. However, they will have to officially close two beds. The overall issue is that 163 beds will be closed at the hospital [in total] and this is not something they will have reached as a result of new forms of treatment (Meeting, September 2013).

Karen regrets that due to the budget’s inability to accommodate beds, it is also unable to continue the patients’ existence. As a result, cost savings are not an uptake of bodily and medical action—that is, patients getting better thanks to new treatments—but are attributable to a disconnect between money and the actions it is supposed to allow. The beds, for their part, are supposed to be a passage point between accounting and treatment, since money is allocated per bed, but when patients are not put in beds, for instance because they are treated on an outpatient basis, then beds stop playing the role of passing patients’ existence into the mode of numbers. The uptake from the physical existence of beds and patients to the budgetary mode of existence revealed how the passage from materialities to numbers was a critical way in which Department H existed. This existence articulated further complications in relation to the new organizational configuration after the merger: the new buildings required a reduced number of beds, and thus, the financing of the department appeared to be significantly curtailed.

Abstractions taking up materialities

Another passage we observed consisted in materiality coming to exist as abstractions. A key concept that was promoted by hospital management and the consultants in relation to the merger was the notion of “task.” Departments were considered to exist through the “task” they dealt with, and they were asked to define their “core task” and to focus on it. This meant, for instance, making sure not to do superfluous things and clarify the distribution of labor among department members. Indeed, the allocation of resources also had to do with the kind of expertise that was required to carry out the department’s tasks. By carefully defining the task, the consultants suggested, departments would be able to get the work done despite budget cuts and take better advantage of the merger. Signe, the head nurse, explains in an interview how the notion of task is supposed to play an articulating role between elements of very different kinds:

We need to find out how to organize ourselves and this is something we must do, not something the top management will come and do for us. We must figure out what lies in personnel responsibilities, what lies in responsibilities in terms of operations, finances, quality objectives all these becomes very relevant during the merger (Interview, October 2013).

The abstract existence of department H, as defined by the concept of the core task, was thus supposed to allow money, physical space, competence, personnel and patients to continue their existence into each other and converge. Even though this abstract existence was supposedly capable to take up the materialities of the new building, in fact it failed, to some extend at least, to capture some of the material existences that were at stake during the merger. As Signe recognized:

We have been told that we own the task, but not our physical location, and that we need to start collaborating much more across sections and departments. Yet, our new physical surroundings do not necessarily reflect this. For instance, we will share physical sections with kidney patients, but these are vastly different domains of expertise, so how do we make this work – that is a question [we need to address] (Interview, October 2013).

In fact, it turns out that very different kinds of tasks would be carried out in the same space. Signe became unsure how to define clear responsibilities between people, and how to spell out procedures for operations, finances, and so forth, when teams of different departments, and therefore patients with different ailments, would cohabitate.

The abstract existence was, however, also allowed, in part, to mitigate this confusion. The two consultants, Anne and Karen, defended the notion of core task, and instead viewed many of the difficulties the members experienced as a result of a disagreement between them on what that task should be. As Karen noted during a meeting with department leaders:

You all tell stories about good cooperation, high loyalty to each other and trust [. . .] however it does not mean that everything works in an optimal way. What is less clear, at least for some of you people, is what the concrete managerial responsibility consists of in relation to your core task as a department. [. . .] When we ask you if you have a shared job as a team of leaders in relation to the department’s core task, we get very diverse answers (Meeting, October 2013).

The abstract notion in itself was capable of allowing the department’s diverse modes of existence to articulate with each other, provided that in turn the staff took it up and provided it existence in the form of a shared agreement as to what “we” as a department are responsible for. To say it otherwise, to exist in the passage between materialities and abstractions, the issue would lie in the fact that an abstract concept also needs to exist also in a different form, as a common belief among a group. If such a common core task could exist, then department H could perhaps articulate other tasks and accountabilities. This abstract existence, in its turn, was further taken up by other modes, which created complications, as we will see below.

Numbers taking up abstractions

In the same way as the abstract notion of a core task had to continue its existence through a shared understanding, the other abstract concept of managerial responsibility, had to exist through other modes. One of these modes was numbers, and especially budgets, which was put to the test by the upcoming merger and the cost cuts. For instance, department H leaders were concerned that there was a discrepancy between the way budgets were decided upon and their level of managerial responsibility. As a ward manager, Lis, explained:

Our different sections also have their own budgets, which makes it easier getting an overview of where the money is spent. The issue, though, is that the budgets do not always reflect our level of managerial responsibility. We do not have the mandate to decide on many things, so although the budget is a huge consideration in our daily work, it is also a thing that we cannot always do much about (Interview, November 2013).

In this quote, Lis points out how local managers cannot change budgetary attributions and must therefore follow them without being able to make amendments. Thus, passing from abstractions to numbers gave existence to a certain conception of how departments and their subunits must be run, and while they may give the impression that they are in charge, these same numbers in fact do not allow the existence of local leaders’ managerial responsibility, as Lis remarks. This contradicts the previous quotes concerning the “core task,” which supposedly allowed departments to decide on how best to distribute responsibility and run their activities. In this sense, at times doctors and nurses had to decide on treatment options that went beyond budgets, and found themselves in a contradiction between the responsibility towards their patients that defines them as health professionals and their existence as members of a department that supposedly operates thanks to a particular budget. The department was thus torn between its existence as a day-to-day service to patients and as an administrative unit existing in numbers and dashboards.

When, during a meeting, the consultants, Anne and Karen, emphasized the importance of defining the department’s core task, the ambiguous role of budgets and finances in relation to the everyday work at department H became salient. The consultants seemed to downplay the everyday presence of numbers when discussing tasks at the department. In the following excerpt, clinical leaders (Nigel, Betty and Fred) respond to the consultants’ (Karen and Anne) suggestion of doing three seminars to define the common core task:

Nigel:

Okay, now I have to ask, where is the department management team in this process?

Karen:

They are not directly part of the program from here, it is targeted at you. [. . .]

Betty:

I have to confess that what is of utmost importance to me is the place I am running in my everyday practice [is that] the common core task that you are speaking about is actually something that involves the department management team, and is not something we can just make decisions on during seminars. [. . .] Aligning these things at the department is also a matter of finances, collaboration with the blood test and biochemistry lab, the radiotherapy department.

Karen:

Okay, but we will not focus on finances, as you mentioned. Actually, we do not care about finances in the program [said in a jovial tone].

Betty responds with perplexity:

We do care about them [finances] [. . .] it is a large part of our everyday task!

Karen:

Well, it is the task of the department management, isn’t it?

Betty:

There are two elements to the financial aspect; one is that they [the department management] have a big part of the job. . .

Fred interrupts Betty:

You've mentioned that the aim was development on the actual managerial conditions of the department: finances are also an important condition! (Meeting, October 2013)

The consultant’s proposal that conversations during a seminar would allow defining the department’s “core task” is first resisted by Nigel who sees that the department management team is missing from this format. Similarly, Betty stresses the importance of having the management team present. These concerns may be seen as showing how an abstraction—the seminar format—fails to take up another abstraction, namely the various managerial responsibilities and the decisional power of each person.

However, what is of interest in this excerpt is how Betty mentions, at the end of her first intervention, a list of elements that she feels matter for the department but are excluded from conversations, including finances. Arguably, managerial abstractions matter to leaders precisely because they support the existence of the financial reality that makes these other elements possible. Karen’s attempt to attribute finances to the management team only reinforces the importance of having them attend the discussion, as the leaders requested. The leaders’ reaction, especially Betty’s, can be understood as reflecting that they cannot consider the existence of department H without also considering its existence through numbers, as their actions must be taken up in budgets to take place. Grasping the existence of Department H requires accounting for managerial responsibility, and in turn the abstract existence of managerial responsibility longs to be taken up in the mode of numbers. In other words, numbers are an important way in which the department, its “everyday practice,” and its hierarchy exist.

The organization’s synaptic mode of existence

The above analysis shows that department H, like any organization, exists through many other things or modes, such as materialities, abstractions and numbers. In turn, each of these beings experiences and bears witness to the others in its own key, which provides it with a unique perspective on “the existence of what they group together” (Stengers, 2000: 97). Buildings, beds, software, managerial and medical responsibilities, core tasks and budgets are all ways through which the department exists. However, this is not only because they would stand in for an intangible organization, but also because they continue each other’s action, as buildings offer space to beds and sections, beds offer rest to patients, as budgets offer staff for each bed and allow (or disallow) managers to make decisions. Interestingly, these passages were more obvious in their breakdowns than in their success.

As the leaders were perplexed by the inability of some modes of existence to take up others and witnessed some existences being “blocked,” they had to actively find other routes through which to channel each being’s action. For instance, they were considering to treat patients on an outpatient basis, which would move them outside of the building, outside of the beds, but also outside of the budget, thus not requiring these elements to take up their biological and financial existence. Hence, the leaders’ perplexity highlights that to organize is to make possible passages between modes of existence.

Budgets, for instance, provide existence to all facets of the department, including to a conception of managerial roles that distributes authority between the department management team and other department leaders. If budgets were omitted, as the consultants wanted to do during the seminars, the chain of existential uptakes would be broken, and the department would not be sufficiently present for decisions to be made about it; decisions would not reverberate down the chain, and indeed, there may be no chain left. Similarly, the head nurse points to the importance of considering the built environment, since any decisions concerning beds, distribution of roles and treatment option must take into account the available space and the presence in that space of patients from other departments.

A crucial aspect that can be noticed in the data excerpts presented above is that clinical leaders always talk in terms of their daily work and of the activities they have to carry out. To them, the existence of their departments and the changes that must apparently be carried out as part of the merger are relevant inasmuch as they impact their action, and in particular the kind of treatments they will provide to patients. This allows us to appropriate the work of Souriau into organization studies and argue that organizing happens each time passages between modes of existence take place and one of them takes up another mode’s action. The reason why budgets matter to beds is not some immaterial relation between the two, but the fact that budgets may interrupt the bed’s ability to offer a resting and treatment space for patients. That is why outpatient treatment becomes an alternative: people have beds and other furniture at home, which may accomplish the same action.

Arguably, another possible reading is that what is at stake is also leaders’ and consultants’ individual existence under the facet of their professional identity. This is particularly noticeable when physicians and nurses feel they cannot give up treatment solely for budgetary purposes or regret that savings do not reflect actual improvements in treatment efficiency. For instance, valuing collaboration with the blood testing and biochemistry lab matters to them as these collaborations allow them to continue their identities: if the lab stopped providing them crucial information, their existence as health professionals would be impoverished. Such a reading based on identity emphasizes the leaders’ understanding of what goes on.

However, many other passages between modes of existence took place, without the necessary mediation of human beings, even though they may be difficult to capture empirically. It is true that our data relies on what people have said, and therefore on one particular form of communication that served, in this study, as a proxy to these other, non-human communications or passages. For instance, the conversational situation of the meeting confronted different configurations of beings against each other and tested the strength of existential chains. In that sense, the meeting itself even acted as a synapse, operating passages between modes of existence. Human communication, then, was a plane of existence where other modes were made to speak to each other and where decisions were made as to whether some beings were included or not, and ultimately, who or what would survive.

Discussion and conclusion

The case presented above shows that, like any other organization, a clinical department exists through multiple modes of existence at once that continue their action into each other. It is therefore necessarily multimodal; it exists as an “and,” “or,” “but” and in other traces of articulation, rather than in any substantive entity. Passages must be found between beings for the organization to go on existing, for it is all about those passages. The many modes of existence that organizations enable or deter matter to organizational members, but also matter to one another, since taking one out—like finances—may alter the ability of the others to exist, to act, and to articulate into a coherent whole. Speaking in terms of modes of existence therefore draws attention to the way in which different kinds of entities do not merely co-exist beside each other inside an organization, but that organizing is passing between modes of existence as they continue their action and existence into each other. The organization serves as a synapse for the continuing existence of the beds, patients, responsibilities, and so forth. Alternatively, since bodies would not be able to continue its existence as patients outside the walls of the hospital, the organization had to adapt in order to serve as a synapse connecting those outside bodies to the hospital by creating additional outpatient services. These existences reveal themselves in the actions taking place, and the possibility for them to be furthered is sometimes enabled, sometimes blocked. Several contributions emanate from our analysis and in the following part we elaborate on them.

A call for irreduction: embracing the multiplicity of existence

Saying that an organization corresponds to the synaptic mode may appear as a reduction to a single mode, but since the synaptic is an articulation between other modes, it is actually an acknowledgement of multiplicity. Each mode matters in itself because we need the physical properties of a molecule to provide medication, the psychological existence of skilled and caring medical personnel to pass it on, etc. However, the existence of all of them as an organization and as a hospital lies in the articulation of all of them. Moreover, any articulation between modes would not lead to the emergence of this particular organization. As such, the synaptic mode of existence contrasts with current understandings of organizations that attempt to list ahead of time the modes by which organizations would exist, or even to reduce them to one sort of entity, for instance, the social or the material (Leonardi and Barley, 2010). A Souriau-inspired view invites us not to think in dialectical terms, as that would suppose only two modes of existence that would necessarily oppose or contradict each other (Putnam, 2015). In this sense, it is not only that some organizations are monstrosities that bring together bits and parts that were not originally meant to go together; instead, the existence of any being, including the organization, supposes that it also exists as something else (Thanem, 2006). By reducing the richness of existence, studies that limit the number of modes of existence fragilize the organizations they seek to explain, as they create “a feeling of a decrease in being,” because “each mode of being, reduced to what it intrinsically is, will appear tenuous and fragile” (Souriau, 2015: 123). We must therefore revisit how we do research and how we write, and realize that even our practices as researchers (fail to) reproduce organizations in particular ways by connecting beings together in specific ways, at the exclusion of others (Beyes and Steyaert, 2012). In particular, giving priority to human experience and understanding, even when recognizing that there may be multiple valid metaphors to speak of organizations, risks assuming that organizations are reducible to what they mean to some people (Morgan, 1986; Schoeneborn et al., 2016). Similarly, thinking in terms of metaphors may suggest that the issue would just be that we analysts are not “speaking the same language” (c.f., March and Simon, 1958: 5).

In contrast, our case shows that the organization exists under several modes of existence; it is many things at once, as passages between entities of different natures actuate those different modes, thus recognizing existential pluralism. Saying that it exists under the synaptic mode is not a reduction to one mode, but on the contrary recognizes that the organization exists in the interstices between modes, where it operates their articulation and ensures that action passes from one to the next. This is an empirical fact with which participants themselves are confronted in critical moments and in their everyday work. Indeed, to quote Souriau (2015: 123) once more: “beings [are] established in several modes simultaneously, making each commensurate with all the others and assembling them all within itself.” In other words, organizing occurs amid complexes of existence.

An eloquent demonstration of this is offered when elements existing under different modes constrain each other and resist human attempts at making them say or do things. For instance, later in the meeting presented above, the consultants suggested that physicians will be able to go back home for the holidays after the seminars, hence implying that time spend with the consultants will be unnoticed in their everyday work. However, the leaders opposed because they actually had to be back to see patients. This statement transposes a 30-day diagnosis guarantee established by government decree, which is embedded into the hospital’s IT system. In this sense, the leaders’ opposition to the consultants, and their presence at the department on those dates, reflects that disease and biology, but also government regulations and IT algorithms, cannot be easily aligned with the consultant’s proposed line of action. Thus, materiality may resist human enrolment (Stengers, 2000), but more broadly modes of existence may be so tightly locked into each other that they resist new uptakes of action.

Ontologizing organizational politics

The inability of some modes of existence or of some configurations of modes to take up new, different forms of action may help strengthen our understanding of the politics of organizing beyond a simple contest for resources, a pursuit of control or freedom from constraints. In our case, the consultants were not deliberately pursuing political goals (at least we have no reason to believe so), and yet politics was happening. Selections were being made; passages were enabled or impeded. Because of the consulting approach that was adopted, the department management team and finances would not be included in the seminars, which meant that some configurations—including the department’s authority structure—risked being left on the curbside. The solution would not only come from the conventional tools of authority and power, such as struggles and persuasion, but also from a refitting of the seminar program to create opportunities for the uptake of existing authority structures and of financial issues, for instance by inviting a member of the department management team and including an updated financial statement in participants’ kits.

If politics refers to the many decisions that are made about group formation (Latour, 2005: 27), that is, about who or what to include and exclude in the organizing process (see also Sturdy et al., 2009), the (in)ability of some beings to take up and continue the action and existence of others to constitute the group and operate under this “we” is also a matter of politics. Indeed, discrimination and other practices that create or maintain power imbalance are closely related to whose voice and action is taken into account and how (Mik-Meyer, 2016; Pompper, 2017). Thinking in Souriau’s terms reminds us, however, that beings, including human beings, exist through multiple modes at once, and are scattered across more or less abled bodies, computers containing their private data, projects they invest their time and energy into, and so forth. The same goes for politics, as a mode of existence that continues into others: artefacts are political (Latour, 1992), and politics have artefacts (Joerges, 1999) and discourses (Chiang, 2015). Being sensitive to the politics of inclusion, therefore, is not only a matter of listening to everyone’s voice in the literal sense, but also a matter of finding ways for everyone to continue their existence, in all of its diversity, through the organization.

Depending on how a financial or bureaucratic system is conceived, it may allow or not the full existence within the organization of some people or things; in case of failure, the organization may deal with these discarded beings by constituting them as “monsters” (Munro, 2001). Far from being limited to exceptional, “unfortunate” events (Latour, 2013b), organizational politics is therefore embedded in the synaptic ability or inability to continue one being’s existence into another. Politics, then, is not only rivalry in the pursuit of interests, in the conventional sense, but also of inter-esse, of being in between (Callon, 1984). As Stengers (2000: 94) notes, inter-esse “not only means to stand in the way of, but first of all to make a link”, because to interest is to create “the sensibility to a possible becoming” (Stengers, 2000: 92). Accordingly, the question becomes who or what will be interested to take up another’s existence. This question is crucial, because, as Stengers (1997: 165) notes, reality itself depends on it: indeed, reality is “that which demonstrates its existence by bringing together a multiplicity of disparate interests and practice.”

We may say, then, that the passage from one mode of being to another is supposed to interest or create a link between multiple beings but also to allow organizational reality to exist in a certain way. For instance, when the consultants in our case invoked a passage between an abstract existence through the “core task” and material beings, doctors were supposed to be interested in the merger and accept the authority of the core task as a way of organizing it. If the doctors allowed this passage to interest them, they also, as Stengers (2000: 94) notes, accept that this passage engages them in a certain way and that it “prescribes a duty and confers a right.” Being included among a group is therefore all the more political as it is through the other members of that group that each person or entity exists. To include someone is to accept that they continue their existence into ours and to form a collective with them is to create devices and structures to allow this continuity. This is political in the same way that we exclude refugees by denying them education in our schools, jobs in our businesses, or healthcare in our hospitals, because it alters their existence and ours, while they may become uneducated, unemployed, and sick and we become an intolerant society with increasing poverty. Similarly, the many beings that we do not welcome in our organizations, for instance, in our case, management team members, finances, and the department authority structure, may become weaker and dwell in the organization’s margins, and we also suffer from their absence. As such, power relations are implicated whenever existences attempt to continue into others. Such passages attempt to articulate disparate interests that do not necessarily align. What is being included or excluded in the passage also shows the inherent relationship between organizing and disorganizing or how connections are both made and un-made in the passage (Cooper, 1986; Knox et al., 2015).

The inevitability of politics and exclusion may be understood by the fact that the organization (the department but also the hospital it was part of) demanded things to be done, and became more demanding as it gained existence through different modes, in the same way as Souriau, in a different text, describes the sculptor as responding to the work of art’s demands as it comes into being (Souriau, 1956). Conversely, as the organization acquires more existence, it also gives up on being something else.

What organizing means

Understanding the organization as existing under a synaptic mode updates some classical themes of organization studies. Organizations have been traditionally associated with notions such as the division of labor (Babbage, 1832; Smith, 1801; Taylor, 1911) and coordination of work (Barnard, 1968; Fayol, 1949). A Souriau-inspired view of the organization as a synaptic articulation between modes of existence reveals that division of labor and coordination do not happen within pre-existing organizations. Also, they do not only concern human beings who need to collaborate. Rather, organizing is coordinating—or articulating, as we have referred to it—among diverse modes of existence and, when they are not sufficient, instaurating new ones. This view of organizing takes seriously the idea that organizing rests on autonomous processes of desire (Hietanen et al., 2020; Linstead and Brewis, 2007), but also clarifies that this desire corresponds to a thirst for further existence through others. This means that the organization exists in the articulating work of making one being’s action and existence into another’s. Recalling our case, are the patients in the beds, are the beds in the buildings and in the budget, or is the budget in the discussions? If not, we need to find other ways of making sure that the things we value—such as patients – continue to exist, for instance by keeping them in their own bed at home: a new form of organizing emerges, namely outpatient care. In that sense, disorganization would correspond to moments when such uptake of action does not happen, and patients, beds, buildings, budgets and discussions each do their own thing rather than continuing each other’s existence (see also Cooper, 1986; Knox et al., 2015; Vásquez and Kuhn, 2019). Organizing, then, is a synaptic meta-mode that federates the others, or, to say it another way, it corresponds to the dash that connects modes of existence.

A synaptic view also contributes to a richer definition of communication, a notion that has been gaining popularity as an exploration of relational organizational constitution (Kuhn et al., 2017). Our case shows that the synaptic mode of existence may be understood as communication between other modes. Our data, which consist mostly of what people have said, may imply that human communication is a privileged mode of existence where other modes are articulated. However, beyond an exclusive focus on written and oral speech, communication-based studies must not only account for exchanges between human beings but also for the passage of action across a diversity of modes. As such, the study of communication’s role in the constitution of organization is not only “a platform of organizational analysis” (Cooren et al., 2011: 1163) but a potential shift in the very understanding of communication. If we want to empirically observe how organizing and organizations take place in passages between modes of existence, and understand the communication between them, then we need a theory of communication that accounts in similar terms for the words of human beings and the kind of contributions that can be made by a wide array of other non-human beings (Bencherki, 2016; Cooren, 2015). This goes further than typical analyses of interview and meeting data. By attempting to also capture how communication may happen within and through technology, bodies, and other beings such a theory views communicating and organizing on the same terms. To this day, organizational communication research has mostly shown how communication in the conventional sense of “what people say, write, or do” (Schoeneborn et al., 2014: 290) contributes to organizing processes, rather than understand communicating itself as co-extensive with organizing (Bencherki and Iliadis, 2019). While the outline of such a perspective, remains to be sketched up, focusing on the organizations synaptic mode of existence may offer a way to pursue that agenda.

Finally, thinking in terms of the synaptic mode, and of communication as one form which this may take, specifies the relational program in organization studies. Until now, relationality has remained a relatively abstract idea, with few analytical tools to look specifically at how relations are established and what it is that happens through them to allow organizations to emerge (Cooper, 2005; Emirbayer, 1997). With the synaptic perspective, we can now hint at how to conduct relational research. Namely, we must observe those moments when the action of one being, existing under one mode of existence, is taken up and continued by another. Indeed, organizing happens when documents, technologies, ideas, procedures, budgets, beds, and people find ways of pursuing each other’s action and existence.