This work presents an approach derived from direct participant observation of small units within institutions, all in the health and social services sector. A range of contributors bring together the results of their own observational projects - in settings as diverse as a mental hospital canteen, an acute psychiatric admission ward and a palliative care unit - to show how they were able to come to a psychoanalytically informed understanding of the cultures that arise within healthcare organizations, and how this understanding can be used to overcome difficulties that arise. This work should help healthcare workers, teachers and managers better understand the functioning and difficulties of their organizations and therefore help in the management and practice of the work.