Wednesday, October 9, 2013

What if...the only model is one person at a time...

There is an increasing demand for services to be delivered in ways that are individualised, self-directed and person centred. 

Many organisations face a financial imperative and an ethical dilemma: they need to adapt in order meet the requirements of the funders and remain financially viable and they live with tension of providing services in a way that is acknowledged to fail to meet the individual needs of the people who receive those services. The corners and sharp edges of people's individuality are rounded out in an effort to meet the most common needs of most people most of the time.

The impact of these strategic imperatives is being felt in boardrooms and in management teams across Australia and in many other places in the world.
The people  responsible for governance and leadership wrestle with the implications for the organisation. However, it's not just the Board members and the Managers who feel it. The impact is also felt where support workers try to respond to the requests for more individualisation and person centredness.

Staff worry about what to do, ‘Can it really be OK to allow this?’ ‘If I do it for this one person then I’m going to have to do it for everyone!’, ‘They keep changing their mind!’. 

Staff members feel exposed and vulnerable. Change increases anxiety; staff teams don’t know what is expected of them. They are don’t know how to do the new thing and are afraid of making mistakes and having to learn new skills. They do not want to have to think about their work and look instead for someone to tell them what to do.

The more individualised a service becomes (and the more individualised services there are) the more complex these services are to design and manage. 

When I was managing a group home in the UK and trying to do things that worked for individual people within the group setting, I quite often went home with my fingers crossed behind my back, hoping that the plan we'd dreamed up for that afternoon would work...that the taxi would arrive on time; that all the staff would show up; that the person still thought that this was what they wanted to do; that everyone would be in a good mood...

The more flexible we tried to be, the more some staff would look for certainty. More detailed instructions. More rules and regulations. More policies and procedures to cover every situation. 
At a time when they need to be at their most creative, imaginative and flexible many staff members found comfort in their default position…just keeping things the way they were. 
Some seized the opportunity to try new things and the benefits to the people they support were enormous. Others sailed too close to the wind, and understood the openness and flexibility of a person centred, self-directed approach to mean that anything goes, putting the people they support and themselves at risk. 

My Group Home experience was about 20 years doesn't seem that much has changed.

The uneven response of staff reflects their understanding of the ideas and their capacity to engage with them. In order to address this, organisations are tempted to look for ways to standardise responses by introducing models and templates but these are no substitute for staff having the ability to think around some of these situations within a framework of values.

In our haste to figure out ‘How’ we move too quickly through other questions that may help us on the journey:
  •            The ‘Why?’ question…why should we do this is the first place? Why is this so compelling? It is really a question about values and leads us into other questions. 
  •             What is it that we believe about the work we do and the people who use our service?
  •             Where are the gaps in our integrity? To what extent is there a difference between what we say that we believe and stand for as an organization and the ways in which we actually deliver services?
  •             What if there is no model? What if the only way to look at this is ‘one person at a time’? What would it take for this agency to take that approach? What would it mean for funding, staffing and the existing resources tied up in vehicles, buildings and equipment?
  •             Could we ever be certain that we got it right? Can we accept that working in an individualized, person centred way means that getting it right will look different every time and will be achieved in ways as different as one person is from the next? What would it take to sustain and support staff to work within greyness and uncertainty? 

As these questions are explored it seems clear to me that what is required at this particular time in the evolution of service delivery is the development of a principled, intentional, person centred workforce, able to respond in a values driven, steady way to complexity and uncertainty.

Organisations need to adapt their culture; to honour and promote a deeper working understanding of their values so that staff can imagine what these look like when translated into face to face encounters with the people they support.

They need to develop a higher tolerance for ‘messiness’; to support honest mistakes and a commitment to learning from them. 

It is essential that they develop robust, strengths based supervision processes that scaffold a more flexible way of working with people.

Flexibility is required within organizational structures and processes in areas such as Finance and Human Resources to allow for individual differences and preferences in service delivery.

The entire organization needs to have an attitude and approach that asks ‘what will it take?’ when considering how to support a person effectively and in line with their wishes.

There is much to be done to create a human service system that supports people to live the life that they choose rather than live within the constraints of a menu of service options. 
It is complex, nuanced work that requires a great deal of thoughtfulness. 

But it is the right thing to do. 

A label of disability, disadvantage or difference should not mean less of a life. Organisations willing to work out how to deliver individualized, person centred services will be challenged and rewarded in equal measure.

 ‘Hope is not the same thing as optimism. It is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.’
Vaclav Havel