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 ago...it 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
