Playing with numbers

RD-M 2013

I am often mindful of the need to criticize the quality of leadership and management in health and social care services; particularly the obsession with numbers, the tick-box mentality, and the blind faith placed in targets for driving change and daily practice across services. I am surely not a lone voice in this critique, but is it valid or just a reaction against the sound of the pips squeaking?

I do believe that an absence of targets or defined outcomes, and a failure to establish high standards for provision of services only leads to inconsistencies between practitioners and teams… what is often referred to as a postcode lottery. Service users don’t deserve to be on the receiving end of either stressed out practitioners fearful of constant criticism, or laid-back practitioners doing their own thing. Audit and regulation have a place, but surely they need to be clearly joined up to practice, not existing in a vacuum somewhat disconnected from the realities within which good practice has to operate.

The ever-growing chasm between person-centred practice and business-focused managerialism does little to promote a culture of organizational collaboration that may encourage a more engaging form of audit and regulation across services. My solution would be to eliminate most of the current audit requirements imposed on practitioners and teams, particularly that which they experience as wholly time-consuming and unhelpful. So far so good, say the practitioners amongst you; please do share your thoughts, but read on before you do…

Over the last 12 years, through the Practice Based Evidence initiative, I have been developing tools designed specifically for use by practitioners and teams. These tools have flexible uses: personal reflection, individual supervision, team development and team evaluation. Used diligently they should be able to provide a host of qualitative and quantitative data, which in turn should offer useful feedback to practitioners and teams for practice development purposes. The Risk Decision-Making publication includes examples of these tools, and a specific example of data emerging from their use in a specific organization to help identify good practice and priorities for further development.

So, the sting in this tail is that practitioners and teams need to own the processes of audit and regulation if they are to reflect and develop good practice. For those auditors and managers fearful of losing their jobs ifPractice Based Evidence emerged as the norm, you could always make use of the data to tick your boxes; better still, you could prioritise your time more effectively by getting in and alongside practitioners and teams to support aquality revolution. You might then be in a stronger position to challenge and inform the thinking of the inter-galactic warlords from distant planets a.k.a. commissioners, Department of Health, Care Quality Commission…

These are just a few thoughts I am passing on as I reflect on years of connections with so many people who are desperately trying to do good work despite rather than because of their masters. Do feel free to offer your thoughts and ideas (with an accompanying dictionary from those of you who find ordinary language an alien concept… with all due respect to the demands of the Plain Language Association).

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Does the whole picture fit together?

AoCC 2009

This question captures the meaning of ‘care coordination’. Are all the elements coming together in a coordinated sequence or pattern? It is a question that we apply to many aspects of our daily lives. We ask it, for example, about the colour schemes and fittings of interior design; the layout of an exhibition or gallery; the clothing we wear in particular situations. Simplicity and straight lines in a map or set of instructions often seem to help us to understand what we are doing, where we are going and how we can get there more easily. Complex pictures and plans might please people who enjoy the challenge of working out puzzles rather than having the solution given to them but, depending on how much time you have and what kind of person you are, high levels of complexity may serve only to frustrate you and turn you off.

The degree of creativity experienced in the smallest to the most complex of mental health tasks will largely be influenced by the attitudes, feelings and personal values that are in play at the time. For example, the simple task of arranging an appointment, and then attending it, might just be part of what a particular person does, and they might do it methodically, with little or no thought. But even a simple task like this can be subject to enormous influences, such as the availability of rooms, effective computer systems, clarity of communication, motivation to attend and transport on the day. Failure to meet the appointment, for whatever reason, has the potential to cause frustrations, fuelling deeper tensions and attributions of blame. But the successful completion of a simple task like this rarely generates the positive feelings that perhaps it deserves. Not all appointments and methods of support are creative, passionate and artful events; but the message is that we need to be more reflective about the smaller details if we are to derive more pleasure from our work routines. This message applies to all practitioners involved in care and support, as the care coordinator occupies a role of supervising the whole picture, not painting the whole picture alone!

Successfully coordinated care and support can be a great source of satisfaction and pleasure for providers and receivers alike. See the ‘Art of Coordinating Care’ manual for a detailed approach to capturing the creativity in the role.

Working with Risk manuals

WWR 2007The ‘Working with Risk’ tools located here have been developed into a 2-day Risk Trainers Manual and an accompanying Practitioner Risk Manual and were published by Pavilion Publishing in Spring 2007.

The article below, written by Steve, gives an overview of the tools. It was first published in   in September 2007 and included here with their kind permission.

PDF: Working with Risk: Steve Morgan outlines a new training pack on positive risk management.

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