(This article is based on a presentation first offered in conjunction with a ‘world café’ conference sponsored by the Southeastern Local Management Entity (LME) and the Southeastern Consumer and Family Advisory Committee in Wilmington NC, October 2005.)
It is not uncommon that questions around the workforce are considered, at least by some, to be mostly a managerial matter, and best handled by people in administrative roles. This view is unfortunate, as the quality of the workforce is of interest and meaning to many others, most particularly the people who use and must rely on services. Significantly, it is precisely these people who may prove to be extremely useful in helping shape a better workforce, providing that roles that support their meaningful involvement are created and creatively supported on an ongoing basis.
Service users are often very conscious of what makes a good workforce, i.e. whether the service is actually good.
Naturally, the interests of service users and families have to rest on whether a service performs as it should. While this is not just a workforce question, as poor results can result from the use of poor models and practices, they are sufficiently entwined that the experienced results of how service is rendered can be all too evident in its impacts on the lives of service users and families. Consequently, many thoughtful service users and families will be able to provide considerable insight into what did or did not work for them. This is turn will provide very good direction for where improvement is needed.
Service users have both a stake in service quality and guidance as to what it is or could be.
When people have to critically rely on something, they quickly form views about whether it meets or exceeds expectations. When encouraged to do so, they can often participate in expanding the view of what is possible with quality. Since they have to live with the consequences of poor quality, this can also provide them with motivation and a sense of what is superficial or worthwhile. Their experience can be the proving ground for discerning that which is authentic and that which is likely to disappoint.
Service users and families can help pick, supervise and release staff.
Who gets and keeps jobs has a great deal to do with whether the work done will be as hoped. Similarly, if those guiding the work includes those with a deep interest and need that it be done well, then one can be sure that the energies of workers will be guided in fruitful directions. Their presence can act to keep such key processes more directly responsive to their needs, thereby ensuring that the workforce is kept attuned to the needs of the people reliant on their work.
Service users and their families can help orient, train and mentor staff.
There is much that staff can learn from people with many years of experience with having had to rely on services. If these experiences are translated into good training and mentoring opportunities, then staff can be helped to benefit by being sensitised to what it is that makes the most difference for the lives of the people served. In time, such experiences can lead to very helpful understandings between service users and staff , opening up the possibilities of important long-term constructive alliances.
Service users can help clarify what it is that they most fundamentally need from services.
Being able to more deeply and accurately understand the lives and experiences of service users greatly increases the likelihood that the staff will be able to respond more sensitively and effectively to these needs. It also can mean that many of the common mistakes and shortcomings involved in meeting needs poorly can be gradually understood and overcome, particularly when this results in patterns of service that are more relevant to people’s actual needs.
Service users and families can help build vision about what is possible and can inspire staff and others.
Often the challenge is not to simply provide services in conventional ways, but rather to expand our vision towards what might be even more superior and needed improvements in the state of the art. Service users often have a sense of what these directions might be, and thus can be crucial participants in any vision building and testing process. They can also serve as an inspiration to staff, other service users and others.
Service users and families can be part of developing needed innovations.
Service users will inevitably have needs that exceed the capacity of present practices, models or systems, and will therefore require that something innovative be created to fill the gap. While not all service users or their families will be innovation minded, they can help by establishing the parameters of what is needed, thereby providing direction and purpose for innovations. For those who are innovation minded they can help add to the process of innovating.
Service users can be a key part of evaluating services
Service users can be helpful both in establishing and using the basic criteria of evaluation as well as methods and practices that could make them knowledgeable and proficient evaluators of services. This has been successfully demonstrated in a wide variety of contexts, including many that rely on the specific concerns of service users and their families. In some instances, service users and families may well become expert evaluators and analysts. This should not be surprising given their experience with the many issues in services.
Service users can safeguard workforce quality through active advocacy, monitoring and raising awareness
Though many systems are not always enlightened enough to recognise or appreciate the value of it, independent service-user, family and related advocacy efforts often serve to highlight critical workforce and quality issues and generate the awareness, priority and momentum needed to get such matters addressed. This is particularly true in instances where the system’s own means to address such matters have not performed as expected. In this regard service-user advocacy becomes perhaps the last safeguard in place that might remain functioning after more conventional ones have failed.
Service users and families can help mobilize support for a quality workforce.
Because of their fundamental long-term interest in a viable and proficient workforce, many service users have become very active in the process of mobilising support for all manner of aspects that help create a quality workforce—including training, wages, benefits, access to basic and advanced educational opportunities, the creation of new roles and positions, job security and employment stability, to name a few. It is their legitimacy and compelling rationales that convinces many others of the necessity to bear the burdens involved in having and maintaining a quality workforce.
Service users and families can be reflective sounding boards for crucial developments related to the workforce.
It is in the nature of progress that ideas need to be considered, evaluated and tested repeatedly before they are eventually adopted as being persuasive. Service users and families can quite realistically contribute to the refining and evolution of ideas both by dissenting where this is needed, and affirming what is sound. In this they bring experience, abilities, values, judgment and wisdom that can often enrich the end result.
Service users can provide leadership and purpose.
Leadership is as likely to be present as a capacity in service users and families as it is in any other group in society. The innate leadership, talent and experience of service users and families should be supported and applied to the many problems faced in workforce development. Often this is done in conjunction with other sources of leadership, thereby creating collective purpose and leadership of the kind that gets things done. This can be invaluable and it is wise not to underestimate this potential.
Service users can contribute to the renewal of the workforce.
Many ideas and inspirations about service improvement first begin in the hardships and discouragements that service users and families have with services. In due course these experiences get transformed into positive proposals for service improvement that challenge and eventually renew service thinking and practice. Additionally, service users and families are often crucial in persuading systems to invest in the renewal and recognition of their workforces, thereby adding momentum to renewal.
Capacity concerns regarding whether service users can carry these roles
Many people will see the roles described above as limited only to a small élite of very exceptional or competent service users or families. This would be regrettable, not only because it indirectly and falsely stereotypes service users and families as lacking capacity, but because it can blind people to the very real abilities that many service users and families have in plenty, but which are undervalued and underutilised in many systems. There is no doubt that most service users and families will have specific individual limitations to contend with in performing these and other demanding roles, but the same could be said about staff, managers, professionals and other such groups.
Perhaps a more constructive orientation would be to simply start with the assumption that many, but not all, service users could potentially perform such roles and that the key thing will not prove to be their capacities, but rather the extent to which they are properly supported and upheld in these roles. With the right kind of support, their limitations could be sufficiently offset to allow their many strengths to gain the attention these deserve. More specifically, systems would do well to engage these strengths through the establishment of specific legitimised projects that concretely involve service users in addressing workforce and quality issues. For instance, most service users can readily play decisive roles in hiring and overseeing the staff in their life, should systems open up such opportunities.
It is important that not only should the opportunity be created, but that energy and investment should be made into identifying and creating the supports that will be most helpful in helping service users succeed with these roles. For instance, many service users find the supervision of staff to be quite stressful and may need assistance in taking on this task, particularly with difficult employees. This may often be a person-by-person matter, such that supports will need to be individually tailored.
The partnerships that involve service users and families with systems need to be based on very ethical foundations or they risk becoming a new way to deceive, manipulate, co-opt or disempower service users and families with all of the detrimental consequences that would come from such abusive relationships. Consequently, systems need to be clear about what an honourable or ‘right relationship’ with service users and families needs to be, as this will be very enabling and augur well for long-term success.
Service user involvements of this kind should not end with the creation of glamorised pilot schemes, but be taken to the level where service user and family influence over workforce and quality issues becomes normative, entrenched and supported in both good and adverse times. * These efforts need to be studied and learned from so that their benefits and challenges become part of the bigger learning of what leads to quality.
Lastly, systems would do well to periodically ask the question of what precisely are the next steps in the evolution of the roles and contributions of service users and families to a good workforce.
Service users and families becoming involved in workforce issues ought not to be in any way portrayed as some sort of a panacea for the challenges of workforce development—this would be deeply misguided and overlook the roles and responsibilities of many other parties to address these issues. Nonetheless, it would also be very shortsighted to unthinkingly exclude service users and families from meaningful roles in influencing workforce issues. So, the better path would be to open our thinking and approaches to these issues of workforce quality in services so as to make the most of the many ways that service users and families can make important contributions.