From case management to client support


Standardisation and Compliance

Over the past few years, I’ve been increasingly concerned about how the work systems in many public service agencies hamper professionals’ ability to really focus on relationships with clients in need and helping them make positive changes in their lives.  New Public Management practices since the 80s introduced high levels of standardisation into public services, intended to increase efficiency, but the results have been very mixed, at best.  Systems focussed on compliance have stymied innovation and downgraded professional judgement.  Much worse, they have misunderstood what counts when delivering services to people, especially the vulnerable.  The Munro Review of Child Protection First Report provides a good analysis of the issues that can be applied more widely.

Services are continually under pressure and tend to manage by getting “cases” through and out of their system.  There are high levels of process standardisation built in, designed to guarantee quality of service, by measuring process as a proxy.  Assessment and review tools are highly prescriptive, aimed at ensuring minumum standards, but have actually forced professionals into a “paper-trail” mentality.  Rather than the tools being used as part of practice, they are often filled in retrospectively, because they “get in the way” of working sensitively with clients.

When you look at these processes and forms, they do, of course, contain very sensible prompts and questions for professionals.  So where’s the problem?

Human Relationships

The case management approach assumes “cases” can be understood, categorised, assessed and planned at given points in a “workflow”.  And that “types” of people need the same thing at the same point.  “Case management” doesn’t generally support a more human process where good relationships are nurtured and the skill of the professional helps develop shared understanding and shape useful plans at the right time, in partnership with clients, their families and other professionals known to the client.  Whilst joint working currently happens through a range multi-agency panel arrangements, or through co-location, the case management IT systems the professionals go back to do not reflect or support this collaboration.  Systems are not supporting human networks and relationships.

Confusing Picture

It’s amazing that when you look up a “case” on a case management IT system, it’s often so difficult to quickly get a sense of the client, who’s working with them and what’s happening for them.  You have to dig around and piece the story together.  These systems, and by extension sometimes the professional practice, is not client-centred.  Odd to say really, but true.

A key role for technology

It doesn’t have to be this way.  There are some encouraging signs.  The beginnings of a very significant shift, I hope.  These problems are beginning to be understood and accepted by local managers who are gradually getting some room to innovate and design for themselves.  The removal of some central government prescription is helping.

Technology is going to play a vital role in shifting the focus onto the client, the help – often delivered by a range of professionals – and whether it’s working.  New tools will be built using an approach to design which involves front line professionals, clients and their families every step of the way.  The powers of the web to connect people together will be harnessed.  Professionals working with the same client will be able to collaborate together – sharing, sense-making, planning.  And the client and their family will be involved in the network too, as appropriate.  Work will still be well-managed but tools will be client-centric and support day-to-day practice.  We will move from “case management” to “client support”.

Pie in the sky?  I don’t think so, but it might be a tough gig ..

Why not come and discuss this with me and others at Futuregov’s launch of Patchwork (one of the tools for the future) over a coffee, or maybe a beer?

http://patchworklaunch.eventbrite.com/

Paul

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