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Action Research: The Outcomes Star and Developing Novel Methodologies

What follows is the start of my action research project deconstructing of the Outcomes Star, a metric bureaucracy instated in various support-need junctures which the person receiving support has to fill in and go over with the person who is giving the support. This is one of various types of bureaucracy which people have to face (both citizen and worker). 

Scene from the film Metropolis
Scene from the film Metropolis

You can read the previous section of this project ‘Action Research: Outcomes and Measures Executive Summary and Recommendations’ by clicking HERE.

The previous section gives an overview of this whole research project along with the key recommendations which I make in view of my experience of the superstructure which I have to negotiate as well as the repeat paperworks which I have to engage in filling in should I want support in various matters.

I have written an ethnographic picture to add flavour to the academic way which I have approached the action research project which accompanies it.  This will hopefully add a sense of the turmoil and complexity which accompanies having to deal with and negotiate so many symbolic systems which dont recognise the intrinsic value people have as whole, sentient human beings.

 

When there is no box to tick, it cannot be ticked; and when there is only a different box to tick, that is often the one which gets ticked.

 

Ethnographic Picture

It makes life miserable when you have to figure out an arcane series of bureaucracies that allow you to tap into support services which you are regularly informed are available and ‘your right’ to access.  As someone who became ‘hard to reach’, I developed this action research project because I burned out in the face of the intractable nature of the bureaucratic systems which are all too often used to keep you chasing your tail with the tacit philosophy that if people choose no longer to engage then that is a problem sorted.

Action research and education has offered me the dignity of putting on record some of my encounters with 20th and 21st century Britain as nowhere in the systems of administration which administrate me is there any significant opportunity to articulate the severe logical and structural issues which recurr.  There is a lack of interest in the problems of the system being identified, and indeed, the more technologised that the systems become, the less the operators of the system can investigate or attend to these failures.

Some examples of system failures include how I chose to give up benefits because I was given the ultimatum to either take the psychiatric medications that had been prescribed to me or not receive the benefits. I chose to forego the benefits because the medication was shutting down my capacity to interact with the world and the long term prospects were permenantly incapacitating as well as terrifying (i.e. developing tardive dyskinesia; a drug induced form of Parkinson’s disease).

Another example is how I sat with senior support workers trying to find a phone number for the Department of Social Security to speak to someone with the agency to make a critical name change in my records; The DSS does not give phone access to the people who work in it, even to established support workers from third sector organisations tasked with helping people with issues.  Again and again the name change would not propagate through the techno-bureaucratic system and reverted back for some reason or another causing identity problems to endure.

The way that support is structured in this era is that responsibilities are devolved onto the third sector in terms of guidance through the system.  Third sector organisations are forced to tender for contracts engaging in a race to the bottom bidding ecology that often results in underfunded staff and initiatives which cannot meet the demand of the client base.

Funders and funding is increasingly being moved towards the Americanised model of ‘philanthropy’ culture where third sector organisations are pressed into providing endless metrics in view of cultures of key performance indicators and converting their community of practice to becoming ‘social enterprises’.  A backdrop to this is deregulation of large companies and a push for ‘small government’.

 

At the bottom, the people like me who need the support to get traction in a bureaucratised world become the metricised human beings who feed into the mill their life in the form that the funders dictate which qualify as representations.

 

What burns is when you have spent your time accounting and recounting your life to people on precarious wages and/or contracts to discover that they have to pass you onto another service as they can only work with you for a short period – otherwise their service gets penalised as not having ‘exited’ a person from the service which is equated to the service not performing well enough.  One picks up one’s hopes and moves on to the next service because it is a scenario that unless you have someone in an official position beside you speaking to the officials operating the governmental systems, your word is doubted (this is a polite way of putting it).

burning out

Over time, be it in psychiatric, homeless, criminal justice, banking systems, DSS or other government departments, you become wounded by the doubt inherent in the system; the attrition caused by ‘lost data’ or processes which have gone wrong, the implicit stance of some hardened workers who are pissed off with the world and see you as chancing or scamming, the confusing nature of the various forms which are never presented in a scheme showing the relationships or arrays of protocols which you have to marry into, the lonely hours waiting in lines on phonecalls or in offices to be told you have to go somewhere else, being surrounded with a sea of other people who are similarly dis-spirited as you are; the attrition eats you up, it has no other fuel to use than the humanity which keeps you sane.

Depression, anxiety and thought disorder develops from the mixing of cynicism you pick up from the departmental hard nuts (who are known to their colleagues as such) and the number of times that you have tried to get another human being to understand that you are trying really hard not to drown; that the world is crushing you bit by bit and you dont know what to do, that you dont have the money to both get on the bus and eat properly for that evening, and that people talk down to you like you are ignorant and/or stupid because you are living the way you do…

Hearing the accounts of one’s own life again and again and again creates a series of re-traumatisations to the things which have put you in the worst spots of your life.  It feels worse and worse as you are encouraged to perform a sort of instrumentalising ritual on the remnants of what hopes and dreams which turned to pain – for example being shunned by family, losing a child you had imagined would be a part of the rest of your life, finding yourself ostricised by a religious community, prostrating yourself for workplaces which are churning through people as fast as KPI’s, hunger which makes your head light and your eyes stare.

The cortisol and adrenaline start to spike and flicker as you lose your footing in social circles you thought stable – because you cant buy a pint, because you cant get on a bus or go on a shared holiday or go to the pictures – it becomes painful and awkward to leave the house, to see the people you thought you were a part of.

Every person you dont know appears to you like someone who thinks badly of you.  People you used to call friends you avoid because you dont like the embarrasment they feel because they can afford to get a chinese meal and you cannot; parties you avoid because you cant stand the next self-righteous declaration of what you should do from someone who ‘cares about you’ but has no idea what it is like to have a pound to last for three days.

Not leaving the house is a survival tactic that saves money and lying face down on a bed for three days seems like a strange mystical state of stillness which can match the hunger that does not abate.  You dont leave the house, you dont eat, this all saves money; you dont see people for a coffee, you dont talk about your life, this all saves face.  Slowly communication skills atrophy along with confidence and a sense of being in the world.  Time plays tricks particularly when alcohol – cheap, nasty, sulfite filled alcohol – becomes a means of passing time and dulling the reality.  It is a world permeated by doubt, and the depiction on the television becomes toxic as it is only your own self which you can see in the cage.

All this circles round in a kind of media induced solipcism in which you are fixed as the source of all the doubt; a miserable creature forelorn of rest, too exhausted to sleep.  Past lives pulse through your thoughts and the worst spectre comes at the lowest ebbs – the thought too awful to say out loud; the big sleep may be more tolerable than being so alone and such a burden.  The mind turns on itself; if I feel this heavy, if these limbs are so hard to move, if even the simplicity of a common garden smile is so immense and beyond my gravity; what must I feel like to others – the others you have been too ashamed to reach out to because Benefits Street has already claimed to tell your story.

All this you have to keep under a lid. Internalise.  Eat it down with the budget food you can buy from pound stores which has higher sugar and less nutrient content – it is Ersatz; it is what society tells you about your life.  You have to keep treading the mill and answering the questions, but all the questions are focused on you on the forms.  There is no space on the forms for how many times you have been stiffed this month by badly aligned or misaligned processes; how many times you have been kicked off the breadline and have to re-apply; how many times you have run out of a building having a panic attack.

Slowly and surely health starts to fail through little erosions to the sea wall defenses like inadequate footwear and materials to do ablutions such as shave.  This further impacts how people attend to you – or dont as the case may be; having a haircut and looking the part is a significant element of societal integration – a part no more or less complicated than the sociological habitus of monkeys.  If you dont look the part, you are not a part of the gang.  This goes for all sorts of fashion and clothing declaratives. The brands you wear are signifiers to others as to whether you are enough of a likeness; the further down the scale the more you get pushed to the peripheries of the outgroup.

Triage

To the medics and dentists, like in the rest of societal structures, you are placed in the triage system.  The term comes from the French word ‘trier’, meaning to separate, sift and select.  It was developed during war by doctors who were treating those wounded on the battlefield.  The damaged were put into three categories:

Those who are likely to live, regardless of what care they receive; Those who are unlikely to live, regardless of what care they receive; Those for whom immediate care might make a positive difference in outcome. This perception determined what resources were and are allocated to helping those who need help, in what order, in which priority – this perception determines where you end up.

Introduce a system of performance related payments with outcomes and measurements to a culture of triage and catastrophes start to be committed by the people employed to avoid them.  Our society uses triage in all its institutions because our culture is structured by its colonial and military past.  Our schools, our economic systems, our hospitals, our doctors surgeries, our social work system, our prisons and civil service, all have this means of acting in hierarchies towards aims.

 

Contained in triage are certain self reinforcing realities which attend to the biases which are held by people in positions of privilege; those people who are used to being listened to…

 

If you shout too much you are obviously healthy enough to complain so dont need help; if you dont shout enough you are already to heavily damaged so unlikely to be a survivor and therefore a waste of resources; you need to shout just enough and in the right ways to fit the esoteric sweet spot – the kind of overton window for action and support which will lead to the outcome which lives up to the desires of the acting medic.  Once in the bottom section of triage things get really desperate because you are viewed as costing resources and unlikely to succeed; these intersectional poverties reinforce each other.

Under pressure doctors and dentists move support away from you to ensure they hit targets set for them that will bring next years funding so that they may save some people from the mire (at least they perceive it this way).  The worst is when they actually hate you, despise you for not looking after your teeth or health and poar scorn on giving you any treatment at all because they perceive that you are just disrespecting their efforts and stealing their power of life and death from other more deserving folks.  Not just the medics, but the administrators around the medics carry these behaviours on in their obedience to authority (as Stanley Milgram put it) and their perceiving that they are protecting the sacred institution.

Being in a triage system sets the scene for being caught in a war.  If we think about it this way, traditional national security concerns were focused on war and terrorism however in 2010 national security policy was expanded to include not just military intelligence and foreign affairs matters but also any area of social, political and economic life could give rise to security threats.

 

If we take this as a model of thinking, and in that thinking trade disruption is equated to war and terrorism on a national level, then can we not understand the effects of austerity policy, tax cuts for the rich and corporate capitalism as a war on the poor ?

 

The Select Committee on Financial Exclusion in their Report of Session 2016–17 (HL Paper 132) called ‘Tackling financial exclusion: A country that works for everyone ?’ spoke about the “The ‘poverty premium’, whereby the poor pay more, which serves to exacerbate the effects of financial exclusion, reinforcing a vicious circle”…

 

Click to Download: 'Tackling Financial Exclusion: A Country that works for everyone? by the Select Committee on Financial Exclusion'
Click to Download: ‘Tackling Financial Exclusion: A Country that works for everyone? by the Select Committee on Financial Exclusion’

 

On page 16 of the report they discuss how “One of the main relationships between poverty and financial exclusion comes in the form of the poverty premium, which is the additional cost incurred by people carrying out their various transactions when compared to people who have full access to financial services. Pay-as-you-go mobile phone contracts, utility payments, high cost credit and insurance are some of the main areas of life where additional costs can be incurred.

 

Disability Rights UK explained the poverty premium as follows: ‘If you are poor, you are paying more for things, because you lack the consumer leverage. For example, if you can make a quick cash outlay you can buy things in bulk; if you are poor you cannot afford to buy things in bulk.’

 

In a similar vein, the Money and Mental Health Policy Institute told us that individuals with variable levels of income may choose to pay for their energy bills via a pre-pay meter, which comes with an additional cost that will contribute to the poverty premium. It was also noted that people can suffer the poverty premium when they lack the ability to buy products online – where the best deals are often to be found – or are unable to subscribe to direct debit payments.

The costs associated with the poverty premium are significant, running into thousands of pounds. A number of evidence submissions estimated that the premium could amount to approximately £1,300 a year per person, a figure first cited in a 2010 report by Save the Children.”

I feel like I am caught in a war in which I am having to defend my every breath taken. One where I am living at the bottom of an exponential curve in caste system Britain where membership to class is simply defined by the amount of cash you have in your bank account – the bigger the amount, the more you get discounts because the more people want to be your friends.

 

Exponential function

 

Why have I written this ?  Because it is important to voice some of the feeling details that are omitted from all the paperworks and bureaucracies which represent me – the straw man who stands in front of me and so many other people.  I cannot go and till the commons any more; I cannot live from the hedgerows and migrate with the seasons.  My life is bound to the cities, policies and practices of institutions, rentiers and private companies.

The poverties – the artificial scarcities in the face of tax cuts – which have been imposed on the social terrain I survive in are substantial.  I want to give time to reveal their substance through this kind of writing that brings together my experience with peer reviewed sources and official documents.  Every time I have to fill out another damn metric for some poor sod who is working on the front lines patching me up or the likes of me, keeping us from drowning, I think about the culture which has created all this in the fifth richest economy in the world.

Austerity is the modern day Robber Barons dressed up as statescraft and legislative representation of people who dont have choices or opportunities. Professor Lawrence King at Cambridge University has been involved in analysing how many deaths in the population are associated with the cuts to services and austerity since 2010.

 

BMJ Open death tolls
Click to Download: British Medical Journal ‘Effects of health and social care spending constraints on mortality in England: a time trend analysis’

 

The paper published in the British Medical Journal is called ‘Effects of health and social care spending constraints on mortality in England: a time trend analysis’ and reports that since 2010 almost 120,000 excess deaths have occurred in England.  The worst affected are in the age group of 60 + but different reports suggest that there are also considerable rises in deaths found in ESA claimant groups.

 

Prof King is quoted as having stated: “Austerity does not promote growth or reduce deficits – it is bad economics. It is also a public health disaster. It is not an exaggeration to call it economic murder.”

 

The United Nations has appointed a special rapporteur to investigate extreme poverty in the United Kingdom.   Professor Philip G. Alston is an Australian international law scholar and human rights practitioner appointed to this role. You can see him talk through his report on extreme poverty in the UK, austerity, universal basic income, child poverty and other things in the video below:

 

 

You can read his statement by clicking HERE

 

This is what courses through the depression that chokes me when I have to fill out more paperwork; my heart beats in my throat, my ears ring, anxiety makes me feel nausea and my capacity to manage things goes through the floor because nobody will ever read most of it.  Most of it has no intrinsic value and represents fragmented and partial realities of my life world; most of it is about creating a culture of competition in the third sector in my opinion, and some of it is about generating niche incomes for a few wily middle managers.

 

 


 

Part 3: The Outcomes Star and Developing Novel Methodologies

This document has been written to develop a novel outcomes methodology which extends its application to the services and systems within which the service users and the frontline workers operate. The methodologies of Action Research, Participatory Action Research are brought together with those of Institutional Ethnography and pedagogies which utilise existential phenomenology. A range of thinkers and subject areas are drawn on to flesh out the issues and contextualize problems which emerge in the study.

This includes a discussion on a necessitated accompanying body of narrative research to bring concrete meaning to the bureaucratic support process avoiding risk of benality and creating paperwork which holds no intrinsic value that can be fed forward. In practical terms this is imperative to client users, in academic terms it is vital for continuing learning in the field; and in service provider terms it forms the critical foundation of material for dealing with structural problems and future training.

The outcome and the output should be synonymous, and a tangible asset which holds intrinsic and redeemable value. The ability to feed forward through documentary processes is a vital part of a resilient, sustainable society as opposed to one which produces paperworks which – after the fact – tell very little of use about what was learned in the complex co-produced living action which is the juncture of a support service and individual’s lifeworld.

The work should be inherently multi-functional operating to constantly add value to each stakeholders lot. This paper questions the practicality of using scales, metrics, and reductive positivism to judge progress and allocate funding, support or resources. The creation of a scale, and a key to the scale, is of itself specific and a significant amount of work which has little (if any) transferable value.

Standardizing is a questionable tactic as there is a lack of opportunity in the bureaucracy, and this theme will be returned to again and again in the document. The practiced reality of the Outcomes Star bureaucracies seems dissonant with the guiding concepts and values cited in its make up as only one part of the client-service ecology was drawn upon to inform the bureaucracy and not the other.

Outcomes star image
Outcomes star

The development of the first version of the Outcomes Star was for the homeless and the subjects/co-researchers were primarily the frontline workers and managers of services.

As the approach has been developed, increasing emphasis has been placed on the experience of service users. Joy MacKeith, Sara Burns and Kate Graham developed the Outcomes Star in a four year iterative process of consultation, development and testing at St Mungos.

St Mungos is a London based homelessness organisation who commissioned an outcome measurement system to work across all of their services from outreach to hostel provision and floating support. The prototype was piloted, tested and modified across St Mungos, Thames Reach, Single Homeless Project, and the Passage. The learning was then drawn together before being published by the London Housing Foundation in 2006.

The Outcome Star was then applied to a number of sectors. The Mental Health Recovery Star was developed in collaboration with the Mental Health Providers Forum, then the Teen Star was developed and Work Star with Camden Council.

The Teen Star required a much shorter simpler tool to hold the attentions of the teenagers and as a result, the quiz format was developed. The development of the Older Persons Star incorporated an adaptation as achieving independence is perceived as less realistic a goal for groups who’s dependence is likely to increase over time [1]. This statement seems to carry with it a number of presuppositions.

Eleven versions of Outcomes Stars have been published including Homelessness Outcomes, Work star, and the Older Persons Star. In common practice, the ‘Compulsory Supporting People Outcomes’ form is completed by service providers when a service user leaves their service and has been compulsory for all services receiving supporting people funding in the UK. This is the most used outcomes measure in the homelessness sector before the Outcomes Star.

The Outcomes Stars have been developed as tools aimed to simultaneously measure and support change when working with vulnerable people. Central to their development, the authors situate the principles of Action Research and Participatory Action Research as methods of practice.

One of the design purposes is to integrate the elements of Action Research into assessment and outcome measurement. This approach was formulated to deepen the awareness of service providers, commissioners, policy makers and regulatory bodies in their quest to find “practical approaches to ‘quality assurance’ of evidence based and evidence generating practice” [1].

As a bureaucratic tool the Outcomes Star gets service users and workers to discuss all the areas of the service users life which are represented on a star. Service users agree as to where they are on the scales, and the process is repeated over time to monitor personal progress with the ideal that this exercise facilitates improvements.

 

Joy MacKeith, one of the authors of the Outcomes Star suggests that to understand the Outcomes Star, it is helpful to understand the principles of Action Research and Participatory Action Research [1] as documented by O’Brien [4], and Carr and Kempis [5]. O’Brien uses the following as the definition:

“Action research…aims to contribute both to the practical concerns of people in an immediate problematic situation and to further the goals of social science simultaneously. Thus, there is a dual commitment in Action Research to study a system and concurrently to collaborate with members of the system in changing it in what is together regarded as a desirable direction. Accomplishing this twin goal requires the active collaboration of researcher and client, and thus it stresses the importance of co-learning as a primary aspect of the research process” [4].

 

Action Research is distinct from other types of research methodology. Primary is its focus on turning the people involved into researchers; the research is situated in real world settings with the aim to solve distinct problems and the instigating researcher does not attempt to ‘extract themselves’ from the situation with objectivity but takes a declared stance as their motive in the research process [4]. For example, a support worker proactively realises their interest in helping a service user achieve a civic autonomy from support, and acknowledges this as their influence.

Becoming Critical Education, Knowledge and Action Research

In their book, ‘Becoming Critical: Education, Knowledge and Action Research’, Wilfred Carr and Stephen Kemmis describe Action Research as critical educational science. Their formulation “rejects positivist notions of rationality, objectivity and truth in favour of a dialectical view of rationality”. The process of Action Research employs the interpretive categories people use as the basis for language frameworks which people explore and
develop in their own theorizing [5].

Action Research provides a means by which distorted self-understandings may be overcome through analyzing the way one’s own practices and understandings are shaped by broader ideological conditions. Linking reflection to action provides a way of becoming aware of how aspects of social order which prevent rational change may be overcome. As the outcome, self-critical communities of Action Researchers enact a form of social organization in which truth is determined by the way it relates to practice [5].

 

  • MacKeith suggests the three core principles of Participatory Action Research as [1]:

    • Empowerment

    • Collaboration

    • Integration

 

In this paper I will be commencing with an examination of these principles and others which she has used to structure the theory and model of the Outcomes Star methodology and tools. The scope of this work will embrace the core ideas cited in the development of the Outcomes Star bureaucracies, interpret them, apply the ideas to the Outcomes Star and broader, administrative bureaucracies, and critically evaluate some of the issues raised to contribute to widening the discourse on how society approaches development.

The perspective taken in Action Research is that of a horizontal researcher/co-researcher relationship which is in contrast to traditional conservative approaches in which solutions are devised by ‘experts’, and where those being studied are seen as ‘subjects’ rather than active participants. In the Outcomes Star context, there is a suggestion that in order for change to take place in people’s lives, service providers must find ways to engage the motivation, understanding, beliefs and skills of the person in the situated context to enable the desired change.

When there are stratifications and compartmentalisations caused through the very instruments which govern the societal structures, it is important that methodologies such as Action Research are developed as tools for getting at the ommitted social science realties, and that as techniques they remain uncompromised in practice. There is scope to bringing scrutiny to bureaucracies based on the premises upon which they themselves were created.

Collaboration on the questioning of the Outcomes Star bureaucracies and others is suggested in its very make up, and provides a reflective opportunity to audit the administration of the lifeworld. The use of the term ‘lifeworld’ draws on Jurgen Habermas’ discussion of competencies, practices and attitudes representable in terms of cognitive horizon and includes the lived realm of the informal, culturally grounded understandings and mutual accommodations [94].

The assessment process is meant to emerge through a dialogue between ‘expert’ and ‘lay person’, ‘service user’ and ‘worker’, principal and agent, which informs the perception of both parties while challenging the identity distinctions. The practice of Outcomes Star bureaucracy is meant as a model of change that the worker uses to measure the process for outcomes. ‘Data’ is collected and is presented back to the user in the form of a geometric star to systematize and visualise the information. Each point of the star holds a theme in the life of the user which is illustrated with a scale on the spine of each point of the star ranging from 0 to 10.

The intention seems to be that this way of expressing outcomes scales implicates holistic thinking and acts as a meaningful symbol rooted in the measurement practice. The service providers must value the client as ‘co-researcher’ and appreciate their rendering of the reality as chief compass to navigate a landscape which is only notionally charted i.e. comparing reality understood in terms of the textuality learned from the support workers education, policy and training versus the idiosyncratic and anathemistic lifeworld experienced by the ‘service user’ in their unique set of circumstances.

The importance of this concorded approach is discussed later when examining the value of an existential phenomenological approach to research and practice. Besides from being standardized into uniform ‘flat-pack’ documentation, it seems to omit the possibility of engaging the client in a socio-cultural investigation of their own circumstances which would otherwise hold considerable benefits for the client, along with service providers in the support superstructure all the way up to commissioners.

Looking outside of the box

As it stands, it neglects valuations of extrinsic circumstance; i.e. evaluation of the clients’ experience of and reflections on the Care Commission. The homogenized bureaucracies which often administrate life saving supports and benefits are often catastrophic in their effect on both service providers and those seeking help from the service providers.

The Outcomes Star approach is one of the attempts at frameworks which help clients think through their life problems and pragmatically reach for solution strategies, integrating bureaucracies into the life of the individual.

This is suggested to give an overview and encourage reflection on action and it’s implications. The practical reality of the paperwork from the author’s experience (Alex Dunedin) is that it is a crystallized, standardized bureaucracy which is iterative and repetitive, dulling the organic interaction needed between the client and worker. As mentioned, the Outcomes Star approach suggests itself to utilise Participatory Action Research to form a list of subject areas which are mapped on a geometric shape (i.e. a star), which can be used as a tool to visualise growth, change and development over time.

Participation involves agency in a co-productive scenario. Agency builds the confidence and self esteem which is vital for productive self awareness as a foundation to change and growth in the service user. The Outcomes Star proposes that the idea of assessment could become a part of ‘treatment’ rather than a separate, uninvested parallel process. If we view participation as production and conceive of it in this scheme, participation could viably form a substance of assessment from which outcomes can be extrapolated.

The realities of the existing Outcomes Star bureaucracies show that the Participatory Action Research is done outside of the client specific context and manifests as a standardized bureaucracy. The Outcomes Stars also seem to have been created as a co-construction between the commissioned researchers and the frontline workers, rather than as a synthesis amongst the client, the frontline worker, and the commissioners.

For the record, it is the opinion of the author that encouragement for reflection and growth generally must come from engaged dialogue reinforced with unique artefacts such as objects, mementos and products which manifest through the interaction. For example, a narrative (such as this paper) which is owned, reified and discussed serves as a catalyst and scaffolding to reflection and growth. Participating in the model of change (i.e. Co-production through Participatory Action Research from each covalent perspective) and reflecting on the data produced (i.e. the Outcomes Star and narrative research etc) in theory prompts constructive change.

W. E Deming discusses the importance of considering the system when evaluating the performance of the individual within a system. Deming has called for the transformation to a new style of management through greater cooperation. Transformation can be achieved by introducing “profound knowledge” into the system.

According to the discussion of the Outcomes Star and Participatory Action Research, the dialogue issues forth a ‘journey of change’ in both directions informing the empowered structures by relating ‘power’ to the service user – should it be articulated or picked up on in the right way. In addition to the service providers perspective on the formation of the topics on the Outcomes Star there should also be an open assessment of the services and systems in which the user subsists. Without this the Outcomes Star seems nakedly uninformed as to major influences and factors as the systems dictate many terms of existence for the user.

 

He describes Profound Knowledge as comprising of four interrelated concepts: “(1) appreciation for a system; (2) knowledge about variation; (3) theory of knowledge; and (4) psychology” [62]

 

Demming Profound Knowledge

 

An evolution of the Outcomes Star is proposed which details the systematic and structural problems encountered from both client and worker.  The mode of working potentially opens a new paradigm for citizen auditing, where services and systems become engaged in a learned manner and accountability is explored in shareddialogues. The use of such a framework or modality would be a valuable tool for identifying issues of social justice as well as providing information for systems analysis on a large scale, which leads towards increasingly efficient means.

In use of the Outcomes Star, the service user is led to a discussion of next steps and action planning – and the reflex of it proposes an interesting societal dialogue; one in which the systems must respond to the expertise and acumen of the service users voice and experience, as well as to that of the frontline worker. The priorities and recommendations found in the Christie report underpin this perspective [39]:

 

Click to Download: 'The Christie Report: Commision on the Future Delivery of Public Services'
Click to Download: ‘The Christie Report: Commision on the Future Delivery of Public Services’

 

Recognising that effective services must be designed with and for people and communities – not delivered ‘top down’ for administrative convenience. Working closely with individuals and communities to understand their needs, maximise talents and resources, support self reliance, and build resilience.

Prioritising preventative measures to reduce demand and lessen inequalities Identifying and targeting the underlying causes of inter-generational deprivation and low aspiration. Making provision in the proposed Community Empowerment and Renewal Bill to embed community participation in the design and delivery of services [39]

However there are possibly antithetical priorities and recommendations in the very same report which arise from dissonant values of ‘high quality service provision’ and ‘driving down costs’: Tightening oversight and accountability of public services, introducing consistent data-gathering and performance comparators, to improve services Driving continuing reform across all public services based on outcomes, improved performance and cost reduction [39]

Michael Fullan suggests that the reason we need ‘learning organisations’ is because change in complex systems is nonlinear and full of surprises. We need new mindsets to help us ‘manage the unknowable’ of which life is partly composed [40]. Regards the Outcome Star usage; a manager of a service for vulnerable families said:

“Because the needs of the parents can be so immediate and pressing when we meet with people we can get sucked into that and not step back and look at the needs of the family as a whole. We find the star very useful in making sure there are not needs that are just getting lost. Also, support can happen in quite a haphazard way. The star makes it more systematic and structured, identifying needs and drawing up an action plan.” [1]

In this testimony it is clear that a list of areas for consideration is helpful to inform a structured protocol of investigating needs associated with a service user. Lists are well known for their organisational utility, however it remains a heuristic device and something which one might question as a therapeutic tool.

Can we regard the repetition and familiarity as aids to the user ? With regards to rote repetition it is wise to guard against the mundane and forcing what should be a dynamic experience into monotonous shapes. We should also be wary of anchoring what should be a progressive experience to what is ostensibly a static instrument on its own. The work of Martin Seligman is worth noting here, as the person who coined and gave explanatory power to the term ‘learned helplessness’ [95]. Do we ‘learn helplessness’ from rote and mechanical behaviours and encounters ?

 

Repetition, repetition, repetition….

 

In this paper I will be exploring these questions through a perspective of enacting the creative process of developing an outcomes system by following key axioms of the Outcomes Star generation protocols. Reconceptualisation of the outcomes paradigm seems an essential part of the Action Research methodology as well as systems development such as is found in British Standards Institute ISO 9001 Quality Management. Implicit in this perspective is that there are improvements which can be made but not forecast, and that the current paradigm of bureaucratic metrics falls short of it’s ideals.

 

References:

[1] MacKeith, Joy (2011) “The development of the Outcomes Star: a participatory approach to assessment and outcome measurement”, Housing, Care and Support, Vol. 14 Iss: 3, pp.98 – 106

[4] O’Brien, R. (2001). “An overview of the methodological approach of Action Research.”. In Roberto Richardson (Ed.), Theory and Practice of Action Research. João Pessoa, Brazil: Universidade Federal da Paraíba. (English version) Accessed online on Feb. 2, 2007 from http://www.web.ca/~robrien/papers/arfinal.html

[5] Carr, W. and Kemmis, S., Becoming Critical: Education, Knowledge and Action Research, Falmer Press, Brighton, (Reprinted 1988, 1989, 1990, 1991, 1994, 1996, 1998), 249 pp.

[39] The Christie Report: Commission on the Delivery of Public Services © Crown copyright 2011, ISBN: 978-1-78045-214-2, Published June 2011, Produced by APS Group Scotland: Accessed online on Feb 2. 2007: https://www.gov.scot/binaries/content/documents/govscot/publications/publication/2011/06/commission-future-delivery-public-services/documents/0118638-pdf/0118638-pdf/govscot%3Adocument?forceDownload=true

[40] Michael Fullan, Change Forces: Probing the Depths of Educational Reform; ISBN-10: 1850008264; page VII

[62] Deming’s System of Profound Knowledge: An Overview for International Educators / Thomas J. Evans, Accessed Online 11.09.2014: http://eric.ed.gov/?id=ED401635

[94] Jurgen Habermas (Author), Thomas McCarthy (Translator), The Theory of Communicative Action, Volume 2, ‘Lifeworld and System; A Critique of Functionalist Reason’, Beacon Press

[95] Peterson, C., Maier, S., and Seligman, M.E.P. (1993). Learned Helplessness: A Theory for the Age of Personal Control. New York: Oxford.

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