Can our human services organisations genuinely personalise the supports they offer in a way that makes sense to the people they serve?
Will person centredness always be struggling in the spaces it makes in small cracks and corners of the system, always in peril of being abolished by the swipe of some bureaucratic pen?
The inimitable John O'Brien recently released a new paper: "The trouble with person centred planning". In it he explores the tension between "lifeworld rationality" and 'system rationality'.
Lifeworld rationality being those ways of thinking that lead to lives that make sense for individual people, whose subject matter is building and enjoying relationships, dialogue between subjective individuals aimed at mutual understanding and change, the everyday components that go to building good days and good lives and characterised by appreciation of individual gifts and contribution and a celebration of the person's unique identity.
'System rationality' being the ways of thinking encouraged by the driving forces of market and bureaucracy that coordinate, standardise, regulate the ways we work, aiming for efficiency, and characterised by indifference to individuals and uniformity in approach.
It's a tension that everyone who has tried to implement person centred change, in the life of an individual, the work of a whole service or the culture of a whole sector has experienced. Part of person centred work is to 'part the veil of indifference' that John describes, showing how a system's standard practises, policies, structures and assumptions are underestimating and limiting the people they support.
Sometimes I feel John sounds quite pessimistic in his article, he describes the society we live in as the most completely systematised in the history of humankind, with tendrils of the market and bureaucracy insinuating themselves into everyday life, commodifying and regulating every aspect of our existence. He says that the plight of those advocating and practicing person centred approaches is that they can never fully overcome "the colonising forces of system rationality" though he does celebrate the space that person centred approaches have managed to carve despite these forces and seeks ways to defend and extend these spaces where people can be present to each other and search together for the conditions that create a good life.
In response to this hint of pessimism I'd suggest that it is not just the personalisers and humanisers, the 'lifeworld rationalists' who face a 'plight':
The systematisers face an equal and opposite plight.
At the heart of the plight of the systematiser, is that their systems are made of human beings. Systems designed on paper are held together by our habits, reinforced by our assumptions. Human beings have powerful minds and hearts, they are able, (sometimes with the help of a few good questions) to think outside of the systems that contain them, to sense the changes that need to happen.
There's something about humanity in that it resists regulation, commodification and standardisation, especially when it is provided with the tools to do something different, allowing what Michael Smull calls 'positive discontent' to manifest itself as change.
The most ironic plight of the systematiser is that their systems usually don't work UNLESS human beings find other ways of acting and connecting with each other beyond those prescribed in the policy and procedure manuals.
It's clear that oftentimes this resistance to systematisation manifests itself very negatively, especially when it takes the form of 'cynical discontent'. The most regulated and systematised environments are the ones where the darkest abuse tends to occur. Locked doors, walls, protocols and procedures do not keep people safe. The human relationships that all those things are preventing are what keep people safe.
When people are given positive tools and approaches that help part that veil of indifference, even for a moment, it's surprising how easily and joyfully humanity can break through. I loved this little vignette from a hospital ward posted just yesterday on facebook by Jo Harvey:
"Last week I spent two days working at London Road Community Hospital in Derby on our personalisation programme. We are working to introduce one page profiles for patients and staff, more inclusive MDT meetings and working together for change. One of the simple but effective things we are introducing to improve the patient experience is to ask each patient each day what would make a good day for them. This week when we were reviewing how the start of the programme has gone, one ward sister shared a story of how a patient had said that it it would make a good day for him if he could see the staff dance. So they did! Lots of smiles on that day. Simple but effective!"This story reminded me of Emma Goldman's quote "If I can't dance to it, it's not my revolution".
Person centred thinking tools aim to find big and small ways to part the veil of system indifference - using a one page profile to seek to learn and list everything that people appreciate about a person, everything that really matters to that person is an attempt to do this.
Being willing to share your own one page profile with others creates opportunities to create relationships that are based on more than transactions, offering insights into what may be shared common interests and other ways of connecting.
Matching up people with staff with the right personality characteristics and shared common interests creates new ways of working and being. Linking people into their communities and finding ways with them that they can contribute to the community creates new opportunities for relationship. Creating organisational cultures that value intentional listening, listening to understand, and demonstrably value it when people act on that listening creates whole new possibilities for change.I love this photograph of a temple from Thailand; just as humanity, given the opportunity bursts through systematisation, this tree has somehow both destroyed and preserved the temple it has grown around. It's taken a dry, abstract and formal structure and turned it into a living, breathing entity, rooted in nature. I wonder whether we can change organisations and systems in the same way, by allowing humanity, and the power of human relationships to really take root, in those little cracks in the system we open up every time we use person centred approaches to appreciate and listen well to people?
