Our public systems become effective when they are used by people, not when they are replacing them

Through my work in Propublic I have had the opportunity to talk with different citizens about their encounters with public service. They have had remarkably similar experiences although they were rather different from each other. One of them was an elderly lady who had been through a cancer treatment program, another was a middle-aged father with a mentally ill daughter and the third was a young woman who had been through a psychiatric rehabilitation program. All three of them had experienced meeting a professional who didn’t see them, didn’t listen, and never got hold of what was central to their story. But also, all three of them had had the opposite experience: meeting a professional who took the patient and their situation as a starting point to find the best understanding of the problem and in consequence the most qualified help to their particular challenges. Thus, they had in common the experience of what it means to be taken seriously by welfare professionals, who have competence and mandate to help and make a difference on behalf of our common welfare schemes.

Even though they also met three different sides of public service (the doctor in general practice and in hospital, the social worker in a municipal family department and a psychologist in the Region), they narrated in a similar fashion about being frustrated or relieved to be met by a checklist or by a professional (human being). The young woman told me how she felt treated like an immature child when, during a cognitive treatment program, she met a psychologist who could only look at her and talk to her through a very strict treatment concept. The picture the psychologist had of the woman never got beyond the patient conception she could read out of her predefined questions and phrases about strategies to obtain coping competence vis-à-vis the woman’s mental illness.  It never occurred to the psychologist that the woman tried to tell her something relevant about her illness and the way it influences her coping competence: “She was so closed that nothing I said to her could make a connection … It was like a chain armour I couldn’t penetrate”.

Similarly, the elderly woman told me that she felt degraded and not taken seriously in meeting with the professionals who brought her through the cancer treatment program. It wasn’t that she didn’t feel thankful to be living in a country where you get such quick and adequate attention as an ill person, rather it was an anxiety and a frustration over not being allowed to talk about how and when she experienced the symptoms that bothered her. The father of the mentally ill girl felt humiliated in meeting with the public sector because he never succeeded in getting through to the social worker with his description and understanding of his daughter’s challenges, and he described how it felt like a downright discredit/devaluation of him as a father and as a human being.

Sometimes humbleness is in shortage in the meeting with the public sector.

Fortunately, all three citizens are recovering today. Subsequently they met a psychiatrist, a doctor and a social worker who had a radically different approach and a competence to understand them. They met their stories with humbleness. Not because these three professionals were submissive, but because they understood the relevance of what the three citizens had to tell them to get an understanding of the problem as precise and correct as possible. But what is humbleness and is it really a value we should be requesting among our professionals? Basically, humbleness means an appreciation of the fact that one doesn’t know all the answer while acknowledging that the other part has something to bring to the table too. When it comes to welfare work precisely this is of essential importance: that the professionals drop the preconceived diagnosis, the preconceived understanding, and the preconceived approach, instead looking into the eyes of the citizens with an exploratory gaze. Sometimes humbleness is in shortage in the meeting with the public sector.

But does that mean that the three individuals I talked to are demanding, spoiled and self-overestimating citizens with no respect for the expert knowledge provided by the public sector? No. Not at all. The idea of the manipulating citizen (although they of course are out there and annoyingly so) must never be the starting point for the meeting with the public sector. It is important to stick to the rule that citizens are not to be morally judged, rather they should be met with an open mind. It shouldn’t be a matter of confirming the systems’ view of the citizens, but of asking questions and exploring while all the time challenging one’s professional knowledge about the citizen, so that concepts, knowledge, and guidelines are used for helping the citizen, instead of using the citizen for a confirmation of predefined concepts, knowledge, and guidelines. Put in another way: we must treat the citizen and not the professional’s idea of him or her. If the treatment of a citizen is going to have a successful outcome, then it is a prerequisite that the citizen is correctly described.

The three citizens I have been taking to all experienced progress and a strengthened recovery-competence after meeting a professional who saw them, listened and were able to make critical instead of mechanical use of knowledge, concepts, and mandatory guidelines.

I don’t believe a leader can issue a decree demanding an increased use of professional judgement

But as a leader of welfare professionals, what do you do when you want to create the framework that makes room for the citizens’ own stories and experiences in the professional judgement?

I don’t believe that a leader can issue a decree demanding an increased use of professional judgement. If there isn’t a culture and documentation practice for including the knowledge provided by the citizen, then it is of no use. In my experience an improvement of the knowledge collaboration between the professionals is a good place to start, among other things by checking and adjusting the documentation tools they are already using. It helps looking closely at data systems and routines for transferring knowledge to ensure that they are supportive and don’t cause the checklist-behaviour that is so incapacitating for the citizens. The documentation practice must never disturb the employees in focusing on the knowledge- and assessment-work necessary for the citizen to recover. Ultimately, it is exactly a strong and qualified knowledge collaboration that will ensure value for the citizen. In practice it all about learning from the knowledge already existing and from the knowledge provided by the citizen. Our public systems don’t get any efficacy until they are used by human beings, not when they are replacing them

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