By David Robinson on Medium December 2017. Republished with permission.
When the director spoke about relating to patients she didn’t quite say “see a patient – run, hide, tell” but the police mantra for dealing with a terrorist attack would not have felt out of place.
I was only listening because I was up next at the conference, speaking about something completely different but I wondered what would happen if I used the word “love” or even “trust”, “respect” or “empathy”. When and how did fear so grip the providers of our public services that our capacity for compassion, the essence of humanity, could be routinely and mindlessly conflated with its brute, polar opposite?
We talk a lot these days about a duty of care but seldom of the beauty.
As a society we have become so afraid of abuse, and so confused by it, that we ask our nurses to look after our elders, our teachers to care for our children, our social workers to support our most troubled parents and then we tie their hands together when the natural reaction, the one that works, is to put an arm around. We should be relentlessly diligent in selecting, checking, training, supporting and managing staff for these positions. Then we should trust them.
Deep Value is a term that Community Links has used for many years to describe the value created when the human relationships between people delivering and people using public services are most effective. In these relationships, it is the practical service or the. transfer of knowledge that creates the conditions for progress, but it is the deeper qualities of the human bond that nourish confidence, inspire self-esteem, unlock potential, erode inequality and so have the power to transform.
The Community Links “Deep Value Literature Review” considered the evidence on the role of effective relationships in employment services, education, health and legal advice. It reached a lot of useful conclusions which I started to edit for this blog. In the end I decided that the full set was too important to be selectively filleted so I am going to cover them all in short form.
Revisiting this work, in which I was heavily engaged six years ago, I am still thunderstruck by the sheer weight of the evidence. We discovered for example, that “the relationship between the advisor and the client in employment services has consistently been found to be a key element (in) helping people into employment”, that “pupils who develop positive relationships with teachers go on to achieve better academic results”, and that “patients who experience a good relationship with their healthcare professional are more likely to engage in positive behaviour change”.
The conclusion was unequivocal “effective relationships are not just a ‘nice to have’ but increase the likelihood of achieving a positive outcome across all of the sectors examined in this review. Effective relationships are not an added extra but are core to the delivery of effective services. Increasing the effectiveness of relationships, therefore, is a lever for improving quality and performance.”
If meaningful relationships became the central operating principle at the heart of our public services the provider would be more effective and more efficient, the client would be better served and both parties would be happier with the outcome.
Here, in summary are the key findings from “Deep Value Literature Review” (Smerdon M. Bell K. Community Links 2011)
People using public services put great importance on the human relationship with the person providing the service.
The elements of what make for effective relationships are strikingly similar across all areas studied in this review. These are:
The effectiveness of relationships is therefore dependent on both parties taking responsibility. Delivering and securing good public services is something of a mutual endeavour and one in where the citizens’ relationship with the state is established. Using public services responsibly and effectively then can be seen as an act of good citizenship.
A critical issue bearing down on the relationship is the ability of a service provider to balance the role of supporter with the role to challenge, to ration public resources and even to issue sanctions. Evidence reveals that even where people do not get the outcome they want from services, if the relationship has been effective they are more likely to accept the result.
Where relationships are effective, they contribute to achieving a range of valuable benefits: the failure to realise these benefits can be damaging.
These outcomes are secured through a range of processes that work better when relationships are effective:
The damaging consequences of a failure to attend to building meaningful relationships go further than simply not achieving the benefits above.
Securing these benefits and avoiding these consequences are particularly urgent for vulnerable people with the most complex problems.
There was a clear consensus in the literature about the types of working conditions and practices which were more conducive to building effective relationships.
The conditions for establishing effective relationships are:
We conclude that the literature shows that effective relationships are not just a ‘nice to have’ but increase the likelihood of achieving a positive outcome across all of the sectors examined in this review.
This conclusion has some clear implications: