The bottom and the top in health and education

The view from the top is different from the view at the bottom. As with binocular vision it can be helpful to have access to both. Unfortunately this often doesn’t happen.

In my research on health service entry I found that people referring in, people seeking services and people working at reception tended to share perceptions of what happens at the entry to services and what the issues and opportunities are. Their views are quite different from those of the senior managers.

Executive staff are trying to address KPIs that include, if not focus on, economic and political imperatives. People referring in, people seekng service and reception staff are trying to facilitate entry, access to and engagement in services. Immediately we see the goals at the bottom amd top of the organisation diverge.

As with vision, this divergence can be powerfully informative, if you use both eyes. Executives however have an understandable tendency to privilege their own view and not actually be familiar with the views of those at the service interface.

In my research on access to primary health services the view at the bottom was concerned about the vulnerability of people when they were looking for services. They noted how impersonal and unresponsive systems could lock people out whereas personable and welcoming systems helped people engage.

Executive staff by contrast were concerned with system efficiency and consistency. They preferred systems that were automated, treated everyone the same and prioritised entry according to category of service required. In my view they mistakenly conflated consistency with quality.

The most resourced and least vulnerable people are the most likely to be able to negotiate impersonal mechanistic systems. The most needy are the least likely. Executives could learn a lot from their front of house staff.

Interestingly I am now observing a similar phenomenon in tertiary education. Restructures arising from the perceptions at executive level that are not informed by engagement with staff who interface with students, nor with the student experience itself.

At the School office level and in academic-student relationships
personal and flexible responses are obvious imperatives for engagement and retention especially for vulnerable students.

At executive level, centralising and mechanising responses to student enquires in the pursuit of efficiency and consistency are privileged inadvertently breaking down the very relationships – school office and academic- that bind and support students to their provider through identification and belonging at the school level.
This is particularly ironic given tertiary institutions are well endowed with researchers who are producing the evidence that can tell them this.

This entry was posted in Uncategorized. Bookmark the permalink.