A business model of care

I have recently been preoccupied with the fact that regardless of the issue at hand, business interests seem to be privileged above all else.  I am concerned about the implications of this in my own field, and have been thinking about the role metaphor plays in perpetuating this tendancy.  Allow me to explain:

We all use metaphors every day.  They enable us to succinctly draw links from one situation to another, transfer knowledge across contexts, communicate with others, and understand our world. They are crucial for communication.

Although metaphors are often thought to be merely linguistic practices, by reflecting on how war metaphors are evoked (such as ”front line’ work, ‘trouble shoot’ and ‘targets’, and of course the ‘war on terror’) it is evident that more is at play.  By noting the capacity of such expressions to provoke certain kinds of action and stifle others, it quickly becomes apparent that metaphors are more than descriptive.  They can serve to promote certain attitudes and actions (that might not otherwise even be tolerated) and silence others. In this way, metaphors do not only communicate norms, but they also to help establish them.

My current concern is the impact of business metaphors when it comes to social responsibility. A doctor friend recently told me about a disagreement she had with another doctor in which he justified a medical decision on the basis that, ‘after all, the hospital is a business.’

By gradually increasing our use of business and economic metaphors in this way and throughout all aspects of personal and professional life, we now seem to have reached a point in which the metaphor has transformed into a taken-for-granted bottom-line truth. Such metaphors/truths can render actions based on a business logic to be more intelligible, rational, and responsible than other potential actions, as was the case with the doctors, above. Thus, economic metaphors are currently serving much more than linguistic functions.

Consider the following expressions and the various aspects of life in which they surface:
• it’s an investment (in your relationship, in the future)
• that’s how we do business here
• it’s a means to an end
• not on my dime
• we need them to buy into it
• more bang for your buck
• I’m not sold on the idea

Although these ways of making sense of experience and justifying behaviour permeate aspects of life as diverse as environmentalism, love relationships, education, war, and democracy, my particular concern at present is what seems to have become a business model of care.

As a child and youth care researcher and practitioner, I can no longer deceive myself into believing the ‘helping professions’ are driven by altruistic intentions alone. It seems that (in Canada at least), social services have fully embraced a business model of care. That is, while other considerations do make their way into decision-making processes, the ‘bottom line’ is often economic when it comes to which decisions are determined to be the most viable, responsible, ‘accountable’, and thus, favourable.

I am most concerned with this overarching business metaphor that seems to guide helping practices.  By noting some of its implications for social responsibility, action, and change, perhaps space can be made for possibilities other than economically-driven ones to be recognized as viable alternatives.

In the caring professions,  evidence-based practice (EBP) has been touted as the most sure way to attain predictability and control, which are, of course, priorities within any ‘business’.  This shift to EBP has had profound effects on policies and practices. For example, addressing social work in particular, Thyer (2008) promotes EBP based on its ability to measure phenomena, evaluate efficacy, save time, attain grants and credibility, and contribute to professionalization. He asserts that by focusing on concrete, measurable aspects of their work, social workers can learn to “ask answerable questions” (p. 344) making success – and the evaluation of it – possible. Despite the fact that ‘quality of care’ does not appear on this list of assets, the reputation of EBP as the most credible approach to care continues to grow.

In the field of nursing, Walker (2003), on the other hand, critiques the assumption that EBP will result in ‘best’ practice. On the contrary, she is sceptical of movements that are based in a desire for certainty. She fears such an approach is more closely linked to economic rationalism due to limited resources than it is to a commitment to ‘best’ practice. Indeed, Walker fears EBP may limit patient choice, create biases that misrepresent evidence, oversimplify the complexities of care, wrongly interpret averages as norms, and compromise clinical freedom. She urges a commitment to developing alternatives in order to remain critical and informed, thus contributing to the provision of quality care.

Economic rationalism is currently one of the key considerations in human service design and implementation and bureaucratic organization (Foster and Wharf, 2007). However, Callahan and Swift (2007) note that this business model of services has sought “little input from its customers” (p. 158).  Moreover, interventions that are considered to be economically feasible are most often interventions that center the individual.  But when conditions are not taken into consideration, the social injustices at play can be obscured, such as the fact that the families most in need of support are not randomly dispersed. For instance, Aboriginal children, families, and communities face a wide variety of social challenges in Canada (which must be understood in context), and are more likely to be deemed ‘at risk’ than non-Aboriginal Canadians (Armitage and Murray, 2007). Thus, an individual-centred business model can give both practitioners and policy-makers tunnel vision when it comes to the broader forces at play.

It is our responsibility to widen this tunnel vision. And this is relevant on both an interpersonal and international level. Indeed, simply reading the international news with this as our lens can draw attention to the fact that the current state of affairs marginalizes some groups, who then experience perpetual and multiple struggles as a result first of certain social conditions and second of the global refusal to acknowledge those conditions. Violence, displacement, poverty, and further marginalization can then follow (see for example the battle for Congo’s mineral assets). Centring helping interventions only at the immediate and individual level does little to alter unjust conditions. By abandoning the overarching business metaphor for care, however, we can begin to widen our perspective and perhaps begin to see our own complicity in sustaining the hardships we then busy ourselves trying to remedy.

Economic metaphors encourage us to capitalize on unjust power dynamics for individual gain, rather than calling them into question. Once inequities are acknowledged, however, ‘intervening’ on an individual level without addressing those larger conditions feels irresponsible. Perhaps intentional use of metaphors that acknowledge human connectedness can move us beyond such power struggles in order to unearth some potential alternatives.  And there are seeds of such potential being sewn:

Recently I attended a day of training that was unlike most I have experienced. Gerry Oleman, a residential school survivor himself, brought together a group of human service practitioners to discuss the plight of Aboriginal communities in British Columbia, Canada. The group consisted of local social workers, police officers, teachers, nurses, and more. By bringing us together simply to hear his story and have conversations, we moved in an entirely different direction than likely would have been the case if the same group of professionals were problem-solving about a particular individual’s situation. Without said individual, we had nowhere to look but to ourselves, and the relationships among us and within our community. Our interconnectedness and the complexities of the issues under discussion were undeniable. Coming at them from an economic perspective would have made no sense at all. Talk of ‘measurable outcomes’, ‘productivity’, ‘accountability’, or ‘incentives’ would have been unintelligible in such a context. Instead, metaphors of webs, circles, and networks were called to mind as we each set to work imagining how change can occur. This brought about concrete possibilities for solutions to concrete problems, but they were significantly different because such metaphors did not allow us to position ourselves as ‘experts’ preparing to help others to change. Instead, we were discovering what we could do to be differently in our community.

Addressing social hardships with a business model of care simplifies the dynamics at play, locating the onus for change outside of ourselves as participants in these dynamics. On the other hand, contextualizing hardships and recognizing their complexities would profoundly shape the way we imagine and enact positive change – locally or globally – with each of us bearing some responsibility.

While we do indeed need to question the ways we understand and engage in economic activity, we mustn’t stop there. We also need to question the way we allow business models to influence the ways we conceive of and engage in other aspects of life as well.

References

Armitage, A., & Murray, E.  (2007). Thomas Gove: A commission of inquiry puts children first and proposes community governance and integration of services. In L. Forster & B. Wharf (Eds.), People, politics, and child welfare in British Columbia. Vancouver, BC: UBC Press.

Callahan, M., & Swift, K. (2007). Great expectations and unintended consequences: Risk assessment in child welfare in British Columbia. In L. Forster & B. Wharf (Eds.), People, politics, and child welfare in British Columbia. Vancouver, BC: UBC Press.

Foster, L. & Wharf, B.  (Eds.).  (2007).  People, politics, and child welfare in British Columbia. Vancouver, BC: UBC Press.

Thyer, B. (2008). The quest for Evidence-based practice?: We are all positivists! Research on Social Work Practice, 18(4), 339-345.

Walker, K. (2003). Why Evidence-based practice now?: A polemic. Nursing Inquiry, 10(3), 145-155.

Tagged as: CSR, evidence-based practice, social development, social responsibility, social work