It’s important to people who use social care services to identify what personal outcomes and experiences they want to achieve from the support they receive, and so an outcomes-based thought process is also crucial for the modern practitioner.
However, when service users and practitioners work together to agree those outcomes and how to achieve them, it doesn’t always mean they come to fruition.
This can occur for a number of reasons, such as a change of mind or revised goal-setting, but on occasion it can also be due to unwanted practitioner interventions.
Social care practitioners consistently contribute to the achievement of a wonderful assortment of outcomes and experiences, but sometimes their input – whether intentionally or unintentionally – can cause those outcomes not to materialise.
I’ve come to refer to this as ‘outcome sabotage’, which can be grouped into five broad categories, and I’ll attempt to explore the causes of this term with examples:
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Communication
Communication errors, either within an organisation or between colleagues from partner agencies, can lead to desired goals not being achieved. This is usually unintentional and occurs when relevant information isn’t communicated effectively.
For example, a service user I support, Jim, was temporarily living in an alcohol detox service before a planned return to his tenancy. Positively, he had much input from multiple services. After discussion at a review, he agreed to be discharged and return to his flat on Wednesday, and he made preparations with family members.
The day arrived but at the last minute, he was told he couldn’t be discharged due to the necessary doctor not working on Wednesdays. He patiently waited an extra five days before returning home, but improved communication could have prevented this.
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Beliefs
Occasionally, a practitioner’s personal beliefs and value systems will conflict with their service user’s and can result in questionable professional decision-making.
For example, Mark visited his GP to discuss a build up of ear wax that was causing some discomfort. He was advised to use ear drops for two weeks to soften the wax in the hope it would eventually dislodge. He wasn’t keen to wait two weeks, so independently sourced a local private clinic who could remove the wax. They use a small suction device that takes only ten minutes and costs an affordable £50.
The practitioner, however, offered advice by saying they thought it was too expensive and there was no way they would personally pay that kind of price. As a result, Mark decided to cancel the appointment and use the ear drops for two weeks.
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Knowledge
Steve has a diagnosis of Korsakoffs syndrome due to chronic alcohol addiction since his early twenties. He hasn’t driven a car for over 30 years, but he requested support to upgrade his paper driving license to a photocard for identification purposes.
The practitioner said Steve couldn’t apply for a driving licence anymore, due to his alcohol related medical diagnosis. This information was incorrect and although he would have an obligation to inform the DVLA of such a diagnosis, it wouldn’t have automatically excluded him from applying or indeed driving a vehicle. This would be assessed on an individual basis.
In this instance, a lack of knowledge and an incorrect assumption led to the practitioner giving inaccurate information, which instantly ended Steve’s desired goal, before it had even started.
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Motivation
This is seldom talked about, but it’s not uncommon for more experienced staff members to take exception to being told what to do by less experienced colleagues.
This can have a demotivating influence and sometimes leads to an intentional decision not to fulfil tasks, when they have been delegated to practitioners by such colleagues. But this act of defiance can ultimately be of detriment to the service user.
For example, a practitioner asked a colleague of the same designation to support Sandra to attend her dental appointment at 4.30pm in the afternoon, the final appointment of a complicated treatment plan. Not only did the worker feel devalued by being told what to do by the relatively new co-worker, they also thought 4.30pm was too late in the day and may cause them to get stuck in traffic if it overran.
So they persuaded Sandra to call the dentist to rearrange the appointment for a time when the co-worker would have to accompany Sandra there themselves. Sandra complied, but needlessly endured dental anxiety for a further week as a result.
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Ease
Finally, sometimes practitioners deliver a form of care and support to people that might not be in keeping with recovery-focused principles. This type of sabotage is usually borne out of goodness, but can also be due to being too keen to get the job done and evidence to superiors what the worker has done during their shift.
This can cause service user dependency or run the risk of deskilling people.
For example, when a practitioner is tasked with supporting a person to maintain a tenancy and to live independently, promoting independence and as many self-management skills as possible should be at the forefront of a worker’s efforts.
A focus should be on involving a person in preparing and cooking a meal, supporting them to go shopping, utilising public transport to attend community appointments, encouraging them make phone calls, instead of doing these things on their behalf.
‘Honourable motives’
The word sabotage suggests a deliberate intention to destroy, damage or obstruct – and I acknowledge that the outcome sabotage I refer to tends to happen unintentionally, with honourable motives present in the practitioner’s endeavours.
Maybe you’re reading this and disagree with my thoughts about outcome sabotage, maybe you have personal examples either as a service user or a health and social care employee that you’d like to share, or maybe you think this isn’t even a thing.
Either way, feel free to comment below or contact me to continue this discussion.
Dan Mushens is a recovery practitioner for Scottish mental health charity Penumbra. He can be found on twitter @danielmushens
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Doctor Dan has what he sees as a prescription for remedying ‘Outcome Sabotage’, the malaise caused by the frequent divergence of aims between social care practitioners and service users.
Communication errors, as in the case he cites, are frequently the results of oversights by medical staff as well as social care workers. I think unfortunately it has become too often the norm for them to cite staff shortages in the NHS for many of the problems.
The Belief section highlights a three-way muddle between service care, service users and the NHS over a fairly minor ailment. Likewise the Knowledge section with a medical misunderstanding blocking a driving licence reapplication.
There is a grim comedy of errors highlighted in Motivation being undermined when staff members are told what to do by less experienced colleagues.
The last of the Five Deadly Sins is Ease, a case where social care practitioners by concern for service users actually coddle them rather than participating in the long-term goal of greater independence.
It’s all, I think, a case for an overall review of the failings in the care system so cogently highlighted by Dan.
Hi Dave, your response is appreciated. I hope I didn’t portray a depressing picture of social care, as I say, workers facilitate a wonderful assortment of interventions leading to good outcomes. I didn’t want to sound controversial or disrespectful, but rather raise awareness of my views and experiences of many years spanning many job roles. Cheers
The Belief section highlights a three-way muddle between service care, service users and the NHS over a fairly minor ailment. Likewise the Knowledge section with a medical misunderstanding blocking a driving licence reapplication.
There is a grim comedy of errors highlighted in Motivation being undermined when staff members are told what to do by less experienced colleagues.
The last of the Five Deadly Sins is Ease, a case where social care practitioners by concern for service users actually coddle them rather than participating in the long-term goal of greater independence.
It’s all, I think, a case for an overall review of the failings in the care system so cogently highlighted by Dan.
Doctor Dan has come up with a diagnosis . . .but what treatment does he suggest? The 5 distinct areas of malaise he has so carefully highlighted could all be applied to public sector professions such as teaching or police work. So why single out social care for a bashing here?
If the medicine is killing the patient as suggested above, then what are the solutions? Time to re-read Michael Lipsky perhaps? the use of discretion by public sector workers could indeed hold the key to achieving those outcomes which so often escape us.
Hi, I have no treatment plan I’m afraid, I simply wanted to highlight something based on my own personal views spanning a decade employed in various social care roles. I wasn’t aware of Lipsky’s work, I’ve just had a look and it seems interesting – thanks for the heads up!
My view is that social care generally creates dependency and the policies/processes and cultural approach all are geared to disempower the service users.
It is not an empowering experience for majority of service users/children/families and the workers values are imposed on them.
Hi there, I think historically your right in suggesting it did create a dependency. I’d like to think society has moved on from that thought process to that of enabling. I think advocacy services could play a bigger part in social care – maybe even make their inclusion and participation mandatory? Those who access services are after all usually experiencing disempowerment/ crisis/chaos/poverty or a deficit in ability in some sense. food for thought.
This happens non stop in MH where outcomes are expected to address the goals a MH Trust, often via NHS England, have set for ‘ recovery. With what were CMHTs being rebranded to ‘ recovery” teams. Combine that with a complete silo mentality and no choice of provider for the pt and you have the perfect storm.
Practitioners fail to accept time and time again that severe enduring MH conditions are a disability. The medical model is all powerful and the narrative is all about someone having a SMI NOT about someone identifying as being disabled. So the Care Act, is an anathema to many in MH.
God help you if you have physical disability as well. Very very few recovery teams have any or sufficient OTs to assess and because the medical model is in play the pt can never be the expert. So assessments are poor or needs are ignored because the practitioner doesn’t feel expert enough to assess and God forbid the pt is expert in themsrlves. If you ask MH services about physical disability in under 65s 10 to the dozen they will quote the NHSE goals on physical illness checks and reduction targets. Or something about the DDA ….
Professionals have a responsibility to assess well. If they don’t present ACTUAL needs to a funding panel then the disabled person de facto loses their statutory right of appea.l. Disability is managed and supported and the barriers acknowledged. That applies to MH disability . Acute illness may overlie, as it would in any other severe condition, but to ignore the disabled identity and be told to recover from it with goals set accordingly is to ignore the whole identity of someone.
Hi there, thanks for your considered response and taking the time to express your thoughts. It seems like you have experienced/witnessed some interesting experiences that have formed your views. By highlighting and discussing, lets hope that change can be effected.