Organizing from an institution-centred perspective or client-centred perspective

2 Aug

How do organizing principles affect how citizens experience government trust or distrust? And what are the implications for citizen trust or distrust? In this blog we compare an institution-centred approach with a client-centred approach. Based on research we did for a government appointed committee into residential youth care[1], we found that there was widespread agreement and support for a child-centred approach to governance, while we could still see an institution-centred approach as the dominant actual practice.

This is the fourth blog in a series. The first can be read here.

In the child-centred approach, the focus is firmly on the  child’s, or family’s needs and logics, while in the institution-centred approach it is on the institution’s needs and logic. This leads to different dominant coping strategies for frontline professionals: either moving towards clients in the child-centred approach, or away from clients. Interestingly, leaders in these organizations stressed that they also felt psychological stress and showed coping strategies as a result. In the child-centred approach a governance mechanism of professionalism, trusting the professional and their professional expertise and ensuring that they are supported, is central; while in the institutions centred approach managerialism is dominant, with a focus on rules and procedures. Here we find “spreadsheet management”, the manager shows no interest in what happens with the staff or the children, but only tracks indicators on their dashboard. And some of the managers and directors we interviewed started talking literally in terms of the PDCA – plan do check act – cycle and other managerialist jargon. That was their protection mechanism, and only over time as they relaxed did they share their concerns and worries.

What is the link of this to citizen trust and distrust?

In the child-centred approach, professionals and their leaders show trust in citizens and dare to make themselves vulnerable and engage in meaningful relationships with their clients. This will most likely be experienced as such and lead to citizen trust in government. Both from the clients, but also from the  professionals who experience that the system trusts their professional competences. And they will tell their social networks of their experiences, spreading the trust.

In contrast, the institution-centred approach where citizens experience the interactions with the organisation as disengaged and often feel as if they are disrespected, is likely to be experienced as based on distrust. This will most likely be experienced as such and lead to citizen distrust in government. Both from the clients, but also from the  professionals who experience the system distrusts their professional competences. This will also ripple through their social networks, spreading the distrust.

Good practices

I can hear some of you think: that is a nice ideal picture, but austerity, lack of resources…

Yes that is why working in the public sector is so much more stressful.

In the Netherlands there are some examples of organizations that have managed to truly work based the client-centred approach. They are still exceptions, but it shows that it can be done. For example, Buurtzorg, an organization providing community health care. They started some 15 years ago with a philosophy of teams of nurses as the central organizational unit and focus. Management is only there to support when asked by the teams. And most activities are done in the teams. They have clever support systems for knowledge management and developed good processes for decision making. They are now the dominant player in community health care, are expanding into youth care, hospice care, mental care; and expanding abroad, for example in the UK, but also in Korea and China. When KMPG evaluated their business model and compared it to competitors (report in Dutch), it clearly scored higher on client and employee satisfaction and health outcome and was cheaper.

Another example is an existing organization that transformed itself is the youth protection agency in the Amsterdam region JBRA, from being essentially bankrupt and under special supervision from the inspectorate because of bad performance; to achieving high satisfaction from both employees and families, saving tens of millions by reduced measures of guardianship and taking children out of their families into care, while getting good reports from the inspectorate. The focus in their organization is also teams of professionals who work with self-developed processes to safeguard due process and high quality.

Relevance for public leaders

Leaders set the tone: do you as the leader lead with the client-centred approach or the institution-centred approach?

To deal with the stressful aspect of the work with clients, emotional support networks of teams with peers with similar experience are needed at all levels, also for the leaders, to help them stay focused on the client. How have you organized your support system? Staying focused on the client-centred approach also requires resisting the temptation to fall in the zero-risk trap, the nanny-state reflex. This asks of leaders that they show a deep acceptance of imperfection, that sometimes things go wrong. Life is not 100% predictable and controllable. It also asks of leaders that they focus on a good conversation, or dialogue, instead of getting into the reflex of more rules or stricter enforcement of rules. And it really is a reflex, you get into it without realizing

[1] Lünnemann et al (2012). Seksueel misbruik in de jeugdzorg – governance vanuit het kindperspectief.