The promise of interoperability at the coalface: Evidence based reflective

practice & outcome driven client service delivery.

Greg Brady

Organisational Development Manager

Connections UnitingCare

5th March 2009

the coalface….

F eelings

I nformation

D ecisions

Outcomes

Bob Dick

“Interface conversation”

Albrect Hemming

L isten

A cknowledge

C heck

E nquire

Bob Dick

outcome driven…We begin with and keep the end in mind!

• Prevention and early intervention policy, services and activities are increasingly designed to be ‘outcome driven’ . That is, reflecting contemporary research and empirical evidence of what works best to achieve the desired outcome (e.g. to reduce the incidence and effect of child abuse).

• At the local level, funded services are expected to be and ideally would have a clear theoretical base and conceptual framework for service provision, monitor effectiveness and engage in reflective practice to support continuous quality improvement.

Evidence-Based Practice is quickly emerging as a contemporary approach to human services work which ideally allows us to articulate a proven basis for our interventions and assessments. It encourage human service workers to continuously and consistently challenge their practice and support accountability aspects of such work.

evidence based….

• Evidence-Based Practice de-emphasises guess-work, intuition, unsystematic thinking, uncritical and unreflective practice and therefore heightens the likelihood of critically-aware, informed, independent and systematic practitioners who are continually up dating and expanding their knowledge bases. (Sackett, et al., 1997).

• It is an approach that combines practitioners’ expertise and experience with the current ‘best’ evidence on practice topics and issues

(Sackett, et al., 1997).

evidence based….

The use of Evidence-Based Practice enables workers to employ practice interventions that have more informed outcomes, engage clients more effectively in the decision making process and develop greater professional and personal authority.

Formal and informal mechanisms for evaluation and review are seen as crucial infrastructure to support evidence-based policy and practice.

reflective practice….• A means by which practitioners can develop a greater self-awareness about

the nature and impact of their performance, an awareness that creates opportunities for professional growth and development (Osterman and Kottkamp, 1993 cited in, Boud & Walker, 2002) .

• Maximum benefits from reflection are said to occur when the process happens in community, in interaction with others; when participants value the personal and intellectual growth of themselves and others; and when participants have time to engage in slow, non-assumptive thinking (Rodgers, 2002 cited in, Boud & Walker, 2002) .

To be facilitated, the interdependence of the practitioner, team and organizational contexts needs to be recognized.

Practitioners need to work within safe containing contexts characterized by:

•clear organizational and professional boundaries; •multifaceted reflective forums; •collaborative and communicative working practices;• and open and ‘contextually connected’ managers.”

Gilllian Ruch (2005) Reflective Practice in Contemporary Child-care Social Work: The Role of Containment British Journal of Social Work 2007 37(4):659-680

reflective practice….

… we may learn best from experience, but people often never experience the consequences of many of their most important decisions. Within organisations we don’t take time to reflect upon outcomes to truly learn from experiences. Self-analysis of this fashion takes vulnerability and this is often frowned upon by the organisation and different levels of authority. Pro-active managers are encouraged and admired when they tackle problems fast. Being truly pro-active means seeing how we contribute to our own problems and solving this first.

Senge (1992)

a challenge…

- A Community of Practice engaged in Values Based Spirited Conversations

Practitioner Community

Board Community

Executive Management Community

Middle Management Community

Client Community

External Stakeholders•Funders•Other CSO’s•Church•Community •etc.

Hum

an Resource M

anagement

Finance & Payroll

Communications & Fundraising

Org

anis

atio

nal D

evel

opm

ent

Property,

Contracts, Fleet

& P

urchasing

Information Technology

Administrative Support

Pro

gram

s &

Ser

vice

Del

iver

y

- A Community of Practice engaged in Values Based Spirited Conversations

The broader community

Spirited Conversations: Playing with future possibilities (inspired by themes emergent in the strengths of the past) whilst being

mindful of constraints.

ConstraintsPossibility

QualityTime Cost

Values based Spirited Conversations (SC)Open Forum

High Trust

Future orientatedStrengths Based

Empowerment Focus

The promise interoperability at the coalface: Evidence based reflective practice & outcome driven client service

delivery.

The nature of human service work is often not conducive to reflecting upon practice and seeking ways to monitor, review and change practice.

If evidence based reflective practice & outcome driven client service delivery is to be more than an aspiration the need for reflective spaces and the technologies to monitor, review and change practice must be acknowledged, specifically resourced, designed and built into Programs and the Organisations that deliver them.

The core challenge faced by the aspiring learning organisation is to develop tools and processes for conceptualising the big picture and testing ideas in practice. All in the organisation must master the cycle of thinking, doing, evaluation, and reflecting. Without, there is no valid learning. (Senge 1992 :351)

the challenge…

References

Boud D & Walker D (2002) Promoting reflection in professional courses: The challenge of context, In: Supporting Lifelong Learning, Harrison R et al Eds, Routledge / Falmer: London.

Macdonald, G. (1998). Promoting evidence-based practice in child protection. Clinical Child

Psychology and Psychiatry 3(1).

Ruch, Gilllian (2005). Reflective Practice in Contemporary Child-care Social Work: The Role of Containment British Journal of Social Work 2007 37(4):659-680

Senge, P. (1992). The Fifth Discipline: The Art & Practice of The Learning Organisation. Random House, Sydney.

Sacket, D.L. Richardson, W.S., Rosenberg, W.& Haynes, R.B. (1997) Evidence –based medicine. How to practice and teach EBM, sited in Darlington,Y. & Osmond, J.L (2001) Using knowledge in practice. The University of Queensland: Brisbane.

Osmond, J., Darlington, Y. (2000) Introducing Evidence-Based Practice, Information Sheet 1 Using

Knowledge in Practice 2000