Why doesn't advocacy case monitoring focus on systemic change?
Many advocacy services capture and manage their case data electronically, but don't do this with a focus on systemic change.
Why not?
I'm lucky enough to be involved in the design of advocacy case management systems through my software business ADI. Electronic case management has many benefits in terms of record keeping and efficient management of records. It also gives advocates flexibility in working arrangements. As systems can now be accessed over the internet, advocates can add case notes both when visiting clients and at home, rather than only from the office.
Probably of most importance for services in regards to electronic case management is the efficient and easy collection of reporting information around case activity. Doing this digitally makes the complex and time consuming process of monthly reporting much easier.
Commissioners capture what commissioners deem important.
Most of the focus in terms of reporting information is to fulfil the requirements of the local authority commissioner, who lays down their reporting requirements as part of the advocacy service tender agreement. My own experience of being asked to develop the reporting systems for services allows me some insight into what commissioners request from services. Commissioners (perhaps rightly in these times of budget constraints) are keenly focused on getting the most advocacy capacity for the money they have available. This "bang for buck" approach means services are encouraged to monitor their output in terms of hours worked, number of cases completed and types of case referral, rather than case outcomes.
Outputs verse outcomes.
Outputs verse outcomes are an important distinction. Outputs represent the activity being done, e.g. how much time has been spent and the volume of activity accomplished. Outcomes are something completely different. They represent the impact advocacy practice actually makes.
Shouldn't a goal of advocacy be to design itself out of the health and social care system?
Perhaps controversially, I'd argue that a goal for advocacy as a sector should be to work to remove the need for advocacy. Surely advocacy exists to represent and support people struggling to be heard within health and social care settings. Their voices are lost, when compared to the competing cultures of professional working environments, hectic health care settings, harsh financial realities and organisational wrongs which can become norms in some settings. If cultures in these settings were better, person led practice was the defacto position, and practitioners and professionals had the knowledge, time and budget to consider better treatments, options and decisions, things would be better. In this Utopian world there would be less need for advocacy oversight or intervention to uphold a person's rights or represent their views. Therefore I believe advocacy should not just be about providing support to the individual, but also about making the "services that deliver services" better.
Systemic outcomes.
In the 2016 NDTi publication Advocacy Outcomes Framework the authors documented four areas in which Advocacy can impact outcomes:
1. Positive outcomes for the person.
2. Changes to the health and social care sector.
3. Benefits to the wider community.
4. Changes in the way advocacy services deliver advocacy.
I found it interesting that 3 of the 4 areas noted relate to systemic change focused on improving the sector, community and service. So are our data collection and reporting systems for the advocacy sector missing an opportunity to improve services for the better? Are we failing our wider communities by not focusing on the collection and measurement of this type of data?
What would systemic metrics look like?
I had a think about the types of data commonly collected by services, and then thought about ways this could to augmented to take a more systemic approach. Here are some of the ideas I came up with.
Improve services.
Collection of the reasons for advocacy intervention is fairly routine, but what about collecting this data together with the details of the alleged agitator, local office, hospital ward, borough, or service? If multiple individual case examples start to mount, this pattern can be identified and the evidence brought forward to healthily challenge the status quo and cultural norms of teams or institutions to improve things.
Monitor and set targets around your outreach and engagement.
Most services conduct some form of outreach activity to engage fellow professionals around aspects of advocacy, how to best interact with the service and when to refer. Instead of seeing this work as an output, make it about outcomes. Set targets for improvements in the numbers, accuracy and appropriateness of referrals and link it to these programmes so you can target activity aimed at improving the referrals side of your service.
Think about the value of your data in supporting campaigns.
How often has your service gotten behind a national campaign to change systems or legislation because your advocates have seen the issues which are being raised on the ground when they work with clients? Imagine how powerful a campaigning tool anonymised data could be in evidencing the problem? You work with hundreds of people a year. That information is a rich source of insight and evidence for social change. How could it be tapped for good?
Extending your reach.
Referral sources and ethnographic client data are regularly captured by services. However I've rarely seen this used by services to identify sections of the community who are not accessing advocacy. This information provides great insights that can drive forward engagement and intervention initiatives aimed at reaching under served and seldom heard groups at the local community level.
Improve practice.
Training and supervision are important activities that improve practice, but advocacy teams are busy. Fostering practice can be neglected when teams are faced with heavy case loads. Record and monitor the time between advocate training and supervisions. Automatically flagging when time intervals go over agreed limits can encourage a busy team to undertake regular learning and reflection, putting the focus back on improving practice.
Improve inclusion.
The social ties, trusted contacts and partner organisations clients rely on are often captured as part of an advocacy case. This information is however rarely utilised in any meaningful way. This information could be used to inform social inclusion initiatives, self advocacy and volunteer advocacy programs.
This is far from an exhaustive or fully thought through list. However, I just wanted to introduce some different ways of considering and using data you probably already collect.
Its not a case of either / or.
Finally, I think it's important to make the point that this article is not making a case to stop collecting data on individual case outcomes that impact specific clients. Rather, it advocates a larger vision where data is also collected with that wider view of improving heath and social care services, local communities and the advocacy service itself.
About ADI
Advocacy intelligence offers ADI. ADI is a highly customisable advocacy case management tool. Importantly it is priced within the affordability range of even the smallest advocacy service, with flexible contract durations that reflect the highly unpredictable nature of project commissioning and re-tendering that services go through. Contact us for more details.