Organizational Professionalism: Social Workers Negotiating Tools of NPM

Data, procedure, and analysis

The current article’s analysis is based on 29 interviews with social workers and managers working at six Danish care and treatment facilities. To engage participants in the study, I approached the managers who then provided contact with the social workers. All participants took part anonymously, which means that interviewees’ names are fictional. The interviews were steered by an interview guide that included wide-ranging open-ended questions, and the focus of the interview was on how the interviewees perceived the scoring schemas and documentation work of the organization. For instance, among my questions were themes such as the organization of the work (e.g., How are the tasks organized?); documentation practices (e.g., How do you fit your observations in to the scoring schemas of the organization?), perception of professionalism (How are your disciplinary training and/or organizational factors affecting your work?), norms and ethics in the job (What norms and ethics do you consider important for your profession, the organization and/or the manager?), and the needs of the clients (What do you prioritise in your relation to welfare recipients?)

After all interviews had been transcribed verbatim, I re-read each interview in its full length to obtain an in-depth understanding of the material at large, for instance, the retold story about what to report in the organizational scoring schemas and which observations were considered “trivial.” Hereafter all interviews were coded using the NVIVO software programme. The initial coding process included a broad range of issues, which were followed by a focused coding process (Charmaz, 2006) that resulted in categories such as “documentation practices,” “computer work,” “social workers’ opinions of meaningful work/expertise” and similar. These categories included interviewees’ stories about how they managed their reporting, their opinions about their assignments, and their own and their colleagues’ expertise. I then compiled a list of the main topics in each category, for instance, the choice of using third person abbreviation of “signed” (detachment) in the individual reports. These topics were then highlighted in the text, and this highlighting was the direct point of departure for the detailed—often verbatim—analysis of the specific interview sequence (which always included the interviewer’s questions and responses).

In disseminating my analysis, I have included a table with “proof quotes” (Pratt, 2008), that is, the many short, single quotes that are the analysis’s outset and justify it. The proof quotes make it clear that the analysis is not only based on the opinions of a few social workers (see Table 1). However, the analysis presented in the paper is predominantly based on “power quotes” (Pratt, 2008), that is, longer quotes and dialogue sequences that illustrate the point of the analysis in a striking way.

The structure of the analysis is threefold. First, I present a brief introductory analysis of how the interviewees explain what they consider to be the core aspects of social work when conducted with welfare recipients with complex troubles. Second, I conduct a more detailed analysis of how social workers from two participating homeless shelters work with the scoring schemas and guidelines of their organizations. Third, I look at seven reports on the attitudes and behaviour of homeless persons living at a shelter (each report is written by 5-10 staff members) to show in detail the challenges social workers face when they must document the troubles and situations of homeless people in accordance with organizational scoring schemas.

Documentation practices in two homeless shelters

At two of the participating shelters, staff report observations of welfare recipients in both text and numbers. Staff “rate” the welfare recipients’ need for support in different situations from 0 to 4. This numerical assessment can be printed as graphs that show progress according to several pre-defined parameters, such as “empowering activities” and “mental well-being” as it says in the guideline. Most staff find writing reports a time-consuming task. In the following sequence, social worker Samantha elaborates about the issue of time:

Every time you jot down an observation, you rate it. In addition, then you can get such fine graphs, so you can determine if the progress [of the welfare recipient’s situation] goes back or forth. … Therefore, I can see the intention in it, but Jesus Christ! [Both laughing]. Well, it takes much time and requires many resources too. We have been understaffed for a long period. People are tearing their hair out and having breakdowns due to stress.

Although Samantha provides a graphic account of the flipside of documenting their work, social workers’criticisms are generally also accompanied by positive assessments of writing reports as found in other research (e.g., Banks, 2013; Farrell & Morris, 2003). The participating social workers emphasise that the scoring schemas create continuity and coherence in their daily work. Many argue that reporting supports a consciousness of their methods, “you can extract ratings on something very specific” and clarify where to “put some effort,” as Vicky, a social worker, explains. A colleague agrees and states that reporting “focuses” the work by giving staff “goals and a way to structure their work.” However, the question is how the demand for increased reporting by the social work profession align with this profession’s focus on relational work with the welfare recipient. The following dialogue provides an elaborate and illustrative description of how a social worker (Peter) perceives ratings and the use of this instrument (no words have been left out in the dialogue).

Interviewer: Do you think that ratings are useful in the work, from your perspective as a social worker?

Peter: Yes, very much I think.

Interviewer: Yes. Ratings agree with your discipline?

Peter: Yes eh or [pause]. I’m having a hard time answering that question because I think maybe it… Therefore, I can easily see that ratings are very, very useful. Therefore, it’s an extraordinarily good work tool. In addition, a very good way to get an insight of what you are really dealing with. Do you have to address someone who is well functioning? Where are the needs of support? In that way, it’s a very, very useful tool. However, I think that nurses are more used to using it from their training. I mean, they address facts, and this is what you are aiming at. Where… In comparison, you are much more… I think in the study programme of social workers there is not really any… There is not really… Well, of course, there is some theory and some knowledge and… However, it is very much like, if you are good at arguing, then whatever you are saying is almost as true as what I am saying. Sometimes it is like, to put it in a very radical way… then I think that sometimes… then I sort of think that the study programme of social workers is not so fact-oriented. I mean not like that of nurses. Therefore, I believe in that sense that it is a good instrument for us social workers… That something more… Somehow something more… Of course, you can structure your work and set some goals for what you want to achieve. However, the very concreteness of scoring schemas allows you to say, “Well, that is the way it is, because that is what you can see.” You cannot say, “Well, maybe because…” or “That is because…” Therefore, in that sense, it’s a very, very good tool. In addition, it’s much more constructive to do it that way.

Rating and scoring in schemas provide something you can “see,” as Peter emphasises, and this clarity is “really, really good.” His long monologue shows that he is very appreciative of the organizational demand of documenting the work because scoring your work in schemas means that his profession’s conclusions also will hold weight in the organization.

However, his hesitant and constant self-interruption leads to another parallel analysis that points to another aspect of social workers’ documentation. It may be the subjectivity of his professions’ “argumentation” that makes it difficult for this profession to fill out the scoring schemas. While he is not proud of the fact that there is no universal way of deciding what is correct and false in social work, it is at the same time this exact focus on relational work and the context dependency of social work that defines meaningful work and expertise among social workers (see Table 1). It requires hesitation, pauses, and several attempts to draw a conclusion that his discipline is not “fact-oriented” (“then I think…,” “then I sort of think…,” “that something…,” “somehow something…”).

Health professions, on the other hand, report their observations in short and precise language, as he explains. Their expertise is in controlling medicine and measuring symptoms in pulse and blood pressure, and so forth. In comparison, the expertise of social workers involves reflections on how individuals behave in situations, for example, when playing a board game. Social workers’ jobs include collaborating with the welfare recipient to push for changes in his or her life. Peter’s social worker colleague Tony calls these things “to feel and sense.” Unlike Peter, Tony is not enthusiastic about the numeric rating and organizational scoring schemas in his work. He rolls his eyes when the interviewer talks about the categories that are the basis for their “rating.”

Interviewer: What about these categories? You rate from 0-4, right? Now you’re rolling your eyes, why is that?

Tony: It’s hard to do and then why do we do it? Rating has to do with evaluating welfare recipients’ behaviour against different criteria. Then you can do a graph that displays, for example, an increase in alcohol consumption followed by escalating levels of problems with social contact. You can register correspondence between the one curve that goes upwards and another curve that goes upwards. Then you can look at them. However, in my opinion, there are way too many possible ways to report and too little consensus on what we should measure, why and when.

Interviewer: So, you can actually measure everything?

Tony: Yes.

Tony’s body and spoken language show doubt in how rating can contribute to clarifying the social problems of the homeless individuals at his shelter. He explains in addition that ratings contribute to extensive paperwork and reports. He problematizes the absence of a consensus of what, why, and when to measure and thereby identifies social workers’ chief problem—in principle, all welfare recipients’ behaviour can be reported in the schemas of the shelter he works in. Thus, his frustration concerns the complexity and ambiguity of social problems that poorly align with the organizational scoring schemas. Whether positive (Peter) or negative (Tony), when evaluating the effect of scoring schemas in social work in homeless shelters, the interviews with all participating social workers show that most often the individual interview person is both positive and negative, when reflecting on NPM-inspired work tools such as scoring schemas and other documentary practices. This ambivalence of what to think about these newer tools shows that expertise is no longer only—or first and foremost—evaluated according to values embedded in the disciplines of professions. Expertise and perceptions of meaningful work are also evaluated according to values embedded in the managerial discourse present at their work organizations. Thus, current NPM-tools changes the work and result in new perceptions of what social work entails and how to define expertise among this group of professionals. This is an example of what Evetts (2009a) call organizational professionalism or NPM-professionalism.

Writing reports in a homeless shelter

Social workers’ measure the need for aid on topics that are hard to define such as “empowering activities,” “employment activities,” “mental well-being,” and so forth, whereas nurses assess easy-to-define topics such as “medicine intake.”

For instance, a social worker notes about a welfare recipient, ”Michael has asked for help to make sense of letters from the homeless unit” and rates her assistance to “3” under the topic “skills of perception,” because there was a “significant need for social assistance.” In other words, the expertise here has to do with measuring a quite complex area (e.g., skills of perception) in a relatively trivial way. Another distinct aspect of reports from social workers is the key role that he/she plays in the reports and its relation to social workers desired a focus on relational work with the welfare recipients. A third characteristic of the reports is social workers use of third person abbreviation of “signed” (“SN”) in the report to hide the subjectivity of the many reported observations. Thus, social workers reports are stories of relationships that include both staff and welfare recipients as the main characters even though the staff’s identity is often hidden under SN. The following extract of a report from a social worker (SN), illustrates this.

Ibrahim looks SN up in the kitchen and is obviously sad. Ibrahim says he needs to talk. SN agrees with Ibrahim to meet in the rainbow office. Shortly thereafter, Ibrahim arrives at the office, telling SN that in addition to mental health problems, he is also physically ill.… Ibrahim says he hates himself because he was once a nice guy with work, and so on. SN tells Ibrahim that even though he has mental challenges, he should not hate himself. SN comforts and tells Ibrahim that there is no reason to hate himself because he is still a nice guy. SN tells Ibrahim that he must keep fighting to get better and even though SN has a job now, then SN can also suddenly get sick and get sad, but that one must not give up.… Because Ibrahim has not eaten for several days, SN explains the importance of correct diet for well-being.

This sequence from a report highlights how relational work looks like in practice. Note that this report includes descriptions of how the social worker thinks Ibrahim’s situation can develop, and the social workers own role in this identity work. This is a story of Ibrahim as well as a story of the social worker’s role in helping Ibrahim get better. When the social worker describes himself in the third person (SN) as a substitute for using the first person (“I” and “me”), he makes a strong case for detachment. It is not him as a named person who interprets Ibrahim’s situation; it is any person (“SN”). The report of this client is accompanied by the score “2” in the category “psychological well-being” and is in harmony with this scoring schema’s demands for numbers. By attributing the text to the score “2” an alternative way of interpreting the report is made. The added number shifts the focus away from the nuances and ambiguities of Ibrahim’s situation (and social work) and underscores the detachment of the social worker’s observations. His repeated use of “SN” is characteristic in the reports of the social workers and shows the basic dilemma of documenting relational work. Thus, the social worker’s role is pivotal on the record—as social work requires—but as a person whose identity is hidden. When reviewing all of the reports of the 58 participating staff members, the profession of social workers uses SN much more frequently in their reports compared to other staff members with different training. This indicates that social workers attempt to conform to the neutrality of organizational guidelines. However, it is doubtful if the social worker’s use of SN instead of “I” or “me” solves this basic problem of the lack of “fact orientation” in social work, as Peter was stating earlier. By using SN no less than nine times in the short (condensed) report, the reader is left with a very strong impression that the reported observation is a report in which both parties played an essential role.

The social workers who explained in interviews that they wished for a stronger fact-orientation may thereby demonstrate that they do not personally identify with the key characteristic of their profession (to work upon relationships). However, this might not be the only interpretation—or the most likely. Their wish for more facts may also indicate that the lack of factual orientations in social work causes the social work profession to be ranked lowest in the hierarchy of professions. Because staff’s documentation of welfare recipients’ situations is conducted by tools that favour objectivity and detachment from the writer, social workers’ expertise may be threatened more than their colleagues with other training such as, for instance, nurses. This finding suggests that scoring schemas and other NPM-inspired tools have effects on the way that expertise is defined in this type of organization. The current strong culture of documenting the work in scoring schemas as demonstrated in the two participating shelters may, therefore, cause new battles of professions (Abbott, 1988) around whether and how professions are successful in integrating NPM-inspired tools in what they consider to be their core competencies.