Quality performance in human services

Leadership, values and vision By James F Gardner and Sylvia Nudler Jessica Kingsley Publishers 371 pages£32

Learning disability is no longer in the limelight. It is assumed, rightly or wrongly, that we have more or less solved that problem. But those people most affected may feel rather less sanguine that their views about their lives are listened to. This contribution is a useful, if rather over-extended, text addressed to professionals and managers who want to bring quality into the lives of people who may find it difficult to say what they want.

Quality in what we call, rather confusingly, service industries has to be assessed by how the service receivers feel.

Having values and vision is not enough; each organisation must have the ability to make these real.

Too often the organisational leader assumes that the vision is shared and the values are mutual.

Today's effective leaders are not warriors, but philosophers who listen, reflect, learn and help others to do the same.

But what about standards? Mr Gardner (whose chapters are the most useful) suggests there is a hierarchy of quality not unlike Maslow's famous hierarchy of needs, where health and safety issues are at the base, nonnegotiable, and on this foundation quality of the environment and then quality of life can be built.

This is a useful way of sorting out what are basic requirements, which can be checked objectively, and what is more subjective and individually defined by clients themselves.

Professionals may find themselves in a dilemma when faced with the idea that clients define quality. After all, the professional will have spent years acquiring knowledge and will have been screened before being allowed to enter their profession.

In this book, Law and colleagues redefine the professional role as 100 per cent negotiator rather than a doer and expert. Obviously, skill as a negotiator may derive from knowledge, but ideally the professional will learn to use this skill in a different way.

This approach is echoed by Sandidge and Ward, who encourage the use of re-framing, changing perceptions by inhabiting other people's worlds.

But when all is said and done, a new approach to clients has to be made to work organisationally. This is best done by a systems approach combining the task, the people and the methods.

There is a danger that some useful discussion is lost in the book's sheer length. Judicious dipping by those interested in changing organisations to be more patient-centred could be worthwhile.

Andrew Wall Visiting senior fellow at Birmingham University's health services management centre.