Anyone having to deal with the health and human services industries knows how rigidly they are controlled by the Medical Model and its sister act, Compliance Surveillance. What goes unnoticed in this mechanically e-captive state of affairs is that the dominant model of assessing and accrediting the quality of care is only one approach to monitoring “patient outcomes”. There are other ways of checking and reporting on how things are going beyond the objectifying, scientistic, reductionist world of “stats”.

Prof. Bob Stake, formerly director of the Centre for Instructional Research and Curriculum Evaluation at the University of Illinois, has been assessing and evaluating systems for more than 50 years, and he is known the world over for promoting the value of Case Study Research. ie. Choosing a micro-example of what needs to be assessed and, to quote Matt Damon from the 2015 movie The Martian, “sciencing the shit out of it”.

Case studies focus on the interactions between humans, as well as the systems and socio-political contexts in which they live and work. They can offer universal lessons by portraying microcosmic details, which reflect the systemic trends that determine “how the world goes round”. Just like fractals.

We need to reclaim this sort of approach to monitoring and reporting on the services that deliver our physical health, mental health, disability, aged care, trauma, welfare and substance use support. Things are not working at the moment, in any way that advantages the “consumers, carers or staff”.

I know, because I have worked on the frontline in all these sectors for years.

We are literally drowning in data, mandatorily collected day-in, day-out by staff who are stressed to the max trying to care for people, while also having to feed the never-ending automated software systems which monitor how and what care is delivered. (More from Bob Stake later).

Historian Yuval Harari, author of Homo Deus, has described the phenomenon that this trend is part of as “Dataism”, which has almost become a new religion – where organisms, us included, are just ways of processing data. And don’t Amazon, Google, Facebook, TikTok etc know all about it, seeing all of us as algorithmic fodder for their individually targeted pinpoint e-marketing.

And, no surprise, so do the MAGA-style, ‘Vote No!’ marketers of endlessly self-referential individual worldviews, and permanent discontent with ‘woke government.’ Funny that, not.

So it is that we are currently stuck in a Groundhog Day, rinse and repeat cycle of dataism in the health and human services surveillance accreditation systems. If we let it keep going as it has been, ramping up each year with more and more “demands for data”, we will all qualify as extras in the next series of Hunger Games.

I recently dared to e-question the CEO of a major national NGO delivering massive government-funded programs in the health arena, about their over-zealous demand for forensically detailed numbers for every interaction of their funded services with the community, at the expense of just taking time for local relationship building, and understanding local contexts. The response? A managerial “going over your head” approach to my local boss, questioning why such an upstart would be allowed to “threaten future funding”. That’s how things roll in Milton Friedman’s legacy world of neoliberal entrapment. Managerial bullies ensure you “Know your place, or else”.

The alternative? As Yuval Harari suggests, break out of the individuated world of algorithmically controlled communication and reclaim our membership of the human race – form into groups and state what you want done differently.

Naomi Klein described this phenomenon in her Afterword for the book The Architecture of Modern Empire: Conversations between Arundhati Roy and David Barsamian (Penguin 2024, pp 238-9):

“It is Roy’s deep understanding of the mechanics of power that is her greatest contribution to movements against neoliberalism… help(ing) us visualise the invisible architecture of modern empire… According to Roy, all imperial projects… share a logic, the logic of bigness… It is this tyranny of scale… that systematically seizes power away from communities and delegates it to centralised governments… Our job, Roy tells us, is to narrow the distance, to bring power and decision making closer to home.”

Re-enter 98-year-old Prof. Bob Stake and his colleague Dr Merel Visse, director of Medical and Health Humanities at Drew University, Madison, New Jersey, with their wonderful COVID19 chronicle A Paradigm of Care (Information Age Publishing, Charlotte NC, 2021).

Bob and Merel “know local”. And they know that local makes a difference. A huge difference, especially when Big Systems fail, such as during COVID19. Merel’s specialty is “what is at the core of being human: care and creativity… (and) What is the importance of unknowing and mystery in the field of care, but also in the humanities, research and life itself”. (ibid. pg 144).

These two collected stories from all over America during COVID19, which illustrated how people choose to care for each, outside of systemic corrals and reporting/surveillance systems. “Our central idea about care has been this: Care exists amidst standards, definitions, sacrifices, and emotions but should be known by personal feelings of what can be made better, particularly in immediate situations for unique individuals and societies. There is no perfect care or pure care – it is situational. It is made up of disparate, sometimes inconsistent, acts, a mosaic of attentions, manifest in human striving, responsive to the ongoing surround of people and happenings” (ibid. pg 141).

Having been an aged care quality assessor years ago, I remember feeling sorry for the facility managers and staff, anxious about the arrival of the assessors (read, inspectors). Fear was the dominant emotion as “Big Brother” turned up to find out what’s really going on. And that was way before today’s level of preset, software-driven, daily e-surveillance arrived.

I believe we need to combine forces, “consumers, carers and staff”, to demand that governments take their foot off the neck of the care industries and allow them to relate to their customers and communities in more natural, human-to-human ways again. And to record their case studies of care as evidence of how things are rolling, unique to each place.

The “consumers, carers and staff” could provide this “evidence” by recording their own little videos and podcasts, letting everyone know what’s occurring locally. And the more data-driven collection of official stats could be reserved for one week every quarter – to satisfy the head office bean counters.

Something has to change, and the only people who can break the neoliberal surveillance system currently controlling everything are “the customers” (and staff & carers of course).

“A paradigm of care is the mindset, the feeling, that care will be made available, with equity, to people and to living creatures and to the circumstances of their lives, as little based upon economic and cultural measurements as can be.

“A paradigm of care is a resonance, a collective relationship of individuals with others and the world as a whole… (It is) an expression of humanism, an increasing devotion to the sanctity of life nearby and afar, an investment in compassion, an attitude of benevolence.” (ibid. pg 142).

Who’s up for it?

This article is Part Two of a Six Part Series - Replacing neoliberal entrapment with a paradigm of care

Read Part 1:

https://publish.pearlsandirritations.com/hoaxes-that-gush-for-winners-and-trickle-down-for-losers/