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Citation for the original published paper (version of record): Soo, C., Chen, S., Edwards, M G. (2018)
A knowledge-based approach to public value management: A case study of change implementation in disability services in Western Australia
Australian journal of public administration, 77(2): 187-202 https://doi.org/10.1111/1467-8500.12279
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1 TITLE:
“A knowledge-based approach to public value management: A case study of change implementation in disability services in Western Australia”
ABSTRACT
This paper provides a knowledge-based perspective to understanding Public Value Management (PVM). As distinct from other approaches to public administration, PVM focuses on collaborative capacity building for the creation of public value. To develop the notion of PVM further, we explore the role of a knowledge-based strategy in a case study of change implementation in 18 disability service organisations in Western Australia. Our findings show important inter-relationships between knowledge management strategy, adopting a person-centred approach to service provision, and sustainability of change implementation. We discuss the implications of the study for disability sector change management and for the further exploration of the strategic role of knowledge management capabilities in the study and practice of PVM in public sector
administration.
KEY TERMS:
public value management, knowledge management strategy, change implementation, disability services, positive behaviour support
2 INTRODUCTION
A recent evolution in public sector philosophy and practice is the emergence of public value management (PVM). PVM is based on a “recognition that government has a special role as a guarantor of public values, a belief in the importance of public management broadly conceived and of service to and for the public, and a heightened emphasis on citizenship and democratic and collaborative governance” (Bryson, Crosby and Bloomberg 2014: 445). The essence of this evolution is achieving public value as the core outcome of public policy development and implementation through collective efforts and collaborative processes (Denhardt and Denhardt 2000). Where traditional and New Public Management (NPM) forms of public sector management emphasised either bureaucratic stability or market-based efficiencies, PVM aims for reform and innovation through networking, dialogue and shared capacity building between key community stakeholders.
In recent decades the Australian public sector has explored new management approaches to providing public services (Greve 2015; Housego & O’Brien 2012). This has been particularly true in the disability services sector where new disability insurance schemes, funding arrangements, regulatory environments and stakeholder expectations have been changing rapidly (Dickinson, Needham, & Sullivan 2014). In such institutional environments knowledge management becomes a crucial administrative capacity. Knowledge retention at the personal and system levels, the strategic use of information management systems and the development of effective knowledge sharing methods are all crucial organisational capacities during times of change.
In this paper we investigate the role of knowledge management in the development of PVM through a case study in the Western Australian disability sector. The case involves the implementation of a culture change program to address the issue of “challenging behaviours” (Allen 2009). This approach, the Positive Behaviour Support (PBS), is a practice philosophy to support individuals, families and service organisations faced with the task of dealing with behaviours of concern to these stakeholders (Disability Services Commission 2013). The case presents an opportunity for exploring the relationship between knowledge management practices and particular PVM characteristics.
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Specifically, we explore the role of knowledge management in i) influencing effective change implementation and ii) creating positive outcomes for key stakeholders in the disability sector. We proceed as follows. First, we present the theoretical background for the study and provide an overview of the emergence of PVM from traditional bureaucratic and NPM approaches to public administration. We also outline the key premises underlying a knowledge-based approach for change implementation. Second, we use a knowledge-based perspective to describe and analyse the disability services case to highlight the growing importance of knowledge management in public administration (Henry 1974; Osborne 2004). The management of shared knowledge is particularly important within the domain of PVM as partnerships and collaborations among key stakeholders are a dominant feature, and hence the need to understand the role of knowledge sharing and transfer in the change implementation process. Third, we present the findings of our case study focussing on the three themes of service provision, change implementation and knowledge management strategy. Finally, we conclude with a critical reflection on the inter-relationships between effective knowledge management and the development of the PVM approach to public administration.
THEORETICAL BACKGROUND
Change theories in Public Sector Administration
The public sectors of many countries have undergone considerable change and reform over the past three decades. The emergence of NPM in the 1980s and 1990s came with increased attention being paid to public spending and the need for accountability and efficiencies in how public services were financed (Armstrong 1998; Hood & Scott 1996). As a result, NPM adopted a number of private sector values and practices including outsourcing services, greater competition, advertising and marketing practices, user pays principles, and customer focused methods of service evaluation (Hood 1991). Along with greater transparencies and efficiencies, however, NPM initiatives have come at the cost of stakeholders participation in the development and implementation of change in the policies and practices that affect them (Bovaird 2007). The much touted increase in “public choice” has been
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accompanied by a confusing landscape of private offerings vying for public attention. As Hartley (2005) notes, innovation under the NPM approach has not necessarily resulted in improvements for service users. A broad spectrum of stakeholders has been sidelined as service development and delivery has moved out of public administration hands and toward private and charitable sectors (O’Flynn, Vardon, Yeatman, & Carson 2011). In response to the limitations of the NPM paradigm, innovative teams and departments within the Australian public sector have adopted a more networked and participative approach to public service. Noting the inherent limitations in the NPM model, O’Flynn (2007: 353) has commented on the need for “a new paradigm for thinking about government activity, policy-making and service delivery” and that this new approach may bring with it “important implications for public managers”. PVM is an example of this emergent form of public management with its focus on collaborative partnerships in identifying common values, developing vision and achieving shared objectives. But this collaborative orientation to public services brings with it the need for knowledge development, sharing and management.
The special characteristics of a PVM approach also make it vulnerable to underutilising the knowledge and practice systems possessed by experienced public servants and administrative systems. For example, the PVM capacity to innovate within community settings makes it even more important that those innovations include information and knowledge management capacities. In developing collaborative means for service delivery it is not sufficient to simply consult with interested members of the public and implement changes based on their expressed preferences. Public collaborations that aim for the co-creation of service innovations also need to be based on shared bodies of information, experience and knowledge. When this is not the case, innovations can be short-lived, naively implemented and result in unintended consequences (Bate & Robert 2002). Collaborative co-creation, whether as co-governance, co-management or co-production (Brandsen & Pestoff, 2006), means that local communities, families and service users can work with government officials to jointly achieve a valued outcome. For this to happen, the expertise and knowledge management capacities of public servants must inform the creation process (Bate & Robert 2002).
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Collaboration, however well intentioned, without judicious use of knowledge management processes and expertise may not achieve the full potential that PVM approaches aim for.
In the next sections we will first discuss some important conceptual aspects of a knowledge perspective in organisational settings and follow this with a consideration of the role of knowledge management in PVM.
A Knowledge-Based Perspective
The primary role of knowledge in organisational performance is to assist in achieving core goals and purposes because the “creation and transfer of knowledge are the basis for competitive advantage in firms” (Argote & Ingram 2000: 150). The distinction between knowledge and information (or data) is important as this points towards the source of such competitive advantage. According to Polanyi (1966: 6), “we know more than we can tell”. This statement emphasises the distinction between tacit and explicit knowledge, echoing Ryle’s (1949) distinction between “know how” and “know that”. According to Ryle, acquiring “know that” does not lead to knowing how to use that knowledge. The example he used is playing chess. Knowing the rules of chess does not mean knowing how to play it, such know how comes from practice. Ryle argues that “learning how or improving in ability is not like learning that or acquiring information. Truths can be imparted, procedures can only be inculcated, and, where inculcation is a gradual process, imparting is relatively sudden. It makes sense to ask at what moment someone became apprised of a truth, but not to ask at what moment someone acquired a skill” (Ryle, 1949: 58). Davenport and Prusak (1998: 5) define knowledge as a mix of “framed experiences, values, contextual information and expert insight that provides a framework for evaluating and incorporating new experiences and information. It originates and is applied in the minds of knowers”. A firm’s resources and capabilities can be important sources of sustained competitive advantage if they possess certain special characteristics, for example, if they are valuable, rare, durable, not easily traded or difficult to imitate (Barney 1991). These kinds of tacit
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organisational capabilities are deeply embedded in individuals and organisational routines and processes and are important resources that are not easily replicated, transferred or imitated.
Empirical studies have explored how these knowledge-based capacities can be created (e.g. Klaas, Semadeni, Klimchak and Ward 2012), shared (Collins and Smith 2006) and transferred (Chang, Gong and Peng 2012) to improve organisational performance. Similarly, the concept of “absorptive capacity” (Cohen and Levinthal 1990) has been extensively studied in the literature. The ability of an organisation to continuously absorb, disseminate and utilise new knowledge is widely regarded as an important determinant of sustainable competitive advantage. Researchers have shown that the development of absorptive capacity contributes towards innovation ( Tsai 2001) and organisational learning (Lane, Salk, & Lyles 2001). These kinds of knowledge capacities are also relevant to the performance of public sector organisations.
The Importance of Knowledge in Public Sector Management
The importance of personal and organisational knowledge in public administration is well established. Henry (1974: 191) argued that
“if new knowledge and new uses of knowledge have profound implications for the policy-making process, it would seem apparent that a new policy or policies are needed for the management of knowledge, if for no other reason than to assure that information is applied intelligently in the analysis and rectification of public problems”.
The unique characteristics of public sector knowledge management capacities come into focus when encountering “wicked problems” (Churchman 1967; Rittel and Webber 1973; Head and Alford 2015). Wicked problems are essentially ill-defined, lacking in clear solutions and hence, not easily resolved. As Rittel and Webber (1973: 160) argued, “the kinds of problems that planners deal with– societal problems–are inherently different from the problems that scientists and perhaps some classes of engineers deal with. Planning problems are inherently wicked”. Weber and Khademian (2008:
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336) outline three dimensions of such wicked problems – (1) they are unstructured with high levels of causal ambiguity (i.e., precise causes and effects are difficult to ascertain) and hence, little consensus around problem definition and solutions; (2) they often exist within contexts of increased political and social complexity, involving multiple stakeholders with high levels of interdependency; and (3) they are “relentless” and cannot be “solved once and for all despite all the best intentions and resources directed at the problem, and efforts to solve the wicked problem will have consequences for other policy arenas as well”.
Several empirical studies have explored the role of knowledge sharing and transfer mechanisms in the context of public administration. Bate and Robert (2002) documented the use of communities of practice to facilitate reforms in the National Health Service (NHS) in England and Wales. Such communities were used as a vehicle for knowledge creation and sharing in a group of local municipalities located in six U.S. states (Smith 2016), as well as the Australian Family Law Council (Osborne 2004). Studies have also explored the role of information technology in developing knowledge-sharing capabilities in the U.S. police departments (Brown and Brudney 2003) and in South Korean public sector organisations (Kim and Lee 2006). Recent studies have explored the critical role of knowledge management strategies in NGOs (Corfield, Paton and Little 2013), and large public sector organisations (Burford 2013). A common thread running through this literature is the importance of adopting a knowledge-based approach to address the issue of “wicked problems” in public sector management. In the disability sector, the issue of challenging behaviour meets all of the wicked problem criteria. Challenging behaviours occur in situations that are multifaceted, causally complex and persistent in creating difficulties for stakeholders. Consequently, knowledge management capabilities are likely to be key assets for disability sector managers when responding to community needs in these areas.
8 THE CASE STUDY
We present the case of the implementation of Positive Behaviour Support (PBS) by a state government disability services department of the Western Australian government (“the Commission”). The case is relevant for exploring knowledge management within the context of the PVM perspective. There are several reasons for this relevance. Rapid change in service design and delivery practices innovations (Stancliffe 2002) means that knowledge processes must also be updated to keep abreast of novel developments. Additionally, funding reforms have stimulated changes in public sector involvement in service delivery, in monitoring of service standards and in responding to stakeholders concerns and individual histories. For these reasons, the case of PBS implementation highlights the role of knowledge management in the public sector. The case also provides a rich source of data and information for gaining insights into public administration practices associated with the evolution towards PVM by highlighting the need for more innovative, high quality services. The case illustrates the need for public sector management to encourage “richness and flexibility in relationships between citizens and governments” (Smith 2004) with the aim of building up capabilities for partnership and collaboration among families, disability sector organisations, businesses and other stakeholders.
Positive Behaviour Support (PBS), challenging behaviours and person-centred planning
PBS is a practice philosophy grounded in safeguarding human rights, improving quality of life and eliminating restrictive practices through systemic change (Carr et al 2002). A key feature of incorporating PBS values in disability service design and delivery is the use of person-centred planning. This entails adopting a holistic and systemic approach in designing and delivering support strategies for the individual. A person-centred approach takes into account all the underlying principles of PBS, by incorporating the importance of stakeholder engagement, ecological validity, a lifespan perspective, and quality of life outcomes, and is based on “deep listening to discover what is
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important to people, what supports they need, and their hopes and dreams for the future” (Sanderson and Kilbane 2006: 22).
PBS has been implemented by the Commission, in consultation with individuals, families and disability organisations, as a strategy for responding to the needs of people with disability who engage in behaviours that place themselves and possibly others at risk. These “challenging behaviours” (Allen 2009) risk the safety or wellbeing of the people who display them or to others who may be affected (Emerson 1995). There is often a very high degree of vulnerability in people with disabilities who engage in challenging behaviours (Allen 2009). Challenging and concerning behaviour can be seen as communicating profound human needs and sometimes indicative of environmental and situational conditions that deny other ways of expressing those needs. As a result, issues of human rights, dignity of choice and quality of life outcomes become critically important in designing flexible and adaptive services. Knowledge plays a central role in dealing with challenging behaviours. The personal knowledge of people’s life histories, the management of knowledge about triggering situational factors, and knowledge about service philosophies, purposes and goals all contribute to the proper handling of challenging behaviours.
In the next section, we describe the research design method and present the case findings in detail, outlining the key themes from the case and discussing their relationships and interdependencies.
Research design and method
Our research approach involved a qualitative focus on rich data about real actions and concrete strategies taken by practitioner managers actively involved in supporting families and service staff dealing with challenging behaviours. The research design was developed to facilitate a research project exploring the state-wide implementation of PBS into disability service supporting individuals and their families in dealing with challenging behaviours.
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The design included an extensive literature review, semi-structured interviews and focus groups. This data served to build a diverse pool of information for a qualitative approach that analysed the data to extract core themes and build explanatory models to integrate themes. The phases in the research were: i) a review phase focused on the review and integration of literature which guided the data collection process; ii) a groundwork phase of interviews with Commission managers who were key figures in initiating the PBS implementation program; iii) attending disability sector forums, and meeting service delivery stakeholders to understand the complexity of the change process; iv) the data collection phase and v) theme analysis phase to identify key themes and emergent issues.
Participant agencies were 18 disability service organisations (DSOs) and their staff. Fourteen of these were from metropolitan suburbs and four operated from country regions. Stratified sampling procedures were adopted for choosing participants within each of the organisations. The three participant groups (strata) included in the sampling were: i) direct support staff: these included operational staff who worked directly with service users, their supervisors, and co-ordinators who also worked with service users, ii) professional and specialist staff: these were PBS consultants who act as internal change agents and professional support providers and iii) executive staff: these included Chief Executive Officers (CEOs) and senior executives. Interviews were conducted with CEOs and PBS consultants, and focus groups with direct support staff. Participants were asked to describe their experiences with PBS implementation at their organisations, with particular emphasis on facilitators and barriers to the change process. All interview and focus group data was recorded and transcribed.
The constant comparison method (Glaser 1965) was used to identify emergent themes looking at the relationship between knowledge management capacities and person-centred service delivery and sustainability of change implementation. Constant comparison is a means for coding text to identify 1st order codes, categorising those codes to derive 2nd order themes and sorting those themes into theoretical dimensions (Dye 2000) To improve the trustworthiness of our interpretative approach, we: i) triangulated our data by using multiple data sources and ii) checked the coherency of those
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observations with key stakeholders in the case. In general, the case provided the opportunity for in-depth observations and gathering of information on the implementation process.
CASE FINDINGS
The analysis of the interview and focus group data resulted in a number of salient themes and theoretical dimensions concerning PBS implementation. In this section we discuss knowledge management strategies within the context of two of these core areas of PBS implementation. The first is the person-centred approach and the second is the sustainability of change implementation. The inter-relationships between these dimensions (Figure 1) illustrate how PBS can be implemented, embedded and sustained in organisations.
INSERT FIGURE 1 ABOUT HERE
Person-centred approach
A person-centred approach to service provision is a definitive component of PBS implementaion. A person-centred approach helps organisations provide accessible, responsive and flexible services that meet the diverse needs and preferences of their clients, thus requiring a deep understanding of each client. Such an approach does not stand alone but relies on other aspects of organisational cultures and capacities to function well. Drawing from the interview data, we highlight the key knowledge management factors that contribute to the effective deployment of a person-centred approach and the implementation of PBS.
Developing deep knowledge about the client
Knowledge of what is important to the individual; their goals and aspirations; their interests and preferences; their background and vulnerabilities are crucial when planning supports. Such knowledge is often tacit as it is developed through deep understanding of “how a person is in the world and how they want to be and what’s important to them and how we get to that”
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Developing such knowledge gives staff the confidence to trial new opportunities, to be flexible in recognising individuals’ choices, and to understand the importance of individuals’ rights in exercising their freedom of choice. As demonstrated below, support workers may have to
develop creative ways to encourage clients to express their preferences, with the intent of staying true to their choice:
“With one client I made him a photo journal with all different activities that he had done and then he put a sticker on the photos of things he liked so that’s the way of being able to
ascertain what’s important to that person, and get that information up in a planning session so that it’s truly theirs and not just the support worker and family.”
Deep understanding about each client’s personal idiosyncrasies helps staff to tailor the supports they offer that are grounded in the recognition of personal rights and dignity, as illustrated below:
“I find that the best way to support him sometimes, if he gets stressed or something, is just to pull back. That’s the best thing you can do that’s helping, he needs his space….if he wants to talk he’ll start a conversation, but if not, I know to stand back.”
PBS principles acknowledge the impact that environments have on behaviour and the need for innovative changes in service environments instead of attributing the causes of challenging
behaviours to the individual. It is important that staff interpret challenging behaviours as the person’s attempt to signal their emotion, to convey discomfort or to communicate their frustration over certain needs that are not met. Understanding challenging behaviours as a communicative purpose shifts the blame away from the service user and finds answer to the challenging in the service environment. One approach to understanding the clients’ needs involves developing individualised supportive communication strategies:
“The young girl that I work with is non-verbal and she’s very tangible. Using objects is how she communicates. With positive behaviour support, we’ve been able to set up in the spare room…..her swimming bag, her going out bag and foot spa/massage thing…and that’s for her to be able to go in and choose from that shelf.”
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To summarise, these examples indicate that adopting a person-centred approach requires not only deep knowledge about the client, but such knowledge is highly tacit and founded on the protection of fundamental human rights and universal values.
Establishing relationship with client
The relationship between the service recipient and their support staff serves as a platform from which knowledge about the client is built up and successful PBS-based strategies are developed. If trust is developed, this provides a foundation from which staff can actively explore new opportunities for them:
“….the whole basis of all this is you have to know the person; you just have to. And to know a person, it’s not sitting down for three meetings, it’s about living with them, going through their tragedies with them, going through their good states and it takes time and it takes lots of time, and nothing will work unless you know.”
Strong relationships with clients require substantial amounts of time and effort to be
established. This approach literally involves “living” life with the person and getting to know them personally. Once such a relationship has been built, the client is more likely to share their
difficulties and needs with their support worker, and such knowledge can then be incorporated into their support plan. As a result, clients are granted a degree of control over the types of support they receive, as illustrated below:
“We had one person recently who was suicidal and self-harming, so we actually sat down with him, went through “why are you doing this? What makes you want to do this?” So it came out from conversations with him, he was becoming anxious and that was what was underpinning it. So we talked about what sort of things make you feel anxious, what can you do to help yourself, what can we do, so he came up with ideas as to how to manage that.”
An established relationship between service staff and their clients not only supports clients’ interaction with staff but also allows staff to have confidence in their own abilities. Confidence is supported through knowing a client’s inclinations and preferences and having an awareness of what to expect in their interactions. One staff commented that: “I mean they can read documentation and go, “Okay” but if they don’t have the confidence to actually deliver those strategies, the paperwork means nothing because it’s about building that relationship”. Fostering a positive work environment
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where trusting relationships can flourish thus becomes an important element of successful PBS implementation.
Developing skills to support PBS
An important theme that emerged from the case study is that support staff may not have the know-how to set up realistic short-term goals for clients to follow to achieve their desired outcome:
“So we've talked about getting some training around smart goals … how to articulate goals in a sort of more measureable way….I think our plans are good, but we've got a mixture of people sort of mixing up short term goals and objectives with longer term ones.”
Lack of skills and know-how about dealing with short-term and long-term goals may lead to staff creating plans that do not take into consideration their client’s capabilities and thus, developing a plan that has potential shortcomings. Staff need the skills to be able to break down larger goals into smaller steps that clients are able to achieve and gradually work towards longer-term outcomes:
“….for a person with a disability we have to break it down a little bit smaller and take smaller steps to get there so it’s just helping them to achieve what they want but recognising that it might take them a bit longer and helping them to do it.”
Staff also need to be able to identify and facilitate instances where their clients can participate in the wider community in order to achieve their long-term personal goal. To help their clients make full use of these opportunities, “skills around how to encourage social interaction and community involvement” becomes critical. More importantly, such skills have to be developed in a way that staff know how to apply the concepts they have learnt in training to the unique context where they interact with and support their clients:
“It’s about transferring that knowledge and understanding but it’s not just a technical thing. Yes, you can read a whole heap of this, you can get the reasoning maybe the processes, but then there is a practical application…..actually putting it into practice.”
As illustrated by the above examples, adopting a person-centred approach to PBS implementation requires highly tacit knowledge and skills, often developed through fostering trusting relationships with each client and in turn, gaining deep understanding of their unique personal traits and circumstances, their goals and long-term aspirations.
15 Sustainability of change implementation
For PBS to have a lasting impact on the overall quality of life of service recipients, it needs to be practiced consistently across different social settings so that self-determination and the opportunity to pursue personal goals is supported. For PBS to be embedded as a philosophy that underpins a DSO’s operations, it has to be consistently adopted across clients, sites and services. It also has to be actively taken up by key stakeholders such as family members, community
stakeholders and other relevant service providers. The case findings suggest two key factors that affect an organisation’s ability to implement PBS consistently and sustainably; i.e., staff turnover and stakeholder engagement.
Staff turnover
The primary point of contact between a DSO and its service users is through its frontline support staff, who play a key role in developing and implementing support plans that are consistent with the principles of PBS. With deep knowledge of their clients and a trusting working relationship with them, support staff can help establish PBS as a legitimate approach for designing person-centred services and achieving lasting improvements in quality of life. However, staff turnover can often disrupt the consistency of person-centred plans and can lead to activities for clients not being actioned and clients’ progress not being monitored, resulting in delays or interruptions in the client’s efforts to achieve their goals:
“I’ve seen a client doing one activity with a staff member and you could see the
outcome…..and the positive aspects about it and when the staff member left, everything went down. So you’re starting again from scratch.”
Continuity in relationships is central to the sustained implementation of PBS. Staff turnover cuts across this and dramatically interrupts the continuity of support and can often suspend many milestones that have been reached. When an experienced staff member leaves, they take with them important client-specific knowledge as well as critical skills developed through training and
supervision in the organisation. The loss of PBS-trained staff is particularly critical as they are often the most experienced and enthusiastic about implementing the change. If turnover is frequent, the
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organisation’s capacity to consistently apply PBS for all of its clients is gradually depleted as they lose personnel that can fully reinforce the principles of PBS in the services offered.
The loss of client-specific knowledge represents a setback in an organisation’s efforts to implement PBS as additional time and resources have to be expended to rebuild this body of knowledge. As mentioned previously, the relationship between the support worker and the service recipient is the platform from which knowledge about the client is accumulated and PBS
interventions are developed. However, that relationship is lost when the support worker who has gained the trust of the client leaves the organisation. It takes time for new staff to re-establish the relationship as well as build their own confidence to work effectively with the client:
“…..it’s about building that relationship and building their confidence to work with that person first and getting the person to know them and then they can actually implement those strategies….otherwise it’s scary.”
Turnover of staff has been attributed to the stresses that staff face when providing support for clients who at times exhibit challenging behaviours. When staff feel that they do not have adequate resources to support their clients, they are likely to burn out and leave their jobs. Their departure further exacerbates the difficulties faced by the support workers who remain as they end up with a greater workload. The following extract exemplifies the difficulties that staff encounter:
“…if you’ve got somebody that’s displaying really challenging behaviours, staff don’t want to support that person because they’ve been there too long and they’ve had enough and they get burnt out … so that’s where you see it in the support staff is because there’s no other staff so they end up doing more and more.”
As illustrated above, staff often encounter a variety of challenges when supporting their clients. Hence, it is important that the organisation explore the causes of potential stressors and make appropriate changes to resourcing, work design and processes.
Stakeholder engagement
To consistently incorporate PBS principles in all support arrangements, it is important for a DSO to actively engage family members, schools, community and other agencies that the client has close contact with. For PBS to have an enduring impact on the lives of clients, autonomy and
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inclusion in community life are to be encouraged and this requires DSOs to enlist the support of multiple stakeholders. More often than not, clients receive services from different agencies and if PBS values are not consistently reinforced by other stakeholders, any positive changes experienced by the client are limited to specific support environments and not replicated in others:
“……at respite you often either don't get the kids for long enough to teach them, or the gaps between are too big and the inappropriate behaviour is being reinforced in all the other settings.”
Engagement of multiple stakeholders implies that, in addition to support staff, there are other advocates within the community who understand the needs of the individual and know how to effectively support their participation in society:
“We have people who go to the swimming pool and people we talk to and they’re in
discussion with us, so the pool attendants, the managers of the pool.... they’re [all] part of that whole process and we know that even though we’ve got the support worker there... there are others within that environment who know the individual, who know their quirks … and know how to support the person.”
Through a networked approach and collaborative partnerships, stakeholders co-create and share knowledge which in turn helps them align their own support plans towards a common objective for the client. Consequently, these relational and collaborative processes in working towards a common objective for the client assist in the consistent application of PBS in all of the support services that the client may engage, regardless of whether it is provided by the same organisation.
Knowledge strategy: Capture and utilisation of information and knowledge
The final connection we wish to consider here is the association between the DSO’s ability to collect and utilise information and to design services that are aligned with PBS values. One of the main characteristics of PBS involves the application of an evidence-based approach and hence, it is important for an organisation to capture, interpret and use information and knowledge that has been collected from all parties involved in service provision, whether it be the frontline support worker, family members or the service user themselves. The following results provide an indication of the
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extent to which the participating DSOs have used knowledge management (KM) systems to facilitate the change implementation process.
Knowledge strategies for developing services
Considering that client-specific knowledge is an important contributor to an organisation’s ability to focus support on personal needs and preferences, having systems to capture this
knowledge will help staff make timely and impactful decisions:
“I remember when he was going through a crisis and he was getting quite aggressive, someone from the office had the idea that maybe it is safer for him to stay at home … but going back to where the team has shared with each other and with me and with the co-ordinator, he hadn’t had any incidents in the public….so there was no recent evidence to say that he wasn’t safe in the community or the community wasn’t safe with him.”
In the above example, prior knowledge about the client’s behavioural inclinations helped staff to design on a support plan that opened up opportunities for the client to participate in the wider community. This knowledge could only be built up by purposeful documentation and review of past incidents involving challenging behaviours. Therefore, knowledge capture plays an important role in determining whether certain activities are suitable for clients. Also, through evidence-based decision-making, staff gain the confidence needed to take calculated risks in offering new opportunities for their clients.
More often than not, frontline support staff are best placed to provide and collect critical knowledge about a client. It is important that organisations support their staff in building a body of knowledge that can be utilised to plan services that are based on the nuances of the individual client: “You get what you know but the rest is, you’ve got to work with the staff that knows them well that they would impart their knowledge and wisdom.”
Knowledge strategies for improving services
Besides its role in service design, effective knowledge capture and sharing can improve existing services and bring about systemic change within the organisation. Data on the outcomes of support arrangements can pinpoint specific areas within an organisation where PBS is not
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arrangements and guide proactive redesign of services and service environments. However, as described in the example below, such reports need to be documented and vigorously evaluated to identify possible trends that can be used to improve services:
“….they have to record an incident if something has happened, and we will follow it up if there seems to be a pattern either with the same therapist or the same client ... The team leaders get the information and I get the information and we collate it all so we will be able, over time, to have a look and see whether this is changing.”
The capacity to identify patterns in the data can create opportunities to adapt services for certain groups of clients that are vulnerable and require specific support or targeted interventions:
“One of the things that we’re really having to work on at the moment … is really around meeting the needs of people who are aging … we’re talking about staff training, we’re talking about environmental design, we’re talking about accessibility, we’re talking about interface with health systems, we’re talking about every aspect of that. So that data is crystal clear.”
The development of a comprehensive and efficient knowledge management system can support the implementation of PBS through facilitating the continuous improvement of existing services, processes and practices. In turn, these improvements over time will help to bring about a change towards greater quality of life for service users.
The importance of knowledge capture and retention
An effective knowledge management system can help an organisation tackle the issue of knowledge loss. As illustrated by the following quote, valuable background information on clients may not be stored or captured well by support staff: “….a lot of the background and the little quirks that people have and things like that is shared by word of mouth.” Staff turnover can impact on the consistency of service delivery and this is further exacerbated by the loss of valuable client-specific knowledge that has taken time to accumulate. As illustrated below, innovative methods to capture knowledge can be developed from staff’s initiative and creativity:
“……we have the scrapbooks so every individual in the house will have a very nice
scrapbook with their story…if you walk into my house and you don’t know any people that are living there, just looking through that book gives you enough information just to
understand the person and just to know what they have been through in their life and then when you move towards the positive behaviour support plans….it actually gives staff a vision that if the person is behaving in a certain way, ...then why?”
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Knowledge capture mechanisms ensure that a person-centred approach is applied consistently in the supports that a client receives, even when key staff turnover. Details about a client’s personal traits, history, needs, preferences and aspirations remain within an organisation via such safeguards. The implementation of well-developed support plans is not hindered when a particular staff member leaves the organisation because the key factors needed to put these plans into action have been captured. In summary, effective knowledge systems can equip organisations with a powerful tool to successfully implement and embed PBS in the services it offers through retaining critical
knowledge.
Developing an organisation’s capacity for managing knowledge
Certain issues can impact on the organisation’s ability to capture relevant information and use it to derive insights that are actionable. Interviews results have identified several barriers that impact on a DSO’s ability to capture and utilise their knowledge. As highlighted below, support arrangements can affect whether reliable data is collected:
“The reality is that different people will be looking after this kid on different shifts but if you want reliable data you're going to have get the same person to look after and to get the data, but you're not getting any measure of how it happens with different people.”
Support arrangements often involve more than a single staff member across different shifts. As a result, there is no guarantee that information about the client has been consistently compiled by all staff members. The issue is compounded further when a client contracts different service providers. Therefore, it is important that DSOs develop the capacity to collate and share information in order for the data to have any positive influence on its services.
Another issue relates to providing resourcing to support staff to accurately and consistently record their observations. Any form of data is only useful for making judgments about service provision if it is captured accurately and timely. Inaccurate data on clients and incidents can be attributed to a lack of expertise on rigorous data collection practices:
“….one of the first things that pinned my interest when I arrived at the organisation is there seemed to be very lax protocols about what gets written in an incident, what constitutes an incident; how we speak about clients and things like that.”
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Therefore, training on how to report critical incidents and standardising organisational protocols on documentation can aid the collection of informative and timely data. The challenging work environment of disability support staff creates demands that impede on their ability to collect vital information as staff often lack time in their work schedule:
“……our staff could support between four and six people alone. To then collate that information on all of them in that one day, as well as provide a quality support. It’s like what’s more important, your support or your administration?”
Providing adequate time, training and supportive work design can support the collection of relevant information that serves as a guide for service planning. These factors can help staff understand that observing clients and accurately documenting key events is a major part of their work routine, as a staff member has observed – “I think it’s hard for support workers because they’re busy being support workers but then they’ve got to document everything and we’ve got to look at some ways to simplify that process for people.”
Finally, staff attitudes toward reporting incidents can impact on how data is captured. Specifically, staff may have the mindset that “a quiet house is a good house”, and are reluctant to record critical incidents for fear of being blamed or held liable. To encourage staff to express their ideas and concerns, it is important for organisations to create environments that are psychologically safe for staff to voice without the fear of being admonished. Such a culture will facilitate the
building of a body of knowledge that can be used to further the implementation of PBS within the organisation. By addressing these issues, an organisation’s capacity to learn is enhanced through collecting quality data to generate critical knowledge for designing services that emphasise the values of PBS.
DISCUSSION
A knowledge-based strategy to sustained change implementation
Addressing the issue of challenging behaviours is a complex endeavour. ‘Problems’ can be interpreted in multiple ways, multiple stakeholders need to be involved, and solutions often require
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imaginative reframing. All this amounts to “wicked problems” where knowledge management becomes an important capacity in public sector management. The case shows that one of the core capacities of a PVM approach to dealing with challenging behaviour is the facilitation of these knowledge-based management capacities.
The creation of public value depends significantly on how the strategic management of knowledge resources are handled. For example, the case findings show that, when well managed, information and knowledge can facilitate a person-centred approach to service design and delivery. Through informing the planning of supports and exploring new opportunities for each client, an organisation’s knowledge base helps to design support services that are based on individual needs, preferences, skills and aspirations. Hence, the knowledge gained through purposeful capture and retention of relevant knowledge helps to build services that are person-centred. The collection of data on client and service outcomes also provides for evidence-based decision-making. Such knowledge can be used to improve and redesign support arrangements that promote informed choice and open up new opportunities. Operational systems and practices can be better aligned with the values of a person-centred approach to service delivery. This alignment creates substantive value for all stakeholders and, in turn, strengthens the legitimacy of the PVM approach to collaborative innovation and embedding the tenets of PBS service philosophy. Service providers can make evidence-based decisions when they have timely access to useful data. Information gathering is a complex process and can be easily undermined when it is not aligned to the core values and ethical guidelines that ensure human rights are protected and that organisational responsibilities are maintained. PBS provides this kind of values-based foundation for an organisation’s information and knowledge management strategy.
Adopting a person-centred approach also guides staff in the types of information that are collected, the range of stakeholder involved in that collection process and how this knowledge is used to implement culture change initiatives like PBS. Transparency, accountability and trust are key aspects in doing this. The development of trusting relationships is a shared characteristic of both a
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person-centred approach and PVM practices and their alignment around this issue of trust can contribute to the effective design and delivery of individualised supports.
A consistent and sustained application of PBS across service environments is enabled through the retention and sharing of knowledge about critical issues such as how behaviours of concern emerge, how they are responded to, what works and what doesn’t. PVM encourages conversations to take place on these kinds of collaboration and sharing. For example, collaborations and knowledge sharing between DSOs, services within DSOs, service staff and other stakeholders helps to ensure PBS-based support strategies are applied consistently.
These case study findings have important implications for both the study and practice of public sector management. The case demonstrates the central role of knowledge-based strategies in facilitating change implementation in our sample of disability services organisations. We found evidence for this in the service philosophy and practice of a person-centred approach to service delivery and design and in the sustained implementation of the PBS culture change initiative. Our findings illustrate the interdependencies between public service management and human services response to complex problems such as challenging behaviours in the disability services sector. These interrelated connections are not reducible to either a fixed set of bureaucratic regulations or to the estimation of financial costs and benefits. The administrative concern with public value is not the sole province of new public sector developments like PVM. What PVM does provide however, as our study discusses, is a set of strategic capacities, including knowledge management, that support the building of networked collaborations that focus on the co-creation of public value. These kinds of collaborations have much to offer community members and families facing complex social challenges.
CONCLUSION
Investigating underlying change processes around policy development and implementation is a vital issue for researching and practicing public sector management. To illustrate the factors
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contributing to sustained change implementation within the context of PVM, we have presented a case study of change implementation in the disability sector in Western Australia. The case study findings are illustrative of the networked and collaborative characteristics of PVM where key stakeholders (i.e., government agencies, service provider organisations, clients and their families) work together to share knowledge and develop insights, and in turn create innovative solutions to resolve the “wicked problems” that are so prevalent in public sector management.
Our study showed how a knowledge-based approach contributes to sustainable change implementation by building capacities for change, renewal and continuous innovation within our sample organisations. Knowledge capture and its subsequent use in service design and improvements is a key factor in providing support that takes into account each individual’s goals, needs and unique circumstances. Using a knowledge-based approach to build such collective capacity is a major contributing factor underpinning the PVM movement towards a philosophy that “treats people and encourages them to treat others with recognition of the full roundness of their human qualities and experiences” (Stoker 2006: 47).
REFERENCES
Allen, D. 2009. Positive behavioural support as a service system for people with challenging behaviour. Psychiatry, 8(10): 408-412.
Argote, L. and P. Ingram. 2000. "Knowledge Transfer: A Basis for Competitive Advantage in Firms." Organizational Behaviour and Human Decision Processes 82(1): 150-169. Armstrong, A. 1998. A Comparative Analysis: New Public Management — The Way Ahead?
Australian Journal of Public Administration, 57: 2
Barney, J. 1991. “Firm Resources and Sustained Competitive Advantage.” Journal of Management 17(1): 99-120.
Bate, S. P. and G. Robert. 2002. "Knowledge Management and Communities of Practice in the Private Sector: Lessons for Modernizing the National Health Service in England and Wales." Public Administration, 80(4): 643-663.
Bovaird, T. 2007. Beyond engagement and participation: User and community coproduction of public services. Public Administration Review, 67(5): 846-860.
25
Brandsen, T., & Pestoff, V. (2006). Co-production, the third sector and the delivery of public services. Public Management Review, 8(4): 493-501.
Brown, M. M. and J. Brudney. 2003. "Learning Organizations in the Public Sector? A Study of Police Agencies Employing Information and Technology to Advance Knowledge". Public
Administration Review, 63(1): 30-43.
Bryson, J. M., Crosby, B. C., & Bloomberg, L. 2014. "Public Value Governance: Moving Beyond Traditional Public Administration and the New Public Management." Public Administration
Review, 74(4): 445-446
Burford, S. (2013). From the Inside Out: Examining a Knowledge-Based Prctice in Large Public Organizations. International Journal of Public Administration, 36: 189-199.
Carr, E.G., Dunlap, G., Horner, R.H., Koegel, R.L., Turnbull, A.P., Sailor, W., Anderson, J.L., Albin, R.W., Koegel, L.K. & Fox, L. 2002, 'Positive Behaviour Support: Evolution of an Applied Science'. Journal of Positive Behaviour Interventions 4(1): 4.
Chang, Y., Y. Gong and M. Peng. 2012. "Expatriate Knowledge Transfer, Subsidiary Absorptive Capacity, and Subsidiary Performance." Academy of Management Journal, 55(4): 927-948. Churchman, C. W. 1967. "Wicked Problems." Management Science, 14(4): 141-142.
Cohen, W. M., and Levinthal, D. A. 1990. "Absorptive capacity: a new perspective on learning and innovation." Administrative science quarterly 35(1): 128-152.
Collins, C. J., & Smith, K. G. 2006. "Knowledge exchange and combination: The role of human resource practices in the performance of high technology firms." Academy of Management
Journal, 49: 544–560.
Corfield, A., Paton, r. & Little, S. (2013). Does Knowledge Managament Work in NGOs?: A Longituditnal Study. International Journal of Public Administration. 36: 179-188.
Davenport, H. T and L. Prusak. 1998. Working Knowledge, Cambridge, MA: Harvard University Press.
Denhardt, R. B., & Denhardt, J. V. 2000. "The New Public Service: Serving Rather than Steering."
Public Administration Review, 60(6): 549-559.
Dickinson, H., Needham, C., & Sullivan, H. 2014. "Individual Funding for Disability Support: What are the Implications for Accountability?" Australian Journal of Public Administration, 73(4): 417-425.
Disability Services Commission. 2013. Positive Behaviour Framework: Stage 2 - Statewide
Implementation of Positive Behaviour Suuport. Perth, WA: Government of Western
26
Dye, J. F., Schatz, I. M., Rosenberg, B. A., & Coleman, S. T. 2000. Constant comparison method: A kaleidoscope of data. The Qualitative Report. Retrieved from
http://www.nova.edu/ssss/QR/QR3-4/dye.html
Emerson, E. 1995. Challenging Behaviour: Analysis and Intervention in People with Learning
Disabilities. Cambridge: Cambridge University Press.
Glaser, B. G. 1965. "The Constant Comparative Method of Qualitative Analysis". Social Problems,
12(4): 436-445.
Greve, C. 2015. "Ideas in Public Management Reform for the 2010s. Digitalization, Value Creation and Involvement." Public Organization Review, 15(1): 49-65.
Hartley, J. (2005). Innovation in governance and public services: Past and present. Public money
and management, 25(1): 27-34.
Head, B. W. & Alford, J. 2015. "Wicked Problems: Implications for Public Policy and Management." Administration and Society, 47(6): 711–739.
Henry, N. L. 1974. "Knowledge Management: A New Concern for Public Administration". Public
Administration Review. 34(3): 189-196.
Hood, C. 1991. A public management for all seasons. Public Administration, 69(1): 3-19
Hood, C., & Scott, C. 1996. "Bureaucratic Regulation and New Public Management in the United Kingdom: Mirror-Image Developments?" Journal of Law and Society, 23(3): 321-345 Housego, A., & O’Brien, T. 2012. "Delivery of Public Services by Non-Government
Organisations." Australian Journal of Public Administration, 71(2): 211-220
Kim, S. and H. Lee. 2006. "The Impact of Organizational Context and Information Technology on Employee Knowledge-Sharing Capabilities". Public Administration Review. 66(3): 370-385. Klaas, B. A., M. Semadeni, M. Klimchak and A. Ward. 2012. "High-performance Work System
Implementation in Small and Medium Enterprises: A Knowledge Creation Perspective"
Human Resource Management 51(4): 487–510.
Lane, P. J., J. E. Salk, & M. A. Lyles 2001. "Absorptive capacity, learning, and performance in international joint ventures." Strategic Management Journal 22(12): 1139-1161.
O'Flynn, J. 2007. "From New Public Management to Public Value: Paradigmatic Change and Managerial Implications." Australian Journal of Public Administration, 66(3): 353-366 O’Flynn, J., Vardon, S., Yeatman, A., & Carson, L. 2011. "Perspectives on the Capacity of the
Australian Public Service and Effective Policy Development and Implementation."
Australian Journal of Public Administration, 70(3): 309-317
Osborne, M. 2004. "Making the Most of the Best: Formulating a Knowledge Management Strategy for a Government Advisory Body." Australian Journal of Public Administration 63(3): 43-52.
27
Polanyi, M. 1966. The Tacit Dimension. Doubleday and Co., Garden City, NY.
Rittel, H. W. J. & Webber, M. M. 1973. "Dilemmas in a General Theory of Planning." Policy
Sciences, 4: 155-169.
Ryle, G. 1949. The Concept of Mind Hutchinson, London, U.K.
Sanderson, H., J. Thompson and J. Kilbane. 2006. "The Emergence of Person-Centred Planning as Evidence-Based Practice." Journal of Integrated Care, 14(2): 18-25.
Smith, A. E. 2016. "Knowledge by Association: Communities of Practice in Public Management."
Public Administrative Quarterly Fall, 656-689.
Smith, R.F.I. 2004. "Focusing on Public Value: Something New and Something Old." Australian
Journal of Public Administration 63(4): 68-79.
Stancliffe, R. J. 2002. "Provision of residential services for people with intellectual disability in Australia: an international comparison." Journal of Intellectual and Developmental
Disability, 27(2): 117-124
Stoker, G. 2006. "Public Value Management: A New Narrative for Networked Governance?" The
American Review of Public Administration, 36(1): 41-57
Tsai, W. 2001. "Knowledge transfer in intraorganizational networks: effects of network position and absorptive capacity on business unit innovation and performance." Academy of
Management Journal 44(5): 996-1004.
Weber, E. P and A. M. Khademian. 2008. “Wicked Problems, Knowledge Challenges, and
Collaborative Capacity Builders in Network Settings. Public Administration Review, 68(2): 334-349.
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Knowledge management strategy
Person-Centred
Approach Sustainability of change
Person-centred principles support
data collection
Evidence-based decision making aides
in knowing the client
Stable and sustained change supports the uphold of PBS principles
Understanding of core PBS principles supports sustainability of change
Consistency in data collection results in knowledge growth
Knowledge retention and sharing fosters sustainability of change
