Today, there is considerable pressure on organisations to work in a user-centred way. There is talk of user involvement in social services, of schools being pupil-centred and of patient participation in healthcare. The user should be able to have a say and influence the process. The point of user-centredness is not that the user should lead the service process – that is still the role of the staff member – but that it should be based on the user’s needs, motivation and resources.
“User-centredness often leads to improved quality for the user and provides the necessary support, resulting in satisfied users who do not require further services and a sense of doing meaningful work among staff. This can be seen as part of the development of our democracy and is a form of co-creation. But it is one thing to say that there is pressure on organisations to work in a user-oriented way and quite another to ask whether they are capable of doing so”, says Pernilla Danielsson.
In her thesis User Orientation in Welfare Services: Challenges from a Public Service Logic Perspective, she investigates whether we can work with user-orientation, not what it is or whether it is good. It turns out that there are still many obstacles.
“Something that surprised me is that I thought it worked better than it actually does. There are too few conditions in place to work with user orientation within the organisations. My research was carried out in units that want to work from a service perspective, which had the ambition to work in a user-oriented way. Yet it was so difficult. Even if there are forums for resident participation, for example, decisions aren’t made there. There are also many decisions that aren’t feasible. There’s a lot of pressure to work in a certain way, and when it can’t be implemented, it leads to workplace issues.”
Barriers and challenges
In reality, the user does not have particularly great opportunities to influence things. For user-centredness to work, it requires a curious, attentive approach to the organisation, where the user is given the opportunity to say what could be improved, and where the organisation is given the opportunity to create solutions tailored to the individual. Unfortunately, there is a limited number of solutions offered by organisations, which also restricts the exploratory phase of the meeting. When staff meet users, it is often already too late in the decision-making process.
“The fact that it does not work today is partly due to a lack of organisational conditions, which leads to superficial user-centredness.”
Fragmentation, preconceived decisions and limited mobilisation of relevant stakeholders and resources mean that resource integration does not work. It becomes too difficult to successfully create new solutions based on what needs to be improved from the user’s perspective.
The user-oriented initiatives that are undertaken are usually driven by the individual employee, not the organisation. Often, the employee has to reinvent the wheel, with the risk of getting it wrong or facing reprimands. Danielsson wishes to emphasise that the manager is key to enabling user-centred approaches. User-centred approaches do not occur solely in the interaction between the employee and the user, but must permeate all levels of the organisation, from political decisions to working methods.
“I noticed that when managers prioritise it, employees prioritise it too. When employees are given more freedom regarding how things should be done, and when their work is sought after and followed up, it also becomes a priority. Today, a lot of the burden falls on the frontline employee who meets the user, without changing the entire system at all levels. But this is not just a frontline issue.”
Another problem is conflicting demands.
“If we look at healthcare, for example, it is supposed to be equitable throughout Sweden whilst everyone must also consider the opportunities available locally. Bureaucracy and politics say different things; budgets vary. These conflicting demands mean that standards fall. The service perspective, and thus user-orientation, becomes difficult to fulfil.”
The thesis leads to a further development of the theoretical frameworks surrounding service logic and resource integration. It helps to advance the field of research within Public Service Logic. It also contributes to increased knowledge of user-orientation. The thesis also offers a practical lesson for professionals.
“You can’t just push this; you also have to create the organisational conditions. It isn’t just the front line’s responsibility to ensure it happens.”
However, improvement is not impossible.
“I still think there are opportunities; if we can incorporate user-centred work at all levels, we will have the conditions required to create a deeper user-centred approach, which will hopefully lead to positive effects such as more efficient services, better alignment with what is demanded and needed, and an increased sense of meaningfulness for employees,” concludes Danielsson.
Thesis defence April 24
Pernilla Danielsson defended her thesis on April 24. Faculty opponent was professor Per Skålén from Karlstad University.
