Aplicación del procedimiento específico para mejorar el nivel de servicio al cliente en

The NHS and in particular, mental health services by their nature are required to be preoccupied by safety and risk reduction in relation to the people who use their services and in some instances the wider public. This can be a legitimate function of their role, but a culture of risk and safety can also raise issues in the conduct of research. In terms of conducting discursive research I was interested in collecting data that were as close to what would usually occur in a CPA review meeting as possible. As part of the recruitment process, care co-ordinators made the first approach to service user participants about potential involvement. The selection of which service users were suitable was left with the care co-ordinator and the wider clinical team. This process was designed with the idea of allowing the team to make decisions about the ability of people to be able to consent to take part. However it is open to the risk that professionals could choose not to ask service users who are able

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to consent but may disagree with their care or potentially embarrass the individual professional or the service. The result being that access is granted by the clinicians to a sub-set of meetings that are chosen by them as being acceptable. Indeed, this kind of professional veto on participation may still occur even if all eligible service users were asked to participate as each professional must also give their consent before a meeting can be recorded. The potential risk being attended to here is the risk to the professional; which is tied in with a threat of surveillance currently being felt by some in the NHS due to recent scandals like Stafford Hospital and government reorganisation.

I was given cause to reflect on the nature of the risk felt by clinicians in terms of being under professional surveillance by a comment made by a member of staff at a team meeting I was attending to explain the research. Having explained the recording of the meetings she asked me if I was working for ‘Panorama’ or ‘Dispatches’. This was treated as a joke by her and her colleagues. However the risk that being recorded doing your job conjures up appears to be the same as being filmed by Panorama; being exposed, blamed and your competency questioned. The pressure apparently felt by health service staff to appear competent places them in a position where they may select uncontroversial service user participants to take part in a ‘good’ meeting. The NHS Trust I collected data from was undergoing a restructure and that change may account for some of the fear of surveillance, however I feel that it was perhaps just a more heightened expression of a more general fear amongst NHS clinicians. Recent inquiries like the one at Stafford Hospital have meant that the competence of health professionals is under scrutiny in

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the media and the feeling I had got whilst conducting my research was that there is a reluctance to risk having your own or your service’s competency questioned. Research, like discursive studies, that look at what clinicians say and do can be construed as threatening because clinicians are made a part of what is under study. Traditionally the ‘studied’ in health settings are the service users not the staff. This conjures an idea of the ‘invisible clinician’ in healthcare; with improvements coming from the study of service users because they are the people who are ill. People are more familiar with a concept of illness being something which is individually located and therefore the ‘ill’ are the people who need to be studied. This view is particularly problematic in mental health, where the very concept of diagnosis is contested and psychological and social understandings of people’s issues are well developed.

A minority of service users who were given a participant information sheet declined to take part, those that did take part were enthusiastic about the research. This could have been due to the selection of participants by the care co-ordinator, but what was interesting was they seemed to grasp the potential use of the study more easily than some professionals. I had assumed that the reverse might be true, so I reflected on why this might be the case. Potter (2005) describes a discursive psychological approach as one built on five main points; psychology as practical, accountable, situated, embodied and displayed. The discursive psychological approach is argued as one that, through these five points, makes psychology relevant to people by focussing on ‘psychology from the position of participants’ (Potter, 2005 p740). Perhaps the service user participants in the research I undertook saw the relevance,

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from their position, of looking at the CPA review meeting in detail. Clinicians through their training and expertise claim access to knowledge and understanding and through this comes power. Any study that examines the way interaction unfolds can also serve to foreground the power relations between the participants. This is potentially uncomfortable for health professionals working in what they see as a ‘caring profession’, where power may not always be acknowledged or made visible. Making psychology relevant to the people who use mental health services seems to be a particular strength of discursive methods and this is achieved through the topics and interests of researchers using these approaches. However, factors like the methodologies and terminology used can make dealing with discursive research rather hard to negotiate. It is to this point, introduced at the start of this paper that I now turn.