‘Empowerment is a reflexive activity, a process capable of being initiated and sustained only by the agent or subject who seeks power or self-determination. Others can only aid and abet in this empowerment process…by providing a climate, a relationship, resources, and procedural means through which people can enhance their own lives.’ (Simon, 1990, p.32) The above quote aptly, sums up critical role of both the user and the public service manager in facilitating the process. The current essay uses my role as a public sector manager in empowering the community on Personal health insurance. It focuses on the ‘Power levers’ (Kakabadse et al., 1988) in an ‘Empowerment Continuum’ (AMA, 1991) framework.
‘Power Levers’
There are different types of power including reward, coercive, legitimate, personal expert information and connection power. (Kakabadse et. al., 1988)
‘Empowerment Continuum’
The ‘empowerment continuum’ involves engagement of the user and the public service provider in a continually progressive process. It is divided into four distinct but progressive stages of information, consultation, participation and delegation. (AMA, 1991)
‘Empowerment Continuum’
1. Informing:
The insurance scheme covered three villages that had no medical facilities. It involved provision of daily outpatient care in the villages by a visiting team of doctors from a medical institute where I worked. An on-call ambulance service was available for patients requiring hospitalization. The nominal insurance cost covered all the treatment costs. As a public service manager, ‘Information power’ was used in informing the potential users about the insurance scheme, type of services, their availability and where and how to access them. The information was in an accurate and in an easy to understand format. The ‘information overload’ was avoided by not giving too much information. ‘Personal power’ was added by face-to-face communication and a direct, personal interaction, as it was a good way to inform and to ensure that message has been correctly received. A feedback mechnism was established through the village council. It ensured that the ‘intended users have received the key information and it conveyed the intended meaning.’ (Willis, 2007) Thus the ‘information power’ was not allowed to become ‘one-way communication by the simple device of providing superficial information, discouraging questions, or giving irrelevant answers.’ (Arnstein, 1969)
2. Consulting:
Initially after the project was started, the response was encouraging but soon it faded away. It was decided to use ‘Expert power’ the power of specialist knowledge, to provide opportunities for consultation by encouraging the users to give their opinions and feedback on the available services and on those that are required. The villagers were consulted on the type and quality of services and if they were agreeable on the model of service provision and the cost of insurance. It emerged that users felt that their initial feedback not been incorporated into the scheme. It was a copybook situation of ‘hearing but not listening’. (Dibben and Bartlett, 2001) It seemed like we had ‘decided to build an acute unit and [were] then consulting on the colour of the furnishings.’(Sayce, 1997) There was thus a gap in what the villagers perceived they would get as services in the insurance cost and what was provided by the hospital. The ‘Expert power’ of the manager was utilised to decide what could incorporated from the consultation process. However this consultation was continuously needed, therefore, it was honestly explained to the users extent to which they made a difference, to policies and practices. The ‘reward power’ was used to give adequate feedback and recognition to the users for their input. The users felt that their consultation was contributing to service improvement. It was to avoid a situation, as one of the respondents to consultation questionnaires had said, ‘nothing ever happens with those damned questions, except the surveyor gets $3 an hour, and my washing doesn’t get done that day.’ (Arnstein, 1969).
3. Participating:
Within a few months of consultation process, the Insurance scheme again gained momentum. The number of users exceeded the expectations and there was demand for extending it to other villages. It was then decided to solicit help from existing users in running the scheme. The ‘Legitimate power’ (power provided by statute) was used, to empower the users by allowing participation in the process of service provision. The ‘information power’ was also used to inform the users on the available avenues for participation and clarifing their role, as participants. To make sure that the users measured up to the task the ‘Expert power’ used to impart the requisite skills to the users through training. It built confidence in the users, for effective participation and helped them to pick from the various available choices. As the management of the scheme went into the hands of the users, there was resistance from the staff in the organisation, to user participation. The ‘connection power’ (power of knowing people) and the ‘coercive power’ (power to discipline within organisation) was used to ‘change values and perceptions of the service providing staff in accepting user participation and user decision making.’ (Birchall, 1998) It required a lot of ‘Connection power’ to avoid the ‘participation gap’ (Lowndes, 2001) and to help new participants to break-into already established groups. The participants decided on what new services were to be started and what charges were to be levied. They monitored the quality of the services and gave feed back on the same. There was thus a meaningful user participation in service provision, as the users to be expressed their views and their views carried weight. (Deakin and Wright, 1990) The users were ‘aware of their real interests’ during these opportunities for participation in decision-making about services. (Lukes, 1974)
4. Delegating:
The next step in the process was delegation whereby the users would become active ‘co-producers’ and my ‘expert power’ would act as a catalyst in training the user group to enable them to take responsibility for the critical decisions. However, delegation, which was the most advanced stage of empowerment, was not possible as it was limited by the level of ‘Legitimate power’ that I as a manager possessed. Although it did not mean setting up of an alternate system of service provision, the available policy framework and the legislative capability did not provide scope for delegation. Delegation or user control was also limited by the capability of the user groups to undertake delegated work.
The entire process of empowerment is examined through a matrix below (Willis, 2007).
Manager’s Role Informing the users/ stakeholders Consulting with users/stakeholders Participating with users/stakeholders Delegating
Control to users/stakeholders
Planning
Information by posters/leaflets/brochures/ e-mail about forthcoming proposals, taking feedback Questionnaires/ surveys for requirements, needs Users help to do need assessment, co-decide on service provision User based Plan/policy formulation
Monitoring of Implementation
Information/ feedback about funds spent/ progress of project Surveys/interviews for service delivery, further requirement, altering/enhancing services Users co-decide the service, help to monitor and modify Users co-produce & monitor the service
Evaluating
Information/ feed back on service performance and quality
Surveys, consultation for evaluation on program quality, need fulfillment, shortcomings Users assist to evaluate, assess and modify the services Users evaluate and modify the service according to needs
A matrix depicting the different roles of public service manager during the empowerment process (after Willis, 2007)
Fulfilling expectations
With increasing awareness, the service user groups are seeking greater involvement in services with higher levels of participation. (Birchall and Simmons, 2004) This happened in our case also and the users wanted larger participation. The ‘legitimate power’ had to be used to limit participative work, to the extent it fitted in the existing professional and legislative framework. The local village politicians were vocal and persistent on gaining empowerment on behalf of the villagers. The ‘information power’ and ‘expert power’ was used to avoid the ‘professional users’ (Campbell, 2004), as these activists were not the real service users and were not in contact with their constituency. Although there was a temptation to ease off the pressure, but this would have resulted in empowering the wrong people.
Other insights gained
During the course of this empowerment analysis I found that a manager may use legitimate, expert and information power to create suitable conditions for the empowerment of the users however, as the old saying goes, ‘you can lead a horse to water, but you can’t make it drink’. I also learnt that the, ‘the manager has to aware be of the predicament that, ‘as to not just why the public should be involved, but also why they would want to be involved.’ (Corrigan and Joyce, 1997; Sweeting and Cope, 1997) Individual service users may decide ‘not to be empowered based the current perceptions of the process or past experiences.’ (Birchall and Simmons, 2004) The public manager has to cautiously balance the information, expert, legitimate powers between the customer, citizen and the community, and ensure that there is ‘no imbalance in empowering one and disempowering the other.’ (Clarke and Stewart, 1992) However, ‘it is naive to believe that there will be unanimous agreement among service users with regard to their expectations’ (Leslie et al., 1998). I learnt that the manager however might use ‘Expert power’ to attempt a closer the fit between service user expectations and decisions made, to provide a higher the sense of empowerment to his users.
Further, it emerged that the manager has to be very careful with the process of empowerment, as it can easily turn to one of ‘disempowerment.’ The appropriation of the ‘Expert power’ by professionals as a critical part of their role may cause ‘disempowerment.’(Baistow, 1994) This can result in ‘professionally defined and service-focused approach in which service users have little say and control’ (Pease, 2002). Disempowerment can also occur at ‘any level of the administrative process, where service user input and its impact disappears into a ‘black hole.’ (Holosko et al., 2001) The manager has to maintain a delicate balance between legitimate, information, reward and personal power. The manager therefore has to establish a procedure of accountability alongside the process of empowerment. (Deakin and Wright, 1990) Accountability helps to maintain a check on the ‘power balance’ of the service provider and gives ‘information power’ to the manager through feedback, on the quality of the services.
Conclusion
To conclude, empowerment is about giving information to people so that they know their rights, supporting people to consider their options and make their own choices and decisions. The power flows from a public service manager to the users groups to empower them. The public service manager may use the Information and Expert power to start the empowerment process by user involvement through information and consultation. This may be enhanced to a more effective level of user-based decision making through user choice by using legitimate, connection and reward powers. Finally, there may be involvement of user capabilities to ‘co-produce’ the service. However, the role of the manager in empowerment is does not end with the users feeling empowered; rather it is a continuous process of not a few steps but the whole journey.
References
AMA, (1991) Quality and Contracts in the personal Social Services, (London: AMA)
Arnstein, S. R., (1969) A Ladder of Citizen Participation, Journal of American Institute of Planners, 35(4), pp. 216-224
Baistow, K. (1994) Liberation and regulation? Some paradoxes of empowerment, Critical Social Policy, 14(3), 34–46
Birchall, J., (1988) Building Communities: the Co-operative Way, (London: Routledge)
Birchall, J., and R. Simmons, (2004) User Power: The participation of users in public service, National Consumer Council, (London: NCC)
Bryant, M. (2001) Introduction to user involvement, The Sainsbury Centre for Mental Health, (London: SCMH)
Campbell, P., (2004) From Little Acorns – The mental health service user movement,
In Beyond the Water Towers, The Sainsbury Centre for Mental Health, (London: SCMH)
Clarke, M. and Stewart, J., (1992) Citizens and Local Democracy, Empowerment: a Theme for the1990s (London: Local Government Management Board).
Corrigan, P. and Joyce, P.,(1997) Reconstructing Public Management: A New Responsibility for the Public and a Case Study of Local Government, International Journal of Public Sector Management, 10(6), pp.417–32.
Deakin, N., and Wright, A., (1990) Consuming public services, (London: Routledge)
Dibben, P. and D. Bartlett, (2001) Local Government and Service Users: Empowerment through User-Led Innovation? Local Government Studies, Vol.27, (3), pp.43–58
Holosko, M.J., Leslie, D.R. and Cassano, R. D., (2001) How service users become empowered in human service organizations: the empowerment model, International Journal of Health Care Quality Assurance, 14(3) pp. 126-132
Leslie, D.R., Holzhalb, C.M. and Holland, T.P. (1998), Measuring staff empowerment: development of a worker empowerment scale, Research on Social Work Practice, 8 (2), pp. 212-22
Lowndes, V., Pratchett, L. and Stoker, G. (2001), Trends in public participation:
Part 2—Citizens’ perspectives, Public Administration, 79(2), pp.445-455
Lukes, S. (1974) Power: A Radical View, (Basingstoke: Macmillan)
Mayo, E., (2005) Empowerment for All, National Consumer Council, (London: NCC)
Pease, B. (2002) Rethinking empowerment: a postmodern reappraisal for emancipatory practice, British Journal of Social Work, 32, 135–147
Simon, B.L. (1990), Rethinking empowerment, Journal of Progressive Human Services, 1(1), 27–39.
Sweeting, D. and Cope, S., (1997) Modernising Local Democracy: Democratic Innovations in Local Government, Local Government Policy Making, 23(5) pp.61-82
Sayce, L., (1993) Mind's Policy on User Involvement, (London: Routledge)
Willis, M., (2007) Service Effectiveness: MBA Course Pack, (Birmingham: IDD)
