Measuring what Matters
What’s the purpose of classifying things? We do this every day – we use it to make sense of our world. At its most basic, it is about pattern recognition and realising that some things are similar and some are not. This can be distinguishing between adults and children, birds and bees, stones and trees. These are not necessarily contentious but classification systems can be more contentious – describing ethnic background, gender preferences, diagnosis in healthcare. These systems are designed with a purpose and sometimes an underlying framework. Whether we agree with these or not, it is important to understand the system and its functions.
Systems often reflect prevailing or dominant ideas and concepts. They are important as they are often used in the determination of resources. This leads to measurement. We measure things all the time – is there enough milk for my cereal or coffee? How many service users are booked in for appointments today?
So is it good or bad? Well that depends on how it is used.
Is what is measured what matters? It’s been argued that what is measured doesn’t have a direct relationship with what matters.
An example of this is that people on average have 8 sessions of a particular therapy and on average they all improve on a questionnaire. However, that doesn’t tell us the variation between those people. Some will have had more than eight sessions, some will have had less. Some will have improved on the questionnaire and some will not. Some may have got worse. Do we know what the questionnaire actually measures? What do we mean by improvement? Is it the right questionnaire to use?
Sometimes what matters may not even be measured at all. An example of this is the psychological professions. Sometimes, some of us are included as Allied Health Professionals and sometimes we are not included at all. Sometimes, we are counted as Additional Clinical Service or even sometimes as Psychotherapists. There is no real consistency around this.
Why does this matter? It matters because we then become less visible or if we’re not included at all – invisible. We don’t then know, for example, how many counsellors are employed in a certain area nor what training they have or development they would benefit from. If we don’t know this then how can we know how many counsellors we might need to deliver services and the planned expansion of services in the NHS Long Term Plan (LTP)? If we don’t know what we need for service delivery then how can we hope to offer psychological interventions to services users in a timely and consistent way?
Another feature of this is staff surveys where psychological professions are coded inconsistently (clinical psychology or psychotherapy) or not at all (listed under Allied Health Professions). This means we don’t have a voice in workplace wellbeing. Surveys by professional bodies (e.g. BACP) and the New Savoy Partnership have tried to address this.
Training and development opportunities often do not include psychological professions in their promotional material so most of us probably would assume it’s not for us. When I’ve queried this, I’ve often been told that it is intended to include us but the promotional material doesn’t always change. This then perpetuates the invisibility.
There have been improvements to coding systems over the years but it has been a very slow process. Sometimes, coding systems are not effectively implemented and this perpetuates the invisibility.
So what do we do about it? I have not found any easy wins. I have found some people really willing to listen and work with the PPN to change things. I’ve also found people who ignore and dismiss the importance of this. Increasing the size of the collective voice can help. As individuals, just asking the questions and keep asking the questions does make a difference. It takes all of us to do it to create that voice. With PPN we’ve come a long way but we still need to continue the journey. If we can all use our opportunities to keep asking the questions then we do make the differences. As psychological professionals, we know change is hard and it can be slow but it can really be worth it.