Davidson (2016) explores whether the culture of modern day palliative social care leaves room for leadership, considering the extent to which the profession embraces and enables leadership, the associated challenges and risks, and presents a call for Specialist Palliative Care Social Workers (SPCSWs) to actively engage with the concept and application of leadership in practice. Whilst focused on palliative care, the research raises important questions about perceived tensions between social work values and the conception of leadership; and in doing so offers relevant insights and reflections for the wider-profession. This blog reviews this research and argues that whilst adding to available literature, the necessity of radical, political leadership in the current social work climate is understated. Further, the blog will contend that not only is leadership a necessary component of the profession, but that leadership and social work values are indistinguishable and inseparable.
Davidson presents a key challenge facing palliative care (and by extension, the profession as a whole). How to provide high quality care to a growing population (where complexity is amplified in marginalised groups)? Several well evidenced assumptions are made, specifically that end of life care (EoLC) needs improving, efforts are being made to so, social work has an important role to play, and that there is a risk that SPCSWs may be excluded from this process. To explore the extent to which the culture of palliative care social work impacts on the opportunity for SPCSWs to serve as leaders, from the perspective of social workers, Davidson undertook a qualitative interpretivist study in which 6 identified leaders within the profession engaged in semi-structured reflective interviews. Responses were thematically analysed to provide a 4-dimensional framework (leadership, cultural, historical and political influences) for a literature review and discussion points. The findings and conclusions provide insight into the state of leadership in palliative care and highlight a number of issues represented across the profession:
Social work as a profession may be reticent to embrace leadership, with SWs being excluded (and self-excluding) from leadership roles – roles which are especially limited at macro level.
Social work values can create conflict. Person-centeredness and leadership are seen as incompatible, with an uncomfortableness with a systemic approach at the detriment of the individual – despite social work knowledge and skills being conducive to systemic approaches. A lack of leadership role models and development opportunities exacerbates this divide, which is further entrenched by residual statutory and organisational preference for the voice of the medical profession.
Evidencing merit and worth of palliative care interventions and processes is challenging in a managerial environment which favours positivist outcome measurements and instruments. Positivist approach to evidence is a challenge to the broad movement away from medical model hegemony towards a more social model of death and dying.
Davidson concludes that a lack of presence at a strategic level creates risk to the profession, with the space likely to be filled by others – social work leadership is needed to avoid this.
The research is not without its limitations – small sample size; findings open to interpretation; minimal reference to other sources of information; researcher bias implicit in Davidson’s ongoing role as a SPCSW and; a circularity to the argument (leadership is missing – respondents confirm assumption – therefore leadership is missing).
However, methodological contentions aside, the research offers a rich vein of exploration for social workers especially when considering the role values play in the identified leadership vacuum, and in catalysing reflection on the nature and professional conception of leadership. The tension identified, between person-centred approaches and systemic leadership are worthy of specific consideration, especially given the current economic and political climate in which the profession serves.
Leadership is an integral aspect of professional guidelines and expectations, but the research suggests a conception of leadership within the profession which conflicts with person-centred values of empowerment and enablement, in which the client is in charge and SWs are a tool to support self-determination and direction. Furthermore, that systemic approaches inhibit a practitioner’s ability to support the individual. Both conceptions are contentious and fail to recognise the mutually inclusive nature of leadership and social work values. Indeed, the political aspect of leadership – and a full recognition and acceptance of the inherently political nature of social work – are largely absent from contemporary constructions of leadership. But leadership is not directing people. Nor does managerial leadership equate to leadership (i.e. the predominant pursuit of organisational goals). Leadership is inherently relationship-based, focused on people, and considerate of both micro and macro level perceptions. Consider:
‘Leadership is and must be socially critical, it does not reside in an individual but in the relationship between individuals, and it is orientated towards social vision and change, not simply, or only, organisational goals.’ (Foster, 1989)
Replace ‘leadership’ with ‘social work’ and a workable definition of the profession, which reflects values and expectations can be found. This concurrence is furthered when we consider the radical traditions of active policy shaping which have cumulatively contributed towards the ongoing pursuit of social justice. Social workers have been leaders in changing government policy to defend human rights and to tackle oppression and discrimination. Ensuring that such statements can be made in the present tense is both explicit and implicit in our profession’s values. Given Davidson started the research from the challenge of providing high quality care in an increasingly complex environment, it can be said that the conclusions presented do not go far enough. Rather than an opportunity for SPCSWs to participate in strategic leadership, it is a duty of our profession to do so. Using our voice politically to lobby for changes to social policy, using our breadth and depth of knowledge and skills (both systemically and individually) has never been of more pressing concern. As the population of those needing palliative care continues to increase, and complexity of intersecting factors from gender to ethnicity to escalating incidents of poor mental health continue to multiple, social workers – across the profession – must take account of growing social inequalities and the impact of political decision making. If we can’t use our voice to be leaders now, what does the future hold? Rather than asking whether the culture of social work leaves room for leadership, we must take it upon ourselves as individual agents, and a collective force, to make room. It is time to rethink leadership in social work.
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