Tuesday, July 24, 2007

Microphobia

AB 1427 is a bill, now in suspense (whatever that means) with provenance that may as well be SEIU (it is not, per se, a union bill but close enough for blogging standards.) It contains no real mechanism for organizing and discussions with opponents, including one I had with a good friend yesterday, typically involve concerns around incrementalism. The fear seems to be that if the union accomplishes something in legislation around this system that the next step will be more invasive and followed by the eschaton.

Many who know me and the few who read this blog may remember that I don't love this bill. But I do think it's a small thing and unworthy of vigorous opposition. Change works best in small steps and if incrementalism is a fear advocates indulge in, a frozen system that can't improve is the natural result, kind of like the one we already complain about. While we are counting increments to fear, here are some the bill contains, other than a unionized workforce:

1. Accountability. The evaluation scheme outlined in the bill seems a little questionable to me, requiring comparison to a control group but offering no incentive or mechanism to establish that control group. To call the evaluation outcome measurement one has to assume that better-trained, longer serving staff automatically lead to better outcomes, which is not unreasonable but is still a process measure. Despite the flaws, the proposal is the first in a while that attempts to measure its own success. If this bill passes, actual valid quality accounting might become a standard part of our system in my niece's lifetime, although it would be rash to presume that it will.
2. Professionalism. From many perspectives, receiving healthcare benefits and regular training units can be more or less indistinguishable from professionalism. Professionalism does not grow more vigorously in a culture of CEUs, like mold in agar, but it is at least true that training and benefits can confer the appearance of a professional class. If the pilot project is successful in making staff more professional-seeming, there is a risk that one day the cowardly lion, tin man and scarecrow will end up agency executives if they aren't already.
3. Incremental Incrementalism. AB 649, a massive, systemic goliath of a bill failed. Last year, a more ambitious predecessor to this bill failed as a gut-and-amend amendment. If AB 1427 passes, we must be concerned that eventually, massive labor unions, trade associations and other special interests will put forward bills encouraging italicization of ambiguous words using permissive language.

5 comments:

paul said...

“Many who know me and the few who read this blog may remember that I don't love this bill. But I do think it's a small thing and unworthy of vigorous opposition. Change works best in small steps and if incrementalism is a fear advocates indulge in, a frozen system that can't improve is the natural result, kind of like the one we already complain about.”

Well said, and worthy of repeat.

Indeed, CEUs and various window dressings can, as you have said, “confer the appearance of a professional class”. However, this reality does not follow necessarily. Behind the CEUs and window dressing there can exist a real professional, but Yes – To be called a professional, more is necessary.

I am more than certain that the definitions and descriptions of the 'professiona' interesting within the walls of the Acropolis. Regardless, it would be unfair to dismiss our history. That history states that some “body of knowledge” is needed before a person can be called a professional. Luckily for us our history does not indicate the size, shape, and type of body that must exist. Can the ‘body of knowledge’ exist locally and be finely tuned to local needs? Sure. Can it be, and sometimes must be, centralized and bureaucratic. Perhaps. While the latter allows pilots to transport thousands of passengers to far destinations and across crowded skies, the former decides where our water comes from and how it can be used. The former might also be able to offer some improvements to the services that we provide to our consumers. Unfortunately, many choose to be unfair and simply call staff Direct Service 'Professionals' thinking that if they use DSP enough somehow Professionals appear from thin air.

Yes, if we allow ourselves to view this bill as our panacea then we may someday find the scarecrow, and perhaps the witch of the west in charge. However, should our metaphoric misfortune become reality is AB1427 to blame, or will our misfortune be the result of a myopic view that entices us to believe that a piece of the puzzle is the complete puzzle? As a side note I believe that in some locals, especially day services, our trio is in charge and our advocates spend much effort screaming, "pay no attention to the man behind the curtain"

“If AB 1427 passes, we must be concerned that eventually, massive labor unions, trade associations and other special interests will put forward bills encouraging italicization of ambiguous words using permissive language.”

Argumentum ad metam aside it is true that we should always be watchful of ALL legislation, especially legislation that takes one, two, or three steps backwards. This is true regardless of the sponsor and promoter of the bill. We should also be mindful of the providers that are irate about 1427 and see no conflict in asking a consumer in need of the services provided to protest alongside. “Here is water, here is food, and by the way how do you feel about this ‘awful’ bill” A wise man once said, “we are not always sure that those who advocate the truth are influenced by purer principles than their antagonists”.

More often than not the slipper slope argument is fallacious. I do not think that is the case here. However, today we have only the camel’s nose in the tent…if that. Furthermore, today’s unions, relative to history, are not massive or very powerful.
Just about EVERY providers would rather NOT deal with another player at the table, especially a quadruped. So, the provider screams, “watch out! It spits”. The union seeks to increase its numbers and influence and states that our quadruped is, “..great transportation for our parched environment”

Personal and profession gain, and other less laudable motives, are apt to operate amongst those who support as well as those who oppose any idea. This is the case irrespective of the quality or value of the idea. The providers and the workers have their unions. We can only hope that the a blance of power might result in a few scraps for the consumer.

Doug said...

Paul, I'm less worried about the camel with nose in the tent than the saracen on its back.

I think the slippery slope argument is ridiculous often enough that I'm prepared to be wrong whenever it's right.

A cloven hoofed quadruped at that.

paul said...

Doug,

AB1427 states that, “The evaluation shall compare participating agencies to a control group of nonparticipating agencies.”?

As a result you opine that the bill, “require[s a] comparison to a control group but offering no incentive or mechanism to establish that control group.”

The control group is previously established by the fact that the pilot does not now exist and therefore EVERYONE is currently a nonparticipating agency. AKA the ‘control group’ is the status quo. Since motivation to establish the status quo is somewhat oxymoronic the only logic conclusion I can make is that you believe that there is a possibility the EVERY provider within the pilot catchment area WILL participate and we will be left with no ’non-participants’ to serve as a control group? Thus we need an incentive to prevent EVERYONE from jumping on the bandwagon? This seems like Scenario Impossible.

How confused am I?

Doug said...

One of us is fairly confused. The control group will have to provide data on staff, turnover rates, client outcomes(!,) etc. without compensation and with some concern for confidentiality. As you point out, though, the number of agencies not involved will include a large number to choose among.

paul said...

One of us is fairly confused.

I do believe that I am the confused one here.

There is no difficulty establishing the control group, but I agree that there will be some cost to retrieving the dependent variable from the control group. The bill states that, “Participating agencies shall maintain data that establishes a baseline and tracks ongoing data on wages, benefits, retention rates, vacancy rates, and costs of turnover for their direct support and supervisory staff.”

Indeed, without requiring the control group to maintain similar data the evaluation will be less valuable, but not valueless.

The alternative is difficult as well. If you require similar data from the control, and compensate them you risk contamination of the control.

But - rats, mazes, and cheese is not my forte