In search of quality

This review of The discovery of quality. Theory and practice of relational caring, the latest book of professor Andries Baart, appeared in the December issue of Optentia News Letter (North West University South Africa).

Though this book on quality of care is in Dutch (De Ontdekking van Kwaliteit, Amsterdam SWP 2018), the review may be interesting for non-Dutch readers to learn about the issues raised and the model developed by Baart with regards to monitoring and evaluation of relational care.

On 21 June the latest book by Prof. Andries Baart was published with the title The discovery of quality. The theory and practice of relational caring [De ontdekking van kwaliteit. De theorie en praktijk van relationeel zorg geven]. Since, the first edition is already sold out and a second print is in process. No wonder with reviews that describe it as: An impressive book with sharp analysis underscored by a grounded and rigorous empirical foundation. The publication is the outcome of a research project that stretched over the past nine years during which Andries has developed a (middle range) theory and an operational model for providing, monitoring and evaluating relational care.

“Main stream quality systems are not (or hardly) able to properly observe and appreciate relational care …”

Mainstream quality systems are not (or hardly) able to properly observe and appreciate relational care because they are oriented to ‘objective’ norms and values. This is generally the case although most care practitioners will also acknowledge that care is mainly ‘good’ in a particular con-text, in a specific situation, at a determined moment in the ‘tangible’ life of a particular person. The book analyses less known problems within modern quality systems and step-by-step develops an alternative approach, based on three pillars: (a) relationality or situatedness of judging quality; (b) the cultivated, self-regulating consciousness of quality and (c) the practical wisdom of the professional caregiver. To tease out these concepts, the author broadly analysed the literature of the last two decades – national and international. Drawing on the conceptual foundations as deduced from the investigated literature in part one, a second part deals with the operationalisation of a detailed and innovative model of four normative layers:

  • humanness (level of the client);
  • solicitude (level of the professional);
  • hospitableness (level of the organization), and
  • justice and decency (level of societal paradigms).

Each of these points of entry into the model is framed by a ‘little philosophy’ and subsequently elaborated on with concrete and observable examples of qualities of care and social welfare. In part three of the book the model is boiled down into ‘working sheets’ with which professionals, managers, CEOs, financing and inspecting shareholders may start an inquiry into the quality of specific projects, cases, and programmes of service provision in the domain of care and welfare. Practical do’s and don’ts are added, based on many years of experience in the field.

This radical innovative book has – which is remarkable – two prefaces: one of the highest functionary of the governmental Inspection and Surveillance Health Care (the inspector general) and the other of the CEO of the National Centre of Expertise for Long-term Care in the Netherlands (Vilans). They both applaud the book for its innovative (conceptual) approach to care, recommend it and admit that working through it is hard work. Be warned! This is a serious piece of work and no page turner…

About the author: Jaco Hoffman

Jaco Hoffman

Jaco Hoffman is associate professor, Optentia Research Program at the North-West University, Johannesburg, South Africa and a James Martin Senior Research Fellow at the University of Oxford, UK.
He researches intergenerational dynamics and coordinates the African Research Network on Ageing (AFRAN) and the Society and Environment Research Cluster at the University of Oxford. His research interests revolve around intergenerational and care issues in sub Saharan Africa.

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