Performance Management of the NHS' Mental Health Care Service Delivery in England: The Role of the Service' Actors' (Clients) Collaboration through Dialogism

Abstract

A welfare state has a responsibility to provide health and social services to the citizenry. The state delegates that responsibility to a number of actors, each of which has its own performance management criteria. To ensure coherence, it is important to manage their performances collectively taking into consideration all the actors inputs rather than only that of government or its agent, the NHS. This turns out to be a difficult task especially that of the mental health care services. The author will be looking at a possible solution to this problem based on the assumption that it is possible to change the way the actors present their stories by bringing them together to share their purposes and common action through the notion of dialogism as way of maintaining plurality of logics: different voices (polyphonic), styles (stylistic), space-time conception (chronotopic), inter-animating discourse (architectonics) and the dynamic interplay of these different dialogisms (polypi). It is this process of plurality of logic that the researcher termed, the Third Cybernetics Evolution, as a way of sequential processes from the First Cybernetics through the Second Cybernetics to the Third Cybernetics. It is argued that implementing these, allows for improved communication among actors, as a way of achieving high quality service. It is suggested that implementation of these concepts and processes implies the use of storytelling as a facilitatory system. It is shown that all actors in the mental health care services delivery make use of this system, albeit often inefficiently. Therefore this may lead to dissipation of the system in the future. To prevent such dissipation, the existing structure needs to be improved through spiral relationships via communication and collaboration through dialogism. The paper aims at flagging the important role played by the weaker actors in collaboration with stronger actors in improving performance management of the NHS's mental healthcare service delivery through Actors-dialogism-system. The paper also focuses on proposition of a system to address issues affecting collaboration among the actors of the mental healthcare service in England.