The service triangle and power: the role of frontline home support workers and consumer‐directed care—an Australian context

• Date: 01 March 2019
• Author: Greg Fisher,Graeme Payne
• DOI: http://doi.org/10.1111/irj.12247
• Published date: 01 March 2019

The service triangle and power: the role of

frontline home support workers and

consumer-directed care—an

Australian context

Graeme Payne and Greg Fisher

ABSTRACT

Workplace relational dynamics change when the customer or client takes on greater

power in the relationship. Adopting a typology of the service triangle, this qualitative

study examines frontline home support workers’perceptions of their power, following

recent legislative change from a traditional agency-directed aged care model to

consumer-directed care.

1 INTRODUCTION

A quiet revolution is going on in Australian community aged care, with the sector undergoing its biggest

shake-up in 25 years. (Hamilton-Smith, 2016)

Economic and quality-of-life imperatives arising from the growth and increasing lon-

gevity of their aged population (Bloom et al., 2010) have driven developed countries

to apply intensified attention to strategic reform of the long-term aged care systems.

Strategies include a shift to the provision of services under models of consumer-

directed care for the aged and disabled who live in their own homes. Over the past

30 years, developed countries have typically moved from traditional agency-directed

models of care to commodified client-centric models of consumer-directed care. While

agency-directed care vests power in the organisation, consumer-directed care,

underpinned by the consumer-directed theory of empowerment (Kosciulek, 2005;

Kosciulek and Merz, 2001), shifts control and power to the client (Benjamin and

Matthias, 2001; Low et al., 2011; Ottmann et al., 2013; Swaine, Parish, Igdalsky

and Powell, 2016; Ungerson, 2003).

As part of a long-term aged care reform package and following trial and evalua-

tion, the Australian Government legislated a change from the agency-directed

traditional model to consumer-directed care, with the aim of empowering aged people

and encouraging them to remain in their own homes as long as possible. From 1

August 2013, all newly released consumer home care packages were delivered on a

consumer-directed care basis, and from 1 July 2015, this was applied across the

community aged care sector. From 17 February 2017, clients became further

❒Graeme Payne, College of Business, Government and Law, Flinders University, Sturt Rd, Bedford

Park, Adelaide, SA 5042, Australia and Greg Fisher, College of Business, Government and Law,

Flinders University, Sturt Rd, Bedford Park, Adelaide, SA 5042, Australia. Correspondence should be

addressed to Mr Graeme Payne, College of Business, Government and Law, Flinders University, Sturt

Rd, Bedford Park, Adelaide, SA 5042, Australia; email: payn0111@flinders.edu.au

Industrial Relations Journal 50:2, 197–213

ISSN 0019-8692

© 2019 Brian Towers (BRITOW) and John Wiley & Sons Ltd

empowered to select their own care provider organisation, with private for-profit

competition entering a market-based system (Department of Health, Australian

Government [Department of Health], 2015; 2017; Department of Social Services,

Australian Government [Department of Social Services], 2015).

The foci of this article are frontline home support workers who are essential to the

effective delivery of consumer-directed care services. These home support workers are

recognised as the ‘eyes and ears’(Stone and Dawson, 2008) of the long-term care

system. Literature describes the role of frontline home support workers internation-

ally (Ashley et al., 2010; Boris and Klein, 2012; Manthorpe et al., 2010; Moran,

Enderby and Nancarrow, 2011), before the introduction the consumer-directed care

model in the Australian community aged care sector (Clarke, 2015) and after (Palesy

et al., 2018), which, typically, is to assist clients with daily living, including personal

and hygiene assistance, domestic duties, community inclusion, social support and

recreational activities. In the current study, home support workers identified changes

to their role as a direct consequence of change to the new model of consumer-directed

care. This represents an important finding.

Research on the Australian workforce and consumer-directed care model is limited

to perceptions of the professional managers, coordinators and home support workers

of the effect of the model on their day-to-day work (Gill et al., 2017; Laragy and

Allen, 2015; Payne and Fisher, 2018; Prgomet et al., 2017; You et al., 2015). Lawn

et al. (2017a) and Lawn et al. (2017b) examined future enhancement and skill

development of the home support worker role. There appears to be little research at

either an international or Australian level, which examines home support workers’

perceptions of change in power in their own role during a period change to a

consumer-directed model. The purpose of this current article is to fill this gap.

Research in this article draws from the foundational work of Leidner (1993, 1999)

and subsequent research, which changed the concept of frontline service work from a

conventional dyadic employment relationship to one of a triadic relationship that in-

cludes the customer or client as the third player in the service triangle (Bélanger and

Edwards, 2013; Bolton and Houlihan, 2010; Havard et al., 2009; Lopez, 2010;

McCammon and Griffin, 2000). Conceptually, a typology of the relational or service

triangle proposed by Havard et al. (2009) was used. The typology concerns power and

subordination change and the diversity and complexity of the work in employment

situations created by the involvement of the client (Havard et al., 2009, p. 273).

Other researchers also acknowledge that, in the context of service work, three

parties, employer, worker and client, ‘shape the workplace control dynamic’. Impor-

tantly, they also recognise that in most care work (including that in the current study),

‘a fourth player also shapes the service relationship, namely the funding

agency/government sector’(Baines and van den Broek, 2017, p. 126; see also Baines,

2004; Charlesworth, 2012; Cunningham and James, 2009). As a funder of most care

work, the government sector operates as ‘a powerful actor shaping managerial

practices, including the terms and conditions of contracts, output measures and

competitive performance management processes’(Baines and van den Broek, 2017,

p. 126). The government grants the power, and the triangular relationship operating

within the organisation becomes a zero-sum power game. This article focuses on

relationships in the service triangle and the effect of the transition to the new

consumer-directed care model of care amongst the three players within the organisa-

tion. Particular emphasis is placed on change in the power of home support workers

during the change to a new model of consumer-directed care.

198 Graeme Payne and Greg Fisher

© 2019 Brian Towers (BRITOW) and John Wiley & Sons Ltd