Frontline home support workers and change to consumer-directed care – the service triangle, power, subordination and alienation, an Australian context

Author: Graeme Payne

Payne, Graeme, 2020 Frontline home support workers and change to consumer-directed care – the service triangle, power, subordination and alienation, an Australian context, Flinders University, College of Business, Government and Law

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Following a recent legislative change from an agency-directed care model to a consumer- directed care model across the Australian community aged care sector, this study examined the effect of the change on frontline home support workers. Consumer-directed care transformed the relationship between the provider organization and aged clients allowing clients greater choice over service provision. This study found that home support workers, while remaining subordinated to their organization as an employee, functioned in a significantly changed and challenging work environment.

Adopting a typology proposed by Havard, Rorive and Sobczak (2009) and theory from Lopez (2010) relating to frontline service work and the service triangle, this study examined home support workers’ perceptions of power and feelings of subordination and alienation during the period of change to the new model. Their perceptions of openness to the change, supervisor support and job satisfaction were also examined.

Two qualitative studies triangulated with two quantitative studies addressed the research problem. Using a two-phased sequential exploratory mixed method research design, a qualitative phase (Phase 1) first gathered data from senior staff and home support workers (n=31) in three not-for-profit organizations. Data were evaluated using template analysis (N. King, 2012) Outcomes from the qualitative study informed the development of a questionnaire for home support worker participants from five organizations, including the first three organizations (Phase 2). The questionnaire was conducted on two occasions, 2016 (n=172) and 2017 (n=174). On each occasion, home support worker participants were invited to complete an optional open-ended question. The open-ended responses in the questionnaires were compared to discover whether there was consistency or change in the perceptions home support workers between the initial stage of the implementation (2016) and a year later (2017). A linear multiple regression analysis of the 2016


questionnaire data and paired-samples t-tests of the 2016 and 2017 data were also conducted to triangulate respectively with the Phase 1 qualitative study and the qualitative comparison of the open-ended responses between 2016 and 2017. A new measure quantifying power and subordination/alienation was developed and validated, which represents a significant and exciting contribution to theory.

This study found that, in the transition to consumer-directed care, home support workers perceived an increase in power to their role, but at the same time, experienced feelings of subordination and alienation that impacted on their client relationships and work attitudes. This illustrated the complexity of power transfer within the service triangle, which, in the case of consumer-directed care, ostensibly occurred between the organization and the client, but, as this study found, notably included the home support worker. Further, this study examined power and subordination transfer through the perceptions of the frontline service worker, rather than through the prism of organizational policy, thus deepening understanding of frontline service work and relationships within the service triangle. Using service triangle theory, this study makes theoretical and practical contributions. It is expected that findings from this study, including the validated measure, will be of value to the community aged care sector, the wider health sector and government policy-makers.

Keywords: aged care, consumer-directed care, home support workers, not-for profit, organizational change.

Subject: Business thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Business, Government and Law
Supervisor: Greg Fisher