The importance of tacit knowledge in practices of care.

BACKGROUND: The paper argues that a high quality personal relationship between professionals and clients is a necessary condition of professional knowledge. This epistemological claim is developed against the background of current methods of quality assessment that rely on objectively measurable 'indicators'. METHOD: A philosophical analysis regarding the nature of professional knowledge in the care sector. The analysis proceeds from Michael Polanyi's concept of tacit knowledge to account for the personal dimension of professional expertise in the care sector. RESULTS: Quantitative methods of quality assessment understand 'quality of care' as being independent from the professional who generates it. Consequently, quality assessment as currently practiced necessarily renders the personal dimension of professional knowledge invisible, thereby excluding it from managerial attention and support. To indicate the relevance of Polanyi's concept of tacit knowledge, the paper offers some observations from the practice of care in a group home for people with intellectual disabilities. CONCLUSION: The paper concludes that a high quality relationship between professionals and their clients is crucial for quality of care. This relationship generates the positive interaction that enables professionals to gain adequate insight in the needs of their clients.

The transformation of human services.

BACKGROUND: Recent studies in the development of professionalism suggest that western society witnesses a transformation of professional practices in human services that deeply affects how professionals experience their work. This paper describes key aspects of this development and presents an account of how it can be explained. METHOD: The paper offers a review of the main features of neoliberal managerialism as it is found in the literature. The paper does not assume a meta-theoretical perspective on this literature but rather presents an account on the level of description of what the literature interprets as a transformation of professional practices. Its method is therefore to report the main features of what the literature describes as neoliberal changes in human services. RESULTS: The review results in an account of the transformation of professionalism in human services that shows two sides. One is that of opposing logics that present the tensions between professionalism and managerialism in terms of conflict. The other side is that of compliance of professionals who seek to find their way in the new realities of a neoliberal service economy. CONCLUSIONS: I conclude that neoliberal managerialism presents serious challenges to professionals in human services to remain faithful to the values of their profession, and that these challenges--on the level of neoliberal society--raise a serious issue about social (dis)trust.

Internal and external goods: a philosophical critique of the hybridisation of professionalism.

BACKGROUND: Recent literature on professionalism describes the hybridisation of professional practices because of the pressures of neo-liberal managerialism. While the general opinion appears to be that this development was inevitable given the task of service organisations to operate on the market, this paper questions that blurring the distinction between professional and managerial responsibilities is sound business advice for market-orientated service providers. METHOD: The method is philosophical analysis. A normative account of 'true' professionalism is discussed in order to determine the relation between professionalism and managerialism. By placing this account in the framework of Aristotelian moral philosophy, three distinctions are presented to argue that professional practices will most likely be successful in managerial terms when the internal values of professional practices are not mixed up with the external values of the service organisation. RESULTS: The analysis results in an argument about economic value as a contingent 'by-product' of professional expertise. The outcome is the prediction that professional activity will be most responsive to organisational goals implemented and monitored by management to the extent that professionals are enabled to serve the goals internal to their profession. Professional excellence will be most profitable when professionals do not have to mind about being profitable. CONCLUSIONS: Neo-liberal managerialism assumes that making professionals share managerial values of accountability and transparency will improve both the economic performance of service organisations and the quality of their services. The argument concerning the contribution to these values by professionals as a contingent by-product of professional excellence shows that this assumption is questionable.

[The post-whiplash syndrome: don't treat, but unravel]. / Het postwhiplashsyndroom: niet behandelen, maar ontwarren.

There are two phases in the postwhiplash syndrome. The first phase (following a sufficiently serious accident) is characterised by pain in the neck caused by soft tissue contusion. In this phase, an explanation and the advice to start moving the neck again gradually after a brief period of rest are sufficient. If this phase is followed by a transition to complaints that can no longer be explained by the physical consequences of the accident, we speak of a chronic postwhiplash syndrome. In such a case there are factors besides the trauma that either induce the complaints or cause them to persist. Unless these factors are eliminated (the biopsychosocial model), the chance of success of any form of treatment is slight. There are indications that therapies directed at aspects of behavioural psychology can make an important contribution to recovery.