Public sector reform of local government and health
From the experience of the past decades we can now agree that reform of the public sector is an essential requirement and a priority. Based on that experience and the evidence gained through real tested alternatives, here is a multi-level framework that provides a systemic view of what needs to be considered for a value driven, mission focused effective public sector.
My journey into the sprawling public sector landscape has immersed me in the reality of public service, experiencing what it is like for fellow people to live in our diverse communities, understanding how the multi-layered aspects of our lives challenge so many of us at various points in our lives. And also learning how our public sector is structures, how it actually works, how it is managed and its behaviours. While also exposing me to the perspectives of local government in its various designs of ‘services’, power dynamics, and support. Uncovering the link this has with policy making. The patterns that we have today are evident are a myriad of silos, misaligned incentives and bureaucratically applied power over others, that point to a system that is suffering from its own chronic disease.
The evidence
Since the 1980’s the public sector in many countries decided to try out a fundamentally new way of working, which we now call New Public Management (NPM). This is based on the notion of a way of working that is more efficient, that is based on private sector principles, where competition is used to drive efficiencies, and where people are seen as customers. Regardless of what we individually think about how appropriate this is, we now have plenty of evidence that demonstrates its ability to create a better, leaner public sector. The simple answer, is that it has failed. This failure is despite the huge amounts that have been spent on improving the current services — we are still in a downward spiral.
- Demand is rising for support and health.
- Services are increasingly stretched.
- Prevention activities have been almost eliminated.
- People are certainly not more satisfied with their lives and their communities.
One of the fundamental issues that we have in place today is a focus on reductionism in the design of our public services. Reductionism is characterised by the splitting up of end to end processes into discrete services and departments, individual targets that drive sup-optimisation, managers that manage numbers, the assumption that value created can be quantified, this is based on the paradigm that supporting people and complex public health services can be designed as though it behaves like a mechanistic design of individual services. The roles of people working in those services are designed into fit standard expert processes. As a consequence of focusing on short term activities and reducing visible costs, we have created the perverse behaviour where demand and costs are rising, due to self inflicted causes.
Many of us have seen and are now actively developing a fundamentally different approach.
The systemic reform framework
The opposite of reductionism is systems thinking. Here, we look at the whole, and work backwards into the detail. We understand how things work by making sense of what is going starting with the human perspective. Value is understood in ways that are real to people. Prevention is seen as the primary achievement of the purpose of the public sector, as it avoids and supports people from falling off the balance that we all hope to have in our lives.
We know the cost of everything, but the value of nothing
Oscar Wilde
My conclusion from systemic research and immersing myself observing the patterns of thought and behaviour at multiple levels within the system hierarchy, is that systems change needs to be thought about on at least a 4 systemic levels:
1. Mission. Purpose-oriented, solution-driven, and shaping. A new wholistic pragmatic vision and policy design approach for politicians, policy makers and leaders.
2. Paradigm. A new systemic paradigm & principles, replacing the reductionism of New Public Management, that focus on value, people, communities, and prevention. Fostering a new way of collaboration and systemic action together with citizens.
3. Organisation. A new organisation metaphor that calls for a new way of managing, responsive local teams, and designing by learning and strength based working. That aligns with the complexity of the reality of the public sectors ability to create value.
4. People & communities. A balanced relationship between the public sector and the value it creates by engaging authentically with people. Moving from ‘power over’ to ‘power with’. Focusing on the ability to catalyse supporting people and wellbeing to live their own lives free from handouts, strengthening communities to self sustain.
Mission is defined by the strategic direction and where the vision resides as to what the health service is about. This is defined by leadership derived from the true purpose of our local communities and health. The way it is described is through statements which represent the focus as would be described by those that it serves. And the mission is made up of other, more detailed statements, that together make up the whole. The mission has to be understood and directly actionable at every level of the whole system.
Paradigm refers to the primary model or theory that the principles that we define of how we understand and design our public services are derived from. Currently, the prevailing paradigm is referred to as New Public Management (NPM). NPM, developed in the 1980’s, is based around the paradigm of private sector business and management models. It focuses on citizens as the recipients of the services, mirroring the customers as a consumer. Its focus is efficiency and good service delivery. It can be recognised by decentralised service delivery models, financial control, value for money, increasing efficiency through identifying and setting targets and continuance monitoring of performance. Control is enabled by handing over power to senior management. Performance is assessed with audits, benchmarks and performance evaluations. NPM commonly uses competition through private sector companies, to deliver what were formerly public services. More recently, NPM is also the ideology of increasing efficiency through the use of digital service design.
The mechanisms of NPM are in legislation, guidance, policies, government and political ruling, the definition of measures, and the allocation of funding.
Over the past decades there have been numerous examples of alternatives to NPM.
Organisation is the body of expertise that we see as a service type. Elements of health and local government provision are examples of such organisations. They are the mechanism by which the public sector is structured and operates. This is where value is created, and it therefore the hub through which the principles of the paradigm are actioned in our communities and with individuals. Over time the influence of the paradigm through to the organisation is the rise of a type of management thinking and action that is derived directly from NPM, based on measuring activity and compliance to rules, documenting actions, the creation of fixed job roles, the standardisation of work through service delivery, the design of individual specialist departments, the minimising of risk, and the use of digital technology as a primary communication mechanism.
People and relationships is the interaction and influence that the public sector has on individuals, families, and communities. This consists primarily of human, power based and behavioural concepts that then create the reality of people. It is both the most important, and most elusive level, in that this is where the engagement and value is created between each group, trust is developed, and knowledge resides. The formal mechanisms of data, costing, and other logical mechanisms are hardly relevant here.
All of the above, taken together, points towards a locus of control that is based as close to where the work occurs as possible.
‘Local by default’
A layered mission focused public sector reform framework
The levels are not distinct, but are simply four different areas of focus of the whole system. Each level is intertwined with the next in such a way that each feeds into each other, and none can be understood or developed without all the others.
mission focused public sector reform framework
These are steps that repeat:
Step 1 is where we learn about people in their communities, and experiment with new ways of working.
Step 2 is where we redesign our levels based on evidence and what we have trialled with new ways of working.
Approaching the implementation
If we managed to fundamentally shift the whole direction of the public sector in the 1980’s, then we know it can be done. We can do it again. Rather than go towards New Public Management (NPM), we need to remove NPM and design a new paradigm. Some of us have been doing this over the past decades, struggling against the stormy waters of NPM, whose force keep our small experiments from scaling into something bigger. Those stormy waters need to be calmed before we can venture into those new territories.
