The question we should all be asking
After reading about another example demonstrating how we can design our public services differently:
“The question I’m asked most is why don’t we run public services like this everywhere? Prof Donna Hall.”
I cannot let this great question rest, as it lies at the heart of the efforts of so many people in the public sector, and in the voluntary groups around the country. But most of all, it is impacting the most to those in need of support.
When I and others have helped a public sector service to transform in the way that Donna is describing, two things happen. After some months or years they either revert back to how they were. Or, the work remains an isolated island within that organsiation.
The answer I witness are, that Public sector managers would love to work this way, but;
1. They are confounded by the reams (box fulls) of compliance that they have to align with. It is not possible to follow this and align to do what matters for those in need.
2. Those managers have a list of priorities, and necessarily, the top ones are ‘how can I run my service, but only with the budget that I have, (that is not enough to deal with the basic problems)?’ There is no room for sitting back and redesigning, they are in crisis mode and have been there since the start to austerity.
3. The services do not have the preventative support they used to have anymore, so demand is rocketing up, and services cannot keep up.
4. The number of staff in their service is not enough to do the minimum work, so they have the terrible job of deciding what not to do.
5. As a manager, ‘I am now doing the work that three managers used to do several years ago.’
6. We used to have backfill to cover holidays and long term issues. Young managers dont even know what that is anymore!
7. I am simply exhausted, I am even working when I am on holiday. I have to look after my mental health.
New Public Management is a paradigm inserted into the public sector in the 1980’s. It defines the current system as we know it, unfortunately its principles are quite inappropriate for public services. So, whatever good work a manager does, it will eventually get washed by the waves of the prevailing mindset. There are now many instances have now demonstrated that replacing New Public Management changes all the above.
To go back to the point, the answer to this question is the only one we should be asking of those public sector decision-makers. It is the only one, because no other question, or initiative, or political party, will create the public services we should have, until we truly understand this. Oh, and by the way, we already understand this, so what is stopping us? Thats a question for another write-up!
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I have to add an extra part to this article here, as the NPM thing is so important.
I find that when older people who were around before NPM, when I start to work with them, they eagerly throw away their NPM shell, and revert back to the way of thinking that they had before.
With those who are younger, and perhaps their first role in say health and social care, they soak in NPM that is around them in all the systemic aspects of the organisation. Over time this becomes endemic and oozes into their bones to such an extent, that they cannot understand of alternatives.
In some recent work with health and social care, I took some nurses, physios, and occupational therapists and they had to learn now to sense-make and understand a citizen holistically. They had always used assessments when they engaged with citizens and knew no other method.
The task is simple, go to someones house, engage with them, to understand and build trust. Then together, discuss further issues that may be connected. A classic highly complex situation. When they began to do this, they could not fathom how to do this without the assessments, and they insisted in having them close to them, just to reduce their anxiety. And, as they were so uncertain, they went in pairs.
One would ask the questions, and the second was there to observe and feedback on how will this worked. They were both quite terrified.
When they returned, they undertook a long structured debrief, that highlighted a list of issues.
You and I could do this at a drop of a hat, as the main aspects to this was not about clinical expertise. They initially hated this as they found it so stressful!
They then repeated this until they got to place of repeatability, and it took them TWO WEEKS before they could do this in a way that they are at least somewhat comfortable.
When they looked back, after a few weeks, they realised how stuck they had become in the old system, completely submerged in a paradigm they had not realised. They then realised how difficult this was and why it is so difficult for others, when it is so challenging to change one simple aspect of their work. For a manager it was far more challenging. Once they had got through the breakthrough of this learning, they became accustomed to observing the principles of NPM, and they were able to more easily push back against them when they continued to encounter it in them.
As Keynes said: “The difficulty lies, not in the new ideas, but in escaping the old ones”.
You can learn more more about how to tackle these issues in my workshop https://www.improconsult.co.uk/service-design-workshop-systemic.html
