Failure in public sector – The Reprise

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I read Vim‘s article on What Does Failure Mean for Public Services  and I wanted to respond. I wanted to build upon Vim’s thoughts from my own perspective. I’ve developed that perspective over a couple of decades working across front-line teams and supporting teams, transforming workforces across public and private sector. This results in me having to balance many different levels of change (including success and failure) ranging from a conversation discussing funding allocations over £100m, followed by a conversation discussing attitudes to change, shortly followed by another discussing the approach for very local decision-making such as choosing the ideal location for a printer.

It’s mostly the same

We should see failure in the public sector in the same way that we see failure in the private sector with the one, not so subtle difference; the public sector is there to make a difference to the population. Pick a public sector service, if it’s not making a positive difference to the population, then it’s failing. I can’t think of a simpler definition. Every other private sector metric (perhaps with some tailoring in the case of profit metric) should apply to the public sector.

Unfortunately, the more we pick it apart, the more difficult it becomes to define failure. And most of that difficulty comes from the difference between providing for the population and providing for an individual.

Most of the failure is seen at the individual level, but not extrapolated quickly enough to realise that the service is failing. Most of the success is also seen at the individual level but we don’t really celebrate these as much unless they’re specifically health-related. For many services, we only notice when they go wrong. For instance, how many local authorities celebrated 0 people in the queue for social housing back in the 70s when it was feasible? Perversely, we may be able to achieve 0 in the queue now, but that could be because eligibility thresholds have risen. It’s not the same service or the same level of service anymore.

At one extreme, we see the death of an individual, we see one person homeless. Then we see multiple people homeless due to congregating together, but it takes longer for social consciousness to become more aware of the deaths of increasing number of individuals. All of this could be failure.

Criminal or Incompetent?

“He’s either criminally incompetent or incompetently criminal”

It’s a phrase I heard years ago from a charitable organisation that raised no money after holding an event where lots of people attended and money changed hands but no profit was made to turn into funds for the charity. We’re talking small money here, margins were very tight, but even so, no-one quite knew what happened.

That’s partly how I think about the systemic failure within public services although I’ll broaden the definition of criminal to include unethical, immoral or against the mass of service users you’re meant to be serving. When a service is failing, I wonder where the decision was that caused it to fail. Was someone competently unethical or incompetently ethical? Competently immoral or incompetently moral? Bear in mind that leaves out the options of competently ethical (where they’ve chosen to improve services and made it happen) or incompetently unethical (where they tried to restrict services but enacted it poorly).

Was it an implementation or management decision by the team manager to assign a lesser-skilled worker to the case where a more experienced one was required? Implying incompetence on the manager’s part.

Or was it because there wasn’t enough money to pay for more experienced workers, resulting in only newly-qualified workers being available? Implying a deliberate decision to underfund on the funder’s part.

Did the funder underfund because they’d allocated more funds to other services? implying an incompetence on the funder’s part.

Or did that funder not have enough money to distribute to the services because of a reduction in centralised funds, e.g. from central government? Again, implying a conscious decision to underfund numerous services.

Expectations

Public services are funded to meet the demand that’s expected to present to that service, e.g. through referrals from other services and bodies, through walk-in or through outreach (where the team goes out educating the population on the service available). It’s always a balance between who is at most need of the service, the funds available, the skills and experience of the team available and the time available to respond.

Considering public services have a duty to provide for the population, if a service cannot meet the demands placed upon it, who is criminal and who is competent/incompetent?

The manager should understand the costs of the service and the variation based on demand being presented. At the point that it becomes underfunded, it’s time to shout. For many services, that point was passed many years ago. Underfunding results in some people not being served or the quality of service (in terms of what can be provided, e.g. the duration of engagement such as number of CBT sessions) is reduced. That then has a further human impact, e.g. people being homeless or in debt which both can lead to homeless and in debt, which leads to decreasing health, which leads to inability to work (but possibly not recognised as inability). Even one day of no service provision can escalate quickly, exacerbated by the climate of mistrust and unbalanced power between those services with funds and those people applying for funds. That one day can result in missing benefits, resulting in deteriorating health (have to choose between rent, paying heating/lighting bills, feeding children and self, getting to a job interview, clothing, etc). So underfunding a service so that it can’t provide to all it’s designed to deliver to has a cascading effect on the system through shifting referrals elsewhere or to a position of no services available and has a cascading effect on the individual.

When viewed that way, is the funder criminal (or at least unethical or immoral) if they don’t fund the service?

Reducing Inefficiency

The issue and opportunity to this point over the last couple of decades has been the inefficiency inherent in the public sector system. Public sector services do not get the same level of investment as private sector. A telco can choose to spend multiple millions of pounds on a transformation programme and it will happen. No questions (or at least no scrutiny other than board approvals and monitoring). A public service has to jump through many hoops (each costing time, effort and money) to prove it’s spending the money wisely. So public sector transformation programmes usually start smaller than private sector counterparts to make the programme easier to approve, and end up being smaller still after being watered down through many approval boards. Each of these transformations leaves an effect, usually positive in terms of efficiency, but often negative in terms of morale and capacity to flex for the next transformation.

There is still room to go in terms of efficiency. There are still pockets with severe inefficiencies, but they’re rarely on the front-line teams to the scale that’s expected. And it’s these teams that are usually the focus of funding pressures, especially in response to changing demographics, e.g. people living longer and living with more serious needs.

Active Maintenance

In addition, services need active maintenance, to some extent in the same way that you take your car in for regular maintenance. However it’s more than that. Active maintenance is not simply day-to-day management and keeping it running. It’s observing the service from multiple angles to understand what’s happening that shouldn’t be, to uncover why it’s happening and to resolve it so it doesn’t happen again. That takes an investment of time and energy.

In most public sector hierarchies that responsibility falls to the manager. The better managers (there are a few of them) have empowered their team to do this daily. They’re succeeding in keeping the service to acceptable levels (although still probably underfunded to do the job they were originally tasked to do) and keeping ahead of changes in demand. Then there are others who are just managing the day-to-day or take on adapting to change themselves. Even if competent as day-to-day managers, they’re incompetent overall since the service remains static.

Failed Culture

Vim mentions that “Failure in the public sector is also rooted in a culture that means you can’t fail”. The issue is wider than that. It’s already failing. It’s already underfunded. Austerity or not, there isn’t sufficient money to meet front-line services at their current level of demand in the way that they are currently working. Asking a team to be prepared to fail is an awkward request since in their hearts, they’re already aware of the people they’re not able to help. Most of the professional health colleges put a focus on treating the person in front of you, not those in the queue later on. Give proper treatment to the person that you’re currently treating. In a throughput setting, such as a hospital ward with a flow of patients in and out, that makes sense. In a setting where you have a caseload, such as found in most social care settings, that makes less sense overall. The opener to this conundrum of supply and demand is that we may be able to help more people and help them better than now through experimentation. And that has to be allowed to fail. 

Even with that opener, bear in mind that there are ethical considerations in most public sector departments, especially those in education, health or care settings. The Authority has a duty to treat everyone from an equitable position, not necessarily equally. So it can’t create an experiment that disadvantages a customer segment. This can be inadvertent, e.g. by promoting one customer segment’s needs, it alters that principle of equitability. So by improving the service for one segment, it can’t make the rest of the service worse. It’s also widening the gap between the treatment of segments. That’s not a blanket “no”, just be prepared to think it through and complete an Equalities Impact Assessment before you start.

The First Draft

Running with Knickers on Your Head

I’m pleased to announce that the first draft of my book on achieving change in front-line services is available. It’s been many years in the writing as I’ve changed direction a couple of times, adapted to newer, emerging methods, but recognised that the core of the book is still as pertinent now as it was when I started writing it.

It’s the first in a series of books. The rest should be significantly quicker to appear and will cover more strategic elements. This is the practical book for anyone.

I’ll be launching the book on Amazon, initially for Kindle, however there’s a chance to get it for free. I’ll put details up soon.

Contingency as a Behaviour

plumbing
After a late evening fixing a plumbing emergency at home, I’m reminded of the concept of contingency and how it can’t be practically be used as a buffer for all non-planned events.
 
So with my current main client, I start out early in the morning, long before must people (or birds) have risen. My wife told me about an hour before I was due to go to bed early in order to wake early that we had an issue.
 
Applying typical contingency management as found in most projects wouldn’t help. That’s the type where a task is estimated to take 2 days, so you add in some contingency for that task. What would have happened in that case? All the tasks had finished, we were effectively waiting for a deploy (ok, it was a deploy of one person to a train, so I’m stretching the analogy a bit)
 
Applying a buffer contingency may have helped somewhat, but again, the tasks had all completed, there was no buffer to call upon before the deploy.
 
House alarms/Burglar alarms encourage similar behaviours. You only discover that the alarm isn’t working when you come to set it on departing your house. Again, no typical contingency would resolve the issues.
 
In the above examples, we’d usually have to add more time for the journey in the morning (possibly even travelling the day before). But the more we do that, the more ridiculous the timescales become and the demands on those involved become more exorbitant to accommodate for any issues. Even with buffer management, at some point we’ve passed the point where the buffer can be applied.
 
The only alternative that I’m aware of for this type of issue is one of preparation. It becomes more about damage limitation. So in my example, have I prepared for what I would do if I have to remain at home, if the train is delayed or cancelled, if the my taxi doesn’t arrive on time, if my car doesn’t start? Those are more the failure modes, as can be explored using an FMEA matrix for example.
 
From that perspective, contingency isn’t just a buffer (whether applied to a single task or applied to the project), it’s a behaviour and it’s planning about what if. It’s about ensuring that you know what to do, have the resources to do it and can execute in the time required, at whatever time it happens.

How much is too much training?

Hospital ward
I’m divided in this, but lean towards only brief training, just enough to inform them, rather than enough to practice.
 
On one hand, it pays to understand why change in general is necessary and specifically, why the change that you’re about to implement is necessary. Often I see professionals who spend time with the person sat in front of them (and so they are patient-centred) but ignore the mass of people also requiring the same service. It’s not that they can’t see the queue (whether a real standing queue or a waiting list), it’s that if they recognise the queue then they realise that they can’t serve everyone to the same level. For some, it’s a question of professional ethics, where their professional body demands that they treat the person in front of them to the best of their ability, regardless of the needs of others. There are good reasons for that approach.
 
Usually, someone, e.g. a manager or budget holder, recognises the capacity issue and so increases the eligibility threshold or reduces the professional time available for that treatment. This is an attempt to average it out. However it misses the point that some treatments take time to work, if you half the time available, then you may get zero results, not 50% of the results had you allowed the necessary time for full treatment. It also leads to a worsening service as the capacity gets further reduced through a series of cuts, so that wouldn’t be the answer that we’d choose given a choice.
 
More fundamentally, the communities that the local and regional health providers serve are different to those that existed 30 years ago and the changed communities have different needs. So, it seems obvious that we have to adapt the service to meet the changed needs.
 
On the other hand, the health professionals are just that; professionals in health. There will be some with additional skills; some complementary, some tangential. I wouldn’t expect health professionals to be experts at change. However they do need to be aware of the change and why they have to contribute. As do we all, no matter what job we perform, no matter which sector we work in.
 
By recognising the above issues, we can more easily understand why we have to continually change. It’s a matter of adapting to needs. However that doesn’t feel like it requires a formal training in the guise of a university module, more an hour or so during induction combined with some questions during the interview to assess their attitude to change. I expect the professionals to know the service best, so they should be best placed to change it rather than having budgetary changes applied without thought to impact on patients.
 
To get this message across and gain acceptance and commitment from the group, I usually go through the need for change at the start of any change programme and definitely before each intervention.
 
One area where I think some training could be useful is in negotiating and debating how services will change. The changes will happen, but being able to influence the changes could be invaluable. Oddly enough though, it’s probably not the health professionals who need the training, instead it’s for anyone who’s trying to change the service, e.g. performance improvement staff, HR/OD, commissioners, etc.
 
I think the reason for my varied opinions above is that I see a difference between management and change management. I acknowledge that management techniques should be taught in advance as well as broad concepts of changes management, whereas the required, more detailed parts of change management can be taught as required.
 
I don’t believe we should conduct changes without speaking to the end customer. Taking on the role of patient, I’d much prefer the consultant to have spent their time learning how to treat patients, rather than learning how to manage change. Let’s permit some degree of functional specialisation, with front-line professionals continuing to be good at what they do and change professionals helping them create/design the service that the patients need.
 
However, I recognise that many front-line professionals either don’t have access to change professionals or do have access but that they’re not listened to. Hence the need for a book that’s applied for front-line staff.

Exclusive Relationships

Exclusivity

Have you considered the exclusivity of your relationships?

This follows on from the post regarding the value of the data and the priority attached to the relationship or the data. I want to further explore the value of the relationship and shine some light on a different approach.

The Scenario

It’s the same scenario as the previous article, imagine you’re in a store, purchasing a product and you’re asked for your email address. How do you respond? Do you have a default answer? When was the last time you chose a different response and what prompted that change?

Rationale

Email
Email

Depending on how you value your time, how you value access to your time (and distractions) such as providing your email or how you value the privacy of your email address, you’ll respond differently to the request. All of these are currency that can be traded:

  1. Your time
  2. Access to your time – this is different to (1) since it relates to an acknowledgement that there is a route to your time, but you can safeguard it. Whereas (1) is more protective of time as a resource or possession.
  3. The privacy of your email address

These can be traded for items in the following non-exhaustive list:

  1. Discounts – immediately applied
  2. Discounts – off future purchases
  3. A free product/service
  4. Entry to a competition
  5. An item/service that others don’t have access to

The one I’m interested in exploring further is 5.

Different Perspectives

Reserved
Reserved

Let’s consider two ways of thinking:

  1. A company asking customers for email addresses so they can email them once a week with slightly reduced clothing that the company wants to sell before it has to sell in bulk to a discounter, so that it can clear space for the new season’s stock.
  2. The concept of fashion store charging for admission, maintaining exclusivity and ensuring that the experience warrants charging for entry.

That first option is the one followed by the majority of companies. We have to question, just how big a financial incentive is required to gain valuable email addresses/contact details. After all, we primarily want to focus on those people who are most likely to buy. More than that, we want to focus on those that we can convince to buy more than they would have done. It’s a balance between offering enough to get people interested but to keep the discount percentage low enough you’re not losing out. Isn’t this the attitude of 95% of retail companies? But it doesn’t feel an equal relationship. We’ll continue to explore the impact on emails, but recognise that there are other, more modern and interactive channels available as well.

That second option introduces another concept that alters the relationship. It focusses on entertaining the customer, providing a valuable experience that the customer would pay for.

Now let’s extrapolate that further by using the same principles.

Can we develop a mailing list that people would pay to be on?

What would we have to offer that customer in order for them to want to pay to access it?

Following the fashion store concept from above, exclusivity is the angle. That fits (5) as above. Instead of a situation where the item of value is the email address and we request that item so we can use it as the channel to contact the customer/prospect, we end up with a situation where the email address becomes the channel but is offered to us (potentially along with payment) so that the customer can access the list. The relationship is reversed.

Nightclubs, restaurants and social clubs/business clubs have been using exclusivity for decades (and centuries in some cases). This isn’t new. Before email, there were postal lists you could pay to be on. Again, this isn’t new.

That relationship reversal then implies one of two choices:

  1. We provide a service centred on exclusivity and customers will pay to access that service via an email list. But the service/product is what they want access to. Or
  2. We provide a service that is in the email content itself. And customers pay to receive that email.

The first is similar to exclusive wine clubs, members clubs, etc. The channel isn’t important, it’s the end product that counts. There’s little value to the email itself; it’s a conduit or an access channel to the product. Some of the crowd-funding platforms such as Kickstarter blend the mass-market with the exclusive by restricting access to early adopters or sponsors.

The second is interesting because it would have to be a information-only service since it’s delivered over email. We’re then left with the question of what content could be provided with a degree of exclusivity and create a demand from prospects? For that, we can look to previous centuries (and the current century and stock market information). The value is in the effort, skill and knowledge involved in the financial analysis that isn’t in the email. Part of the perceived value is in the brand and reputation. Hence the existence of con artists creating ponzi schemes on the back of fabricated or incremental reputations.

Conclusion

We’ve covered the concepts of the items of value that a potential consumer could be traded, the items that they could be traded for, explored the idea of creating a chargeable service and how exclusivity could apply to that service.

Where does that leave us?

We could create exclusivity in our relationship with customers by restricting the size of the segment (e.g. first 100), we could offer that email for a cost, we could create a difference in the products/services specific to the segment or we could create an exclusive product where the channel communication itself is the product.

How accurate is your testing routine?

Traynor Guitar Amp

Testing is not just for software, but for the business processes, organisation or service that you’re implementing?

I’ve seen many test routines that are too artificial, too removed from the reality of what the users will go through. Fortunately this factor has improved over time, especially with more focus on user stories.

Let’s consider one of the best examples of testing I’ve ever seen. Guitar amps are generally fragile. They’re usually robust enough for scrapes and minor bashes as you’re carrying them through doorways, but they don’t survive being dropped down stairs very well.

One amp manufacturer had a test routine of removing the glass valves (they’re replaceable consumables) and then throwing the test amp from the roof of the building to emulate the journey that some amps go through. On the ground, they inserted valves and powered it up to see if it would work.

How does that compare to your test routine? Is yours as accurate to the reality that it will be used in?

Here’s a clip of the actual test

Art requires rigour, science requires creativity

RigourAndCreativity

I heard this quote the other day, but I didn’t catch who originally said it.

Art requires rigour, science requires creativity

The first point is that it’s contrary to the standard view. The second point is that both perspectives are valid and that there shouldn’t be that much of a difference.

It then made me think of typical transformation programme roles and the relation between creativity and rigour. Most roles have a balance between the two, with that balance changing according to the standard role and, at times, according to the demands on that role.

RigourAndCreativity
Rigour And Creativity

For instance, process analysts should generally follow a set of standards. Business Analysts have to be more creative, but still have methodologies to follow. Service Designers have less rigour methods, usually a composition of tools and techniques rather than the standardised methodologies of previous decades. At the more rigorous side, project managers have their methodologies and frameworks to follow. Programme managers see a wider scope and have more creativity in organising the interdependencies. Which then fits nicely with my normal comment that a Business Architect has more in common with a Programme Manager than a Project Manager; there are more skills in common, even though the professional methods involved are different. Which leads me to the Business Architect who has to know when to be standardised and when to be creative. There has to be the flexibility to modify the approach to suit the needs of the client, depending on the stage of transformation.