Failure in public sector – The Reprise

support-2355701_1280

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.

When is the Right Time to Change Your Mind?

When is the Right Time to Change Your Mind?

Reflecting
Reflecting

You have many opportunities in life and business to change your mind. Each of us has many opportunities, but we don’t always take those opportunities. We may be conforming to social constraints and expectations or don’t want to risk appearing inconsistent by changing too often. Let’s look at a non-serious example and extract nuggets we can apply in a business context.

1) The Background

I’m in a situation right now where I’m having to re-evaluate my aims. Fortunately it’s not a serious situation and there are a few parallels to my professional life. I play guitar and I own a few guitar amplifiers. Each guitar and amp has its own tonal identity and quirks. I pick the right tools for the job; playing in a 60s Motown/soul band requires different guitars and amplifiers than playing in an 80s hair metal cover band.

At a gig at the beginning of Summer this year, I played using a very nice amplifier and it sounded awesome with the band. I really enjoyed how it sounded and I probably played better because I was comfortable that it did the right job.

2) The Hypothesis

I thought that I could use the same amplifier with a few changes in my set-up (i.e. a different effects pedal or two) and I would again have an awesome sounding rig, but this one would be suited to the 80s hair metal cover band I’m currently playing in.

Two things to learn from this: Continue reading “When is the Right Time to Change Your Mind?”

Service Improvement Book – In Progress

Lean Service Improvement Book

After a year or so working with a large, complex client and some time before that working on a startup, I’m back to writing the book I started a couple of years ago.

Three good things have come from this break:

  1. Both of the experiences have confirmed that the book needs to be written. What I have seen in the last two years has proven to me that there is a gap and this book will fill that gap
  2. Both of the experiences have provided more evidence about which tools and techniques work well
  3. From a personal perspective, the break has given me more motivation to complete the book

I expect to be publishing in 2016.

Applying Lean Startup in the Public Sector

Yesterday, I presented at #Leanconf 2013 in Manchester. It was the first Lean Conference covering Lean Startup in Europe. There was a great energy to the 2-day event with a variety of planned and unplanned talks plus lots of opportunity to network without the usual tradeshow conference feeling of being stalked by sales managers.

I don’t think I’ve seen a community spirit like that in a long time; every attendees helped someone else no matter how far along their own ideas were.

Pivoting as used in Lean Startup in Public Sector
Pivoting as used in Lean Startup in Public Sector

In the spirit of the energy that I encountered at the conference, I’ve placed the slides on slideshare. If you download the presentation, you can read the notes which will help you make more sense of the slides. Hopefully the video will be online as well soon. When it is available, I’ll update and post a link to it. The slides are at bottom of this article.

Background to the Programme

The programme I discussed in the presentation was a 2+year programme with a large city council in England. The programme was internal to the portfolio that handled Adult Social Care. It had a £1m+ budget with a team ranging from programme manager, business analysts, data analysts and communications officer, plus a governance structure and other associated stakeholders.

The aim was to make Adult Social Care more efficient, by removing waste, focussing on flow and reorganising around the value to the customer. All typical lean concepts. We did this with a mixed method that I’d developed specifically for this client. The method merged elements of Lean with Lean Startup with DSDM and Theory of Constraints, all under a typical local authority governance framework using  Prince 2.

The scale of change was to alter the way of working of 200-300 social workers/care managers, their team managers, their business support plus associated teams. Most were involved in the change and took the opportunity to steer the change in ways that would benefit their service users. Additionally partner teams (e.g. those responsible for 1000+ support workers within the council, NHS staff, payments and contact centre staff) were brought into the process and contributed to the changes where possible.

Customer Development in Social Care

Due to the time available for the talk, I didn’t discuss Customer Development. I’d like to address that here. Firstly, my customers and those of the programme, were the workers on the frontline of social care. However, we also had a duty to their customers, i.e. the service users of the city and, wider still, the overall population of the city.

We used common Lean and Six Sigma techniques (e.g. Kaizenblitz, Voice of the Customer, Gemba plus interviews, workshops, etc) for understanding the wishes and activities of the frontline workers. The default position was always to go and visit the workers where they worked including a visit out to service users where possible and where permitted. There was no “ivory tower” mentality and as little desk-based research as possible.

I did want to get to the wishes of the end user, i.e. getting the answers to what mattered to the service users. We were able to do this through a service user forum and similar activities. Just to clarify, the forum is actually a real meeting, not an online forum. However the typical customer-development approach of “get out of the building” isn’t necessarily a good idea in this case. The reason is that any change has to be ethically sound; it can’t introduce discrimination nor can experiments (or MVPs from Lean Startup) that make the situation worse for those on that trial path.

The ethical dilemma is exacerbated further when you consider the concept of equitability in that any change has to be able to be applied to the entire population of service users if appropriate to them. So if you make a change to services in October, you’d better think about how you’re retrospectively going to apply those changes to service users referred back in April onwards. That could be as simple as a rule stating that they’d change at the next review point or it could be a specific project to apply it now.

A good example of the fundamental ethical issue can be found in the simple concept of asking customers “what can we do to improve?”

I love that question; it encapsulates the whole point of speaking to customers about what they want without biasing them towards a particular solution. It usually turns any negatives about current experiences into positive actions for change.

However, frontline staff wouldn’t want to ask that question of their service users in all circumstances, e.g. those with a current likelihood of being violent, those recently bereaved or in any situation where the service user or social worker is likely to come to harm. That means that the results from a survey of such a basic question would already be biased.

Similar nuances were found in almost every typical method for achieving customer development, whether phone surveys, online questionnaires, paper-questionnaires, focus-groups, questions tagged onto the end of a visit, etc.

Now, as mentioned in the slides, greenfield opportunities such as those found in newly-commissioned projects whether within local authorities or within NHS CCGs (Client Commissioning Groups) are ripe for Lean Startup and may benefit from a more thorough application of Customer Development.

What Messages Can you Take Away from the Presentation?

  • That you can successfully apply Lean Startup in the public sector
  • That if you can do it in local authority (which is about the worst-case scenario for successful implementations), then it should be implementable in other large, existing organisations, whether private or public.
  • That you may not benefit from applying all of Lean Startup; the corollary is true in that you can benefit from using some elements of Lean Startup. It depends on what you are trying to accomplish.
  • That the behaviour of staff (inherited from the culture of the organisation) will likely be your biggest obstacle.

The Slides

 

Any Thoughts

I’d like to hear your comments, so leave a comment below or contact me

 

Forthcoming Book on Improving Your Own Service

Lean Service Improvement Book

Some of you may already know, I’m in the process of writing a book on improving your own service.

Lean Service Improvement Book
write by followtheseinstructions under CC BY-SA 2.0

I’m aiming the book at the people who work the process themselves, e.g.:

  • nurses
  • social workers
  • claims adjusters
  • HR/OD staff
  • office managers
  • office administrators
  • hotel staff
  • and their managers
  • and change agents/analysts

As you can see, it’s not restricted to any industry, but will be most relevant to those working in service industries (whether from private, public and 3rd sector), so that should include:

  • public sector
  • health
  • finance
  • retail
  • leisure
  • legal

More accurately, the information in the book could be useful for any industry, however there already exist books for improving manufacturing production processes, so I have not covered them.

What’s the book about?

The focus is on improving a service without recourse to large consultancy fees and should work well on small changes locally within a team and managed changes with partner teams and organisations (e.g. suppliers and B2B clients). It’s heavily based on Lean concepts, using simple tools, but also includes a framework in which to manage the changes. I’ve borrowed from a number of methodologies and concepts to meld together a method that is suitable for the average worker and implementable in any service team.

Your Input

While I’m happy to write this book alone and for everyone to read, I really like the idea of the readers contributing their thoughts as I write it. This fits nicely with the Lean Startup model, so to accomplish this, I’ve listed the current table of contents below. Please have a read through the table of contents and let me know what you think. If you’re interested in this book, let me know what you want to learn from it.

Draft Table of Contents

Section I: Beginning
1    Introduction
2    Background
3    Where to Start?
Section II: Redesign
4    How to Redesign the Service
5    Detailed steps for How to Redesign a Service
Section III: Other Paths
6    Refocus service on customer
7    Only have today to make changes
8    Bottleneck Resolution
9    Reduce errors and improve service
10    Create a new service
11    Improve office layout
Section IV: Case Studies
12    A Real World Example: Capacity and Value Stream Owner
13    A Real World Example: Duty Role in Social Care
14    A Real World Example: Urgent Cases in Social Care
Section V: Extensions
15    Other sorting methods
16    Making it Happen
17    Managing the Change
Section VI: Continuing
18    Sustaining Change
Section VII: Reflections
19    Important Perspectives
20   Other Frameworks
21    A final piece of advice
Section VIII: Appendices
22    Appendix A: The Rules
23    Appendix B – Pocket Guide for Service Redesign
24    Appendix C – Indicators of Blocked Flow and Waste
25    Appendix D: Tools
26    Appendix E: References
27    Quotes

Service Redesign

Yorkminster
Yorkminster
Yorkminster – design on design on design

Are you designing a service or transforming an existing service?

For redesign, we help organisations to reform teams more logically and change the way that they work resulting in more efficient processes. This is more structured and more logical than older BPR (Business Process Redesign) concepts as we’re heavily influenced by Lean but in a service environment.

At the smaller end of the scale, there are service improvement engagements and delivering strategies and methods for continual improvement. We can’t implement the continual improvement for you; that has to come from within your own organisation, but we can be there with you on your journey.

For new services, we assist organisations in developing their new operating models. At this level, it’s not the strategic target operating model, it’s a more tactical design that has to be workable in a live situation with real customers. It should link to the target operating model and indeed should move your organisation closer to achieving that target.