How To Design For Better Outcomes

Our job is to the mind the gap between the bureaucracy of our systems and the opportunities in our communities – Cormac Russell

Sometimes it’s preferable to pull the plug on a service before you see it collapse in front of your eyes.

A recent report says we are trapped in a reactive spending cycle on public services – with hospitals, schools, adult social care, and prisons all being propped up with cash bailouts ‘just to keep troubled services going’.

We instinctively know that the demand issues that are hitting the social sector are a result of complex problems. We know that billions of pounds may give some short-term relief but won’t tackle the root cause.

Are we destined to be forever reactive, or is there another way?

There’s a reason many of our organisations are waiting for the next crisis: they are designed that way.

  • Health services are designed to be reactive: only around 3% of national health sector budgets are currently spent on prevention.
  • Prisons are becoming overpopulated because the system is designed to accommodate overcrowding.
  • Housing and social care are designed to be difficult to access – with multiple providers of similar services.

Seemingly we get the outcomes we were designed to achieve. How can we design better ones?

As with so many things – the answer lies in going back to the start.

Clanmil Session (1)

At Bromford we’ve gone back to problem definition across every aspect of our organisation, dividing it into 31 unique service areas.

We started with a very simple task for each leader: define your service offer in just 150 words.

Not to describe what a service does, but to question why it even needs to exist in the first place.

 

Asking why a service needs to exist means you can pose all sorts of playful questions with the intention of shaping a better outcome.

What we found was many of our services have an imbalance between solving problems for the customer and solving problems for the business.

A good example is a reactive home repairs service, good for the customer (get stuff fixed relatively quickly), bad for the business (costly and a logistical nightmare).

That then leads you to explore new lines of inquiry – how could we coach customers to repair things themselves? How could we better balance reactive and planned services?

Across the social sector, reactive services aren’t just bad for business, they fundamentally disempower citizens.

Many well-intentioned services can replace, control or overwhelm the power of community to do things for themselves.

The social sector is a field of business that profits from past societal failure – providing episodic interventions when things go wrong rather than pre-emptive problem-solving.

Our role then to is to move beyond designing reactive outcomes and into designing for progress.

That means thinking about customer needs right at the start of the process – something that sounds obvious but just isn’t applied in practice. This lack of design thinking is exactly why people aren’t getting the sort of social outcomes they expect.

As citizens, we aren’t interested whether you’ve hit your targets or your service level standards. We don’t care about your transformation plans and your five year forward views.

We don’t care about your outcomes – only the progress your outcomes represent.

  1. Hi Paul – a great blog as always. I just wanted to pick up on a point of emphasis. I think the proactive/reactive distinction is possibly unhelpful or at least distracting. I work a lot in healthcare and see services being commissioned all the time for proactive care. With very few exceptions these inflate demand and activity in the system without improving outcomes. In fact, they often make them worse. Screening, monitoring of long term conditions, reablement, expert patient programmes, etc. They all make so much sense at a level of principle but at a level of practice things frequently break down.

    Experience tells that this is because a concrete understanding of value is missing. That goes to your point about design thinking so I think we agree on what it takes to do better. WRT to proactive/reactive though, perhaps its more useful to just think in terms of value and where/when that can best be created? Until and unless value is understood, neither proactive or reactive interventions will succeed and, in public services at least, this will only further inflate demand, activity, cost, harm and risk.

    So how I’m reading the message of your blog is not that it is about proactive/reactive but that it is about:

    1. recognising that to create value, the scope of service needs to be set by the value requirement not by the service offer.
    2. recognising that the value requirement is not the same as the transactional demand for service. Demand is a symptom of the context from which it arises. To understand value we therefore need to understand context, not demand.

    Interested – of course – in your thoughts on this. Am I getting or missing your point?

    Reply

    1. Thanks you’ve articulated that perfectly and I’m in two minds whether to amend the post. You’re right – it can be an unhelpful distinction and actually, it’s perfectly possible to be reactive, profitable and match customer demand!

      This sentence nails it “until and unless value is understood, neither proactive or reactive interventions will succeed and, in public services at least, this will only further inflate demand, activity, cost, harm, and risk.”

      I can’t say it better than that!

      Reply

  2. […] short answer is: because they’re not designed to deliver that value (Thanks […]

    Reply

  3. A good post that enters into the depths of our public services, rather than a superficial one. Thats great and we need more of this.
    I agree that one of the issues with public services is the focus on reactive vs proactive. Its endemic everywhere in the public sector at the moment. The points that you mention in the comments about value is a good one, but I would like to keep the focus on reactive vs proactive.
    Why are managers doing this? Is it as simple as helping managers to act proactively? In my experience managers would love to act proactively – and the first step in that is to Understand. Understand how the current system is working, Understand the root causes of issues, Understand what people really need to improve their lives. Managers get caught up in the daily operational fire-fighting – its like a drug. And when there is a lull, the manager tries to catch up on their emails and other planning, listening to staff issues, etc.

    What I have found works, is to get the senior manager to give permission to the manager to have non-operational time. Even if its a couple of hours a week, its a start. I find that managers cannot do it for themselves. Then they can focus on Understanding, and concepts like Value. Austerity has created this fire-fighting working environment – that drives senior managers to slowly squeeze out the time to reflect and manage proactively. If they have the space, then Design Thinking and innovative people who have already done the detail work can interact with the managers and help to move forward with innovation and systemic change.

    Reply

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