How Do You Solve A Problem Like The NHS?


There comes a point when numbers get so big as to become near incomprehensible.

Almost five million people are waiting for health treatment in England alone. Almost 1.2m of them have been waiting at least six months for ‘vital appointments’. Some within the NHS say that in reality that number is far, far greater – perhaps no one even knowing the true number.

I’m currently in recovery following an operation that (hopefully) finishes off my extended exposure to the NHS last year. I’ve been in the fairly unusual position of being an in-patient both at the very height of the pandemic in April 2020, and its low point a year and a half later. By no way am I an expert on the NHS but I would say I’ve now built up a degree of patient user experience that I didn’t have two years ago.

So – as a kind of innovation challenge: where would you start with tackling the NHS problem?

First of all – what actually IS the problem? My experience has been uniformly excellent, only ever let down by a creaking admin that admittedly became much improved through technology during the pandemic. However it seems to be true that once you’re ‘in the system’ the system largely works for you. However gaining access to that system , especially if you’re not an emergency, is a hopelessly disjointed experience. And many of the people working within it are simply exhausted – even before the pandemic NHS workers were taking an average of 14 days off sick every year, compared to 4 for the average UK worker.

Perhaps the biggest problem for the NHS is that you can’t have a sensible conversation about it. If you criticise it in any way the assumption is that you want to privatise it.

League tables have been used to support arguments that the UK health service is one of the best in the world – and also that it is a failing system. For most actual users it is neither of these things, so the obsession with deifying the NHS and its employees is actually unhelpful for everyone. The truth is that the NHS is sometimes great, often not so great and sometimes just plain bad— and it’s nowhere near close to the best healthcare system in the world.

Perhaps because we are dealing with multiple problems we need a multiplicity of solutions. In short though, problem solving should be a priority for the NHS – rather than disruptive innovation. As Greg Satell writes in a different context, we have the power to shape our path by making better choices. A good first step would be to finally abandon the cult of disruption that’s served us so poorly and begin to once again invest in stability and resilience, by creating better, safer technology, more competitive and stable markets and a happier, more productive workforce.

The most famous quote (wrongly) attributed to Henry Ford is “If I had asked people what they wanted, they would have said faster horses.” We don’t need faster horses is the cry of would be innovators everywhere. But in the NHS, faster horses are perhaps exactly what we need right now.

The NHS is observably an environment where efficiencies desperately need to be gained – and on tight budgets a lot of that will have to be through marginal gains and frugal person centred improvement – a sort of healthcare jugaad. Jugaad is a Hindi word that roughly means ‘solution born from cleverness.’ It’s usually applied to a low cost fix or work-around. In a culture where people often have to make do with what they have it’s an improvised or makeshift solution using scarce resources.

I’m not saying that we should rule out innovation altogether and only focus on the basics; but a greater emphasis needs to be placed on harnessing and developing ideas and spreading them across the system. NHS employees will tell you of something working on some wards that have been shut down because it doesn’t fit in with the overall ‘plan’. In any complex system there is often a drive to scaling up which destroys some local innovation. ‘Small, localised and spreadable’ is often more sustainable.

It’s also clear when talking to staff that many are victim to the very large number of administrators in the NHS and the urge to keep changing things. Many talk of process changes ‘all the time’ – something that has , necessarily, accelerated during Covid. The effects of this constant change trickle right through the system: employees wake up wanting to do something good and then find there are new regulations and new rules that act as a barrier.

Of course there is a whole other set of problems outside the immediate control of the NHS.

If the primary problem is demand, then that needs to be tackled. We’re living longer, getting fatter and people now have more chronic and complicated diseases. The Office for National Statistics attributes just 5% of total UK Government healthcare expenditure to ‘preventive healthcare’. We need to remove the politics from healthcare and have a sensible conversation about how much of GDP we are going to commit to not just treating problems, but preventing them in the first place.

The NHS has myriad innovation programmes, challenges and accelerators. It’s not for me to judge any of these. However it’s clear that right now there’s a capacity issue meaning the people, services and systems who would stand to benefit most from innovation end up missing out.

So perhaps it’s time for the NHS to focus employees on becoming better localised problem solvers who can work on existing real-world issues that staff and patients face every day.

Revolutionising the NHS is less likely to come from some grand plan and more likely to result from local trojan mice changing small things in big ways, attacking new problems, and spreading new ways of working. Not winning wars but infiltrating new territory.

All of that requires a less abrasive form of politics, a more forgiving internal culture, and a little less hero worship. Not easy to achieve, but absolutely worth fighting for.


Photo by Andy Holmes on Unsplash

Four Factors Hindering Transformation

The problem with good service design is that you don’t notice it.

It’s only when you experience truly bad design that you appreciate the good stuff.

That’s why so few organisations are design led. They focus on designing out the bad rather than designing in the good from the beginning.

Earlier this week I ordered a package – to be delivered from the Royal Mail.

It required a signature so I arranged it to arrive on Thursday when I planned to be working from home.

On Tuesday morning the Royal Mail sent me an SMS and email to say they were pleased to announce that the item would arrive earlier than expected.

They might well have been pleased at the early arrival, but I was 60 miles away and stuck in a meeting. There was no option to request a redelivery. No option to even cancel it. Just accept an inevitable failure. 

Any redelivery could only be attempted after they had first failed to deliver it.

Here was a company actually wasting the time of their employees and their customer – and seemingly proud of it.

In defence of Amazon and Uber

It’s easy to criticise the likes of Amazon and Uber for their ethics , but we forget at our peril the benefits these providers have bought us.

But they don’t pay taxes! As if no company ever evaded taxes before Amazon.

But they exploit workers! As if taxi drivers were never exploited before, or resisted the opportunity to exploit us customers.

We shouldn’t let these type of companies off the hook for their transgressions, but neither should we forget what life was like before their breakthroughs in customer experience.

Getting a delivery within 24 hours or not having to queue for a taxi now feels so normal that one starts to wonder why it took so long.

The incumbent companies they disrupted all had the same money, time and technology to change the way they did business, but they resisted the opportunity to shape themselves around what customers actually wanted.

Why digital transformation isn’t enough

Richard Godfrey makes a similar point about the failure of banks to reimagine their services. Setting up a new account in most cases still requires a bank visit, or an e-form or a phone call at the very least.  How can that still exist in a world where you can sign up for a Monzo or Revolut account in minutes by downloading an app and proving your identity and address with image capture software and facial recognition?

As Richard points out, most ‘transformations’ are nothing of the sort, but simply a digital overlay on top of how business has always been done. He wonders why the process of claiming housing benefit can’t be made so easy. Of course it can, people just don’t want to make it easy.

As someone who has worked to redesign services from the ground up, putting the customer in control, I’d say you can’t underestimate how difficult this culture change required is.

Many of our organisations – despite the rhetoric – have policies and procedures that are profoundly anti-customer. We have built checks, balances and verifications into our process because , deep down, we don’t actually trust the motivations of the public.

This is an uncomfortable truth – but goes some way to explain the difference in satisfaction levels between some of the public and private sector.

PNG_Public_sector_CX_Ex1

A new post from McKinsey finds that whilst many the public sector and governments are moving forward with customer experience initiatives, in general private-sector organisations are a lot better at providing services.

I don’t always agree with the private/public distinction but some of the stumbling blocks they identify are helpful. The common traits that prevent genuine transformation are:

  1. A monopolistic mind-set. When customers don’t have a choice, it dramatically removes a major incentive to innovate and improve service.
  2. The public sector have to be fair to everyone.  They can’t just ignore certain customer segments. This ‘fairness’ often solidifies over time into a principle of providing one-size-fits-all service. Or rather, one-size-fits-no-one.
  3. We often lack the capabilities needed to assess and address gaps in customer experience. Those with deep analytics skills, as well as human-centered design skills, are often in short supply.
  4. Data is typically incomplete or sequestered in silos. Organisations often lack a full, timely picture of the customer’s overall experience.

This ‘fair for everyone’, but exceptional for no-one, agenda presents a genuine design challenge. The capacity for innovation for huge, but the capability for it is virtually zero.

It’s hampered because innovation requires a tolerance for failure , and upsetting people.  It’s too easy to see the short-term political consequences of initiatives gone wrong and debate whether public money is going down the drain.

However we have a responsibility to take risks – we need to cultivate a culture of innovation, and sometimes that means spending money trying new things, and being ‘unfair’ to some people.

What if Uber and Amazon did health, housing and social care?

Three years ago I wrote a post speculating on that very question – it remains the second most popular piece on this blog.

I don’t stand by everything I said back then, but I do agree with the final point.

Any sector that has multiple players performing similar services is ripe for disruption.

There’s no question about whether the Uber , Amazon, Facebook and Alibaba of the public sector will emerge.

It’s simply a matter of when.

Is It Time To Rethink Industry Awards?

Award schemes have become a form of media. They exist to generate income for an organisation through a combination of entry fees and overpriced chicken dinners – Stephen Waddington

It can sometimes feel like there is an industry awards ceremony for every night of the week.

A Google search for ‘housing awards’ will get you 500 million results and nearly 700 million for ‘health and social care’ awards. That’s without awards for charities and other non profits.

There isn’t a resource where you can find exactly how many ceremonies there are in total (there’s at least sixty four UK award schemes for health and social care) , but it’s clearly very big business.

With all these awards schemes recognizing excellence you’d think customer satisfaction would be soaring to hitherto unseen heights – but that’s clearly not the case.

So what are the benefits of awards ceremonies?

Brand Recognition: A relatively quick way to signal you are above the competition is by seeking out and winning awards in your industry. This is nothing new, it’s basic marketing – companies have been touting their award-winning products for over a century.

Boost Employee Moral: For individual colleagues or teams winning a recognised award gives you public recognition, this gives people their moment in the limelight.

Encourage Self Reflection: The actual act of entering an award is a discipline that, if done honestly, encourages you to articulate why you did what you did and what you learned.

Let’s be honest though, the sheer amount of award schemes means they don’t deliver any true recognition of excellence. As Stephen says in his piece – with disciplined planning and a good entry form anyone can become a winner.

Do Industry Awards Inspire or Inhibit Innovation?

Awards and accreditation can actually act against the interests of customers.

  • They can encourage people to aim at the prize rather than the journey.
  • They can encourage organisations to tell good stories rather than promoting transparency and encouraging learning from failure.
  • They can imply that innovation is a single event, when it hardly ever is. Truly significant change is achieved over years, sometimes across generations.

And awards ceremonies can actually embed silo thinking — by promoting innovation at sector level when the really wicked problems need a more joined up approach

Serena Jones has noted that publicity from awards can help us reach new partners and investors. “They also highlight and circulate new ideas, approaches, methods which challenge us to do things better or different”.

This is helpful” says Serena, “But perhaps other mechanisms (without awards) can achieve the same outcomes?”

 

In 2014 I collaborated with Shirley Ayres in an online competition to find the people using digital tools to connect and share knowledge in new ways. It was called Power Players.

What was intended as a slightly light-hearted alternative to formal ‘awards’ turned into something else. Hundreds of people voted and the posts themselves have had over 40,000 views.

What was different about the list was the transparency.

As Shirley wrote  at the time “Digital technology has democratised access to information and created very different ways of enabling people to connect and share resources, thoughts and opinion. We live in a digitally connected world and in the crowded social space online influence is becoming increasingly important.”

I’m disappointed in the lack of innovation in the recognition and awards space in the five years since Power Players. Outside the social sector platforms like TripAdvisor, Trustpilot and Glassdoor have harnessed the digital voice of consumers to provide a more transparent way of recognizing excellence.

Indeed, transparency is where most traditional awards, many self nominated by the recipients themselves, completely fall down.

There is rarely clarity on why someone wins, why someone loses, or why someone was ruled out in the first place.

In fact the awards business wholly lacks any real transparency which is why many people leap to the conclusion that winning comes down to who sponsors what and which organisations buy the most tables.

Social media has enabled a new transparency, you can no longer control your messaging within closed industry borders.

We’ve still got organisations who are still adapting to an era where they can be answered back and where they don’t have the final word.

Many still think their brands can be controlled (they can’t).

Many still think that their brand is their own (it isn’t).

As Jayne Hilditch has said  – every time an organisation over claims how good it is, another piece of trust with the customer dies.

Those organisations who act like ‘awards tourists’, gathering baubles in very public shows of self affirmation may find themselves having to answer difficult questions.

Who really benefits from awards – and how? 

 


 

Image by analogicus from Pixabay 

If We Don’t Develop Different Relationships, We’ll Lose Our Legitimacy

If we do not respond to people and communities’ desire for power, we will lose our legitimacy and waste the potential of the many ways they can have agency over what matters to them. If we do not continually, bravely work to build trust, we will lose the essential foundation for everything we do. – Civil Societies Futures

I’ve had a week of fascinating conversations, all linked by one theme, the apparent reluctance of many of our institutions to cede any sort of meaningful power and decision making to communities.

Part of the problem is the social sector is a field of business that profits from past societal failure. The entire premise relies on reaction.

When your business model is founded on profiting from being reactive – there is little incentive to change.

There’s also a very real question about skillsets and mindsets. During my conversation with Lizzie Spring it became apparent that at some point we shifted from entrepreneurial community based models (think: the birth of the social housing movement for example) to ones based on efficiency and the accumulation of wealth.

Necessarily this has forced organisations to be more ‘business like’ with career pathways for ‘professionals’.  It’s hardly surprising that communities feel organisations have become more distanced, remote and less accessible.

CHC Trust Presentation (1)

A couple of weeks ago a consortium of housing providers tweeted an animated GIF showing a lonely looking person peering out of a desolate block of flats. The tagline read something like ‘Housing Associations provide services to some of the most vulnerable and hard to reach people in the UK’.

What on earth are we trying to say? 

A number of tenants jumped on the tweet and pointed out – quite rightly – that it is the institutions themselves that are hard to reach not the people they serve. It was deleted by the following day.

It would be easy to write things like this off as the mistake of junior comms person but this attitude speaks of something far more fundamental: that organisations have become disconnected from their original purpose and are happy in their role as rescuers of people.

CHC Trust Presentation

In today’s world of rising demand and scarce resources the doing, not just the talking, needs to be new and different. You can’t change a relationship without actual changing your behaviour.

A new report from Adam Lent and Jessica Studdert sets out a compelling case for a deep shift in public services based on a completely new relationship between citizen and state. This relationship rejects the hierarchical and transactional mindsets of traditional service models which all too often bypass people’s assets and capabilities.

It highlights the risk of seeing citizens only as atomised consumers – something the digital transformation zealots are actively encouraging. This consumerism only leads one way – to a growing sense of alienation and frustration with public services and the state.

The report goes on to state this isn’t inevitable. There is a huge opportunity to change.

CHC Trust Presentation (2)Our communities want change – and they know what’s not working. This appetite for power and influence is a once in a generation opportunity to reconnect with people and establish entirely new relationships.

We mustn’t all focus on housing the homeless. We mustn’t all focus on filling prisons or A+E departments. 

We have to move to a more preemptive model that builds on what is already there rather than seeing our organisations as curators of the worlds problems.

The conversations I’ve had this week, and the grassroots innovation that some organisations are fostering (notably in Wales), fill me with a lot of positivity.

The modern social entrepreneurs aren’t waiting for permission from regulators or consensus from their industry body. They aren’t bothered about awards or being seen at industry events. They never look at benchmarking. Many of them aren’t even paid or employed in the social sector.

They know that the way we have become organised is dysfunctional – and they are forging ahead with relationships first and services last. They are working with communities as equals rather than as professionals.

They might not know what works yet but they are clear about one thing: not returning down a path to paternalism and disempowerment.

This incremental change can build and gather momentum – becoming massive change for the entire social sector.

No-one is stopping us.


 

This post has been inspired by conversations this week with Lizzie Spring, Shirley Ayres, Serena Jones, Chris Bolton, Ena Lloyd and Pritpal Tamber. Thanks guys

The full slide deck on rebuilding trust as featured at #CHCGOV19 is featured here 

The Problem With Professionals

Social progress is about the expansion of freedom, not the growth of services – Cormac Russell

Our digital networks, Twitter, in particular, are unparalleled listening tools.

I follow thousands of accounts, many organised into lists so I can get a sense of what’s going on in innovation, technology, health, housing – and the social sector generally.

Right now – I think there’s an interesting development happening that’s worthy of comment.

It’s this:
  • It appears organisations risk becoming more siloed. Whilst digital connects us in ways never before possible – whole sectors are still just talking to themselves.
  • This sense of disconnection is being made ever more visible – to the public, to patients, to tenants of social housing.

Social media isn’t the great leveller we thought it might be – but it’s certainly a great revealer.  It’s not shifting the balance of power — but it’s shining a torch on where power is held and how it behaves.

Dissonance

A couple of weeks ago I was on holiday flicking through Instagram. By complete chance, the algorithm had placed two photographs directly above each other.

  • Firstly was the imposing black husk of Grenfell Tower –  a monument to the dead and ignored.
  • Next to it was a picture from a sector awards ceremony, with a champagne bottle placed in front of some happy smiling ‘professionals’, celebrating how good we are at engaging communities.

I’m not naming the sector (you can probably guess) but it’s kind of irrelevant. We’ve all been there and done it, and celebrating success IS very important – but our digital behaviours are now being represented and recreated in contexts we are not even fully aware of.

The Problem With ‘Professionals’

What social media does very effectively is highlight where friction occurs. Nowhere is that friction more evident than when people in housing, health and social care cast themselves, often unintentionally, as professionals and experts to be listened to.

This behaviour can give off the impression of an exclusive club, populated by those in the know, who are using their exclusive access (and exclusive language) to solve problems and design services on behalf of citizens.

The professionalisation of the social sector – conducted in a such a public way -immediately places one group in a position of power and influence:

Empowering words, but disempowering actions.

The digital age is disrupting the accepted rules of discourse. No longer is a relationship solely between citizen and institution. What was once a fairly binary one to one relationship behind closed doors is now conducted within a much wider social and public context.

Engagement Versus Empowerment

Across the social sectors, practitioners and organisations play many different roles in the implementation and diffusion of the ideas and projects that they seek to promote. Some of these roles can serve to empower communities, while others can actively disempower them.

As Phil Murphy commented engagement isn’t a destination, it’s a route to empowerment. Services are sometimes a means to an end but rarely an end in themselves. There are few things that happen in communities that can’t be solved by communities themselves.

We can’t continue adopting a deficit mindset where the answer to everything is:

  • More Government intervention
  • More resources
  • More services
  • More ‘professionals’

We need to move away from focussing on what’s wrong, and seek to solve problems with communities not for communities.

If we continue to behave as a professionalised class – organising ourselves into deeper sector silos, talking to each other and forming policy on behalf of other people – we’ll bring about our own demise.

We’ll see a ‘Brexit-Effect’ – with the neglected and unheard looking for an opportunity to get back at those who had never listened to their grievances or invited them to the top-table.

People can clearly see where the power is held.

Sooner or later they’ll want to take some of it.

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.

Building Trust and Standing Out in the Digital Age

commshero-paul-taylor

In many ways the events of 2016 are less a surprise and more the logical outcome of what we already knew.

As I wrote early last year – we are in an era of ‘trust deficit’ – where more people distrust institutions than believe in them.

When belief in government, business, media and nonprofits dips below 50%, you are bound to see mavericks emerge to challenge the incumbents.

At opposing ends of the spectrum Farage, Trump and Corbyn have used digital and physical networks to leverage the untapped potential in these communities.

Question is – will this mood of anti-establishment dissent sweep across the social sector?

Let’s be challenging:

  • Housing talks to housing.
  • Care talks to care.
  • Health talks to health

I could go on. It’s not so much an echo chamber as an entire galaxy of echo chambers – each their own solar system of professional bodies, conferences and award ceremonies.

If a malcontented public has taken a swipe at the political establishment for being out of touch and bureaucratic – we surely have to consider ourselves fair game too.

The only difference being we can’t be voted out.

But what if Uber really did do health, housing and social care? It seems impossible to imagine our failure to adapt and change is not being carefully watched by leaner, smarter start-ups.

As consumers we are well-informed and volatile as never before. Through pervasive social media and connectivity we are inundated with information which magnifies any grievance – real or imagined.

At Comms Hero this week Grant Leboff pointed out that we’re now so inundated with noise even Coca Cola are marketing as one brand in an effort to stand out.

The point Grant made was clear – in an age of storytelling you need to take a position. If you have no position you won’t keep attention. And most communications fail as we don’t have the balls to take a position.

Conversely there’s huge opportunity here for organisations:

  • Mediocrity doesn’t happen by accident. It’s a choice you get to make everyday. You can take a position tomorrow.
  • Trust is built through engagement and integrity -we can consider whether every action we take is a trust builder or trust killer.
  • We can enshrine transparency as part of our values – with less talk of innovation and more demonstration of our impact.

In the US election only one voter in 50 viewed both candidates as trustworthy; nearly one in three voters said neither was.

Without trust, institutions just stop working. The incumbents get disrupted. 

Many organisations have chosen to ignore the warnings about public expectations of more openness, transparency & accountability.

Any leadership team or board who are not actively building trust right now are in peril.

 

What if Uber did health, housing and social care?

the-future-of-finance-16-638

If you’ve been to a conference in the past 12 months – you’ll almost certainly have seen the slide above, or a version of it.

Mentioning “disruptive innovation” adds a sprinkle of sophistication to otherwise ordinary presentations. It’s a sit up and take notice slide that says: ‘Better listen, or you could be history.”

However – it doesn’t always hit its intended target. A significant portion of the audience at a couple of events I’ve been to recently have looked at each other as if to say ‘that couldn’t happen to us’.

The reason for this seems to be the comfort blanket that can come with extended working in the public and social sectors.

The thinking can go like this.

  • We are different.
  • We deal with people who are highly complex with multiple needs and vulnerabilities.
  • No tech outfit could hope to understand the extent of the personalisation involved in our services.

It’s optimistic thinking – probably the same that was held by some taxi firms pre-Uber and hotels before Airbnb.

It’s going to take radical change a lot closer to home before many managers recognise how profoundly the rules of business have changed in the digital age.

Arguably though , it’s already happening. I’ve made a slide of my own that might be more relevant to the public sector.

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Far from fantasy – we are at the beginning of the end of one size fits all health, housing and social care monopolies.

Some examples:

Mercy is a hospital with no beds, no waiting rooms and no patients.There are nurses but they work virtually, providing care across 33 hospitals. The strategy is quickly expanding beyond hospitals and into the home. By keeping tabs on patients at home, Mercy can help keep people with chronic conditions out of the hospital.

Buurtzorg is a care system without managers, even though it has 9000 employees. To kill bureaucracy and overheads there are no call centres. Nurses take the calls. In self-managing teams of ten they plan patient visits and decide how long they spend there, depending on their judgement of the need.

Honor is home care without direct employees. Like Uber , the care professionals here are self employed and use an app that helps them find and keep track of job offers. Applicants undergo background checks and in-person interviews to screen them, with only 5% allowed onto the platform so far.  More flexible than traditional care – it allows people to book packages in just one hour increments, and aims to foster long-lasting relationships between caregiver and the customer.

What these systems and technologies do is to enable existing infrastructure to be used more efficiently. They are harnessing the power of the connected citizen rather than the analogue organisation. As Alastair Parvin has written – we are no longer stuck with the choice between the public sector and the private sector. The citizen sector now needs to be recognised as a viable, industrial force.

Is it impossible to imagine a local authority as just a digital platform with its services all outsourced?

Paul Blantern, Chief Exec of Northamptonshire County Council is almost there. The Council employed 12,000 people when he took over. Today they employ 6,000 and his vision is to reduce that to just 150. He was asked in this programme “Is there anything you wouldn’t outsource?”. His response – “No – it’s all about the outcome to the end user.” Essentially the ‘Council’ could reduce to zero as long as people feel the services are still good. [UPDATE MARCH 2018: This approach was ultimately disastrous]

Is it impossible to imagine other organisations , housing associations for example, being managed entirely differently? Rather than multiple companies we may see a singular platform where users themselves directly procure the services they need from the cloud. The next generation of housing manager could be an algorithm rather than a person.

It’s not just housing. Any sector that has multiple players performing similar services is ripe for disruption.

There’s no question about whether the Uber , AirBnb, Facebook and Alibaba of the public sector will emerge.

It’s simply a matter of when.

 

[Credit to  Mike Clark and Shirley Ayres for inspiration on the slide! Thanks both]

 

We need more people solving problems – not professionals.

Everyone has a story to tell, everyone has strengths beneath the conceptions that you have of them. But if you’re curious enough, you may just find that the answers you’ve always been looking for are there, often right beside you. – William Lilley

o-GLASS-WATER-HALF-FULL-facebook

Everywhere you look at the beginning of 2015 you will see a crisis.

In case you missed it there is currently a crisis in Accident and Emergency Units which is part of the wider health crisis. There’s a housing crisis as well. And a crisis in social care , unemployment , education and policing. Not forgetting the welfare crisis which is wreaking havoc on millions.

There’s crisis everywhere.

The current trend in mainstream politics , and on social media , is to talk of Britain as broken.  And then we act all surprised and outraged when people turn to parties like UKIP who hark back to a golden age that never truly existed.

People are so sick of hearing about crisis they lose faith and begin searching for someone who appears to offer a more compelling vision. Who can blame them?

Except if you scratch the service on any of those things you’ll find the crisis label to be untrue, or misleading at the very least.

What we have is an excess of demand over supply and deeply dysfunctional systems.

Most of our public services were designed pre-decimal never mind pre-digital.

We really shouldn’t be surprised they aren’t fit for purpose.

The problem lies with the people who created those systems and who work within them. Us.

Over new year I had a break at one of the Red Sea resorts seeking a bit of winter sun along with scores of pasty faced Europeans.

One of the benefits of being locked into an all-inclusive euro-mashup is you have some very random conversations with people we are told are hugely different to us , but are of course not.

The best conversation I had was with an Italian guy and one of our Egyptian hosts.

We were talking about the various crises our countries are experiencing and the role of communities.

Sal was telling us of the boom in the ‘suspended coffee’ movement in Italy.  The concept is pretty simple: You walk into a coffee shop, and instead of buying just one cup of coffee you also buy one (or more) for someone in need. Your get yours and the second coffee is “suspended”. It can be claimed or given out by the barista to people they think deserving. I always believed that the movement was a modern viral phenomenon but Sal told us it was a Neapolitan tradition that originated in World War II. The principle is that in a time of hardship, Italians can lack many things, but not coffee!

Ahmad told us about the rise of the “Town Helper” in parts of Cairo and Alexandria. Because of the huge drain of young men to work in the Red Sea resorts many of the families left behind face a significant skills gap. These guys work incredibly long hours with hardly anytime off. When they do  get a few days off – every few weeks – they return to their families for precious time with loved ones. To make sure they spend the maximum time with their families they fund , largely through tips from tourists , a number of people to do tasks whilst they are away from home. Each Helper , is shared between a number of families , to plug the gaps that have been left in communities.

I talked of the growth of Food Banks in the UK which we largely view as a sign of failure but actually speak of tremendous generosity – of communities looking after their own. I don’t pretend to give lots, I just throw a few things in the collection on every visit to the supermarket – to the extent that I’ve actually stopped thinking about it. It’s just a little pay it forward gesture that millions of us are doing without prompting. I also told them of the Bromford Deal and how we are embarking on a huge cultural shift to unlock potential in people rather than seeing ourselves as professional rescuers.

I talked of how the Deal is – at its essence – a belief that people don’t exist in a state of need and can do amazing things if we empower them and step out of the way.

Due to excess brandy the conversation veered off in all sorts of directions: but the important thing is we all agreed that some of the best initiatives don’t come from Government. None of the above did.

For many years we’ve built infrastructure and services that people neither need or want. We make interventions without outcomes. We produce reports that have no readers. 

We must ask ourselves how we became so removed from the people we were set up to serve. 

Our communities are not in crisis.

There is a massive untapped reservoir of skill and talent that we chose to ignore because we thought we could do it better as professionals.

We couldn’t.

Let’s put it right.

Don’t Listen To Your Sector: Be More Weird

Be_different___Smile_by_screamst

Had a bit of drama over the past week. I’ll recap it for you as quickly as possible – as most readers of this blog don’t work in the same sector as I do.

Essentially Mick Kent, my CEO, wrote a challenging piece setting out why we have embarked upon a different service vision. Bromford are celebrating 50 years in business – so you wouldn’t think it particularly controversial to reflect on the past and consider the future.

Not so. The piece sparked some astonishing responses – especially on social media. Many in the sector expressed derision and even outright contempt. How could one of their own say such things?

But experience suggests this is just a natural crowd reaction to someone stepping out of line and being different.

You’ll never see a sector – be it Housing, Care, Support or Health, drive innovation. It’s simply not in the interests of the majority to reward disruptive behaviour.

It’s one of the eternal challenges for industry bodies – they have to reflect the views of their average member. And the views of the average member are, by definition, average.

You’ll never find a sector that is wholly admirable either. Be it banking, retail, travel or charitable – you will find the good, the indifferent, and the bad.

And you’ll also find a few disruptors – pacesetters who are pushing forward with a bold new vision. Often that vision will be treated with initial scepticism – sometimes by customers as well as industry peers.

In the last month the 2013 UK Customer Experience Excellence Top 20 was announced. You’ll see that it’s made up of companies who have faced criticism precisely because they challenged the accepted order of things.

Let’s glance at the Top 10 :

10 – Waitrose – Broke out of their southeast heartland despite people saying, “It’ll never work in the north”.

9 – M+S – Launched Plan A (“because there is no Plan B”)  a programme to instil innovation across 81,000 employees and lose their old fashioned image.

8 – Ocado – A High St store “without any stores “ founded by three guys with no experience of retail. “A disaster waiting to happen” said critics.

7 – Lush – Showed cosmetics can be ethical and environmentally responsible, whist also being super indulgent and pleasurable. ” We hire for values , not skills”.

6 – M+S Simply Food – Darling of the middle classes opens branches in railway stations , airports and hospitals. Critics predict failure – “People will resist the idea of carrying high cost food shopping around with them.”

5 – Virgin Atlantic – Challenging the establishment, improving service and astounding its customers: “We’ve never been afraid to upset people”.

4- Amazon – From “destroyer of Book Shops” to “destroyer of the High Street”. Adored by their customers.

3 – First Direct – The only bank people love. Launched with two ad campaigns:  a negative one showing the everyday aspects of normal banking. A positive one showing how good First Direct would be. The banking sector was appalled. Customers applauded.

2 – QVC – Almost universally derided on its UK launch in 1993. Now a global leader in video and eCommerce retail. Just launched QVC Sprouts, a crowdsourced competition to search for the best up-and-coming entrepreneurs and new products

In first place? John Lewis.

A few years ago I was talking to John Lewis employees at a conference where they had been speaking. They told me that far from being lauded by their own sector they were often criticised. People said it was arrogant and pretentious they had their own language (colleagues as “Partners” for example). Their recruitment practices and culture had been described as “a cult”.

“People just think we are a bit weird,” they told me. “But we’re not bothered by what the industry thinks. Just the customers.”

I imagine the retail sector were cynical about the fuss around The Bear and The Hare , the Christmas advert by John Lewis . As was I.

Screenshot 2013-11-22 09.01.30

Nearly 8 million YouTube views. Number 1 in overall UK Customer Experience. Profits of 415 million.

A lesson for innovators – don’t listen to your sector: Be Different. Be More Weird.

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