Tag: NHS

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

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How Can We Move From Demand Led Service In The ‘New Normal’?

In the early hours of Good Friday I found myself undergoing emergency surgery after a complication during an earlier test. Even in the midst of some pretty intense pain I was unwilling to go to hospital – a mixture of fear of contracting a certain virus and some overly optimistic thinking about my super human ability to recover without any professional intervention. It was probably Karen wilfully ignoring my instructions not to call an ambulance that saved my life.

Eleven days later I was discharged from hospital after major surgery and two COVID-19 tests. Family and friends were unable to visit so I had a lot of time for self reflection, and to observe from the inside how systems operate during periods of genuine crisis.

The term crisis is overused.  Every day the news is filled with stories about war, terrorism, crime, pollution, inequality, and oppression. There’s a health crisis, a housing crisis, a climate crisis , and a social care crisis. So many “crises” they have to jockey for position in order of seriousness.

What the COVID-19 crisis has done very effectively is to say “hold my beer” to the others – becoming the defining crisis of the moment.

One of the most interesting things about my experience of hospital was the apparent disconnect between the media reporting of what was happening on many wards, and my own actual experience.

Family expressed concern for the health workers without PPE at the same time as staff told me there wasn’t a problem. People told me the system was in meltdown when my observation was of staff continually adapting to new working practices based upon the evidence and experience of the previous day.  Even if the system was in ‘crisis’, at a local ward level people were pulling together and solving problems in new ways. Freed of some of the usual ‘rules’ people were succeeding despite the system rather than because of it.

The NHS is brilliant at coping with an emergency , both at scale and at the individual human level. I simply couldn’t fault my experience, from the operation to the recovery to the after care. The people ARE heroes. It’s not the time to pick fault with the system , but where it often falls down is in some of the basics. These are often things that are less urgent to professionals , but more important to us as citizens , such as communication and keeping us informed of progress.

This is not limited to the NHS , far from it. It’s a symptom of systems that are designed to be reactive rather than pre-emptive. They tend to be designed from a ‘service’ point of view – managing demand – rather than through person centred design, the principles of which are the opposite of service led design.

During my stay, staff noted how demand had dropped. People simply weren’t coming to Accident and Emergency anymore. The country had either stopped having heart attacks and strokes or were delaying reporting them.  This drop in demand isn’t limited to the NHS. Other social providers are seeing similar trends. The phenomenon has also occurred across the US and in parts of Asia.

So why has the system been able to manage demand, something that’s been a problem for decades, in just a matter of weeks?

Obviously , fear is playing a part. In a lockdown scenario people’s priorities have a major shift. Things that would once be major causes of anxiety get reordered in the face of a common enemy.

That said , there is something to learn from how the latent and underused power of community has been leveraged to protect our most precious resources.

People have begun supporting and caring for one another to an unprecedented extent, with community led groups popping up to address immediate needs in ways our organisations simply can’t. It is neighbours that have shown themselves to be the most useful support network in a physically distanced world.

YouGov have reported that only 9% of Britons want to return to life as normal after the end of the lockdown. 40% of people say they feel a stronger sense of community since the virus shut down normal life, while 39% said they had been more in touch with friends and family.

What this seems to indicate is that far from communities resenting a shift away from a passive provider-consumer relationship – they actually desire it. They want a greater say, they want more power to influence local decisions.

There’s a danger here of being overly optimistic as Simon Parker has warned. “Simply willing a better world is not enough. You have to dive into the complexity, dance with the system in its full, messy intractability”.

System change never comes easy. It means thinking beyond individual sectors and requires the whole system to work together, through health, housing, employment and social care. There’s opportunity here if we are brave enough. 

That said , a lesson so far from COVID-19 is that the best currency for change is local. People are discovering their neighbours for the first time, spending less time travelling to soulless business parks , and spending time and money where they live.

Powerful forces will resist any attempt to make this a new normal. It’s not how capitalism works.

However my recent experience has led me to believe that the organisations that emerge stronger from this crisis will be ones who have abandoned doing things to people, and moved to seeing themselves as equal partners with communities.

That requires making a move from telling to listening.

A move from obsessively managing demand to leveraging the skills in the community.

A move from filling the gaps with more services to closing the gaps through social connections.

 

 

Image by Queven from Pixabay 

What Coronavirus Tells Us About Risk

As I sit down to write this post I’ve just received an email from a weekly design blog I subscribe to.

This edition is titled , alarmingly, ‘Pandemic Prep’.

It begins “We are interrupting our regularly scheduled newsletter format and rhythm to advise our clients and subscribers to prepare for the possible impacts of the coronavirus”.

Now I don’t know about you, but when seeking advice about pandemics I might look to the NHS or the World Health Organisation but I’m not sure service designers, innovation labs or bloggers would be my go-to source.

At the time of writing COVID-19 has led to approximately 3,000 deaths reported worldwide.

Deaths from regular flu on the other hand are somewhere between 291,000 to 646,000 deaths – every year.

Coronavirus is extremely serious and could yet reach pandemic levels –  but it is also a  good illustration of how we can overestimate personal risk. UPDATE 4/3/20: The virus has killed about 3.4% of confirmed cases globally. The seasonal flu’s fatality rate is below 1%

That said , why are people worrying about receiving post from asian countries , or whether you can catch the virus from beer, or even choosing not to order food from chinese takeaways?

According to Dr Ann Bostrom,  the mind has its own – entirely non-evidenced – ways of measuring danger. And the coronavirus hits nearly every cognitive trigger we have.

Paul Slovic, a University of Oregon psychologist who helped pioneer modern risk psychology, speaking to The New York Times, helps explain what is going on in our minds here.

When we encounter a potential risk, our brains do a quick search for past experiences with it. If it can easily pull up multiple alarming memories, then our brain concludes the danger is high. However it often fails to assess whether those memories are truly representative.

“A classic example is airplane crashes. If two happen in quick succession, flying suddenly feels scarier — even if your conscious mind knows that those crashes are a statistical aberration with little bearing on the safety of your next flight. But if you then take a few flights and nothing goes wrong, your brain will most likely start telling you again that flying is safe.”

When it comes to the coronavirus, Dr. Slovic says, it’s as if people are experiencing one report after another of planes crashing.

This week we’ve launched the new Bromford Lab Podcast and in the first edition we interview Vicky Holloway and Mitch Harrington exploring the relationship between risk management and innovation – and our propensity to sometimes see risk in the wrong places.

Many of our organisations, we know, are risk averse and constrain innovation. The culture is superbly designed to repel anything new or mysterious.

There are two main reasons for why we over emphasise risk:

We are scared of making mistakes

Failure is rarely promoted or even talked about in organisations. This can breed a culture where there is a fear of failure.

Existing in a culture like this will promote risk aversion as once colleagues are fearful about something they will tend to overestimate the likelihood of things going wrong. Research show that fearful individuals overestimate the danger associated with their feared objects or situations.

In the same way as my fear of spiders leads me to overestimate the ability for a spider to harm me, an organisation whose biggest fear is negative media attention will tend to overestimate the reputational damage of trying out a new service or project.

Successful innovation however requires us to fail more often, and to get better at how we fail.

Arguably it’s not fear of failure we need to tackle but fear itself. How does fear manifest itself where you work? What are you frightened of and what is it preventing you from doing?

No-one ever gets fired for exaggerating

The second reason organisations can overestimate risk is there are few negative consequences for estimating risk too highly.

Underestimating the risk of something bad happening has seen organisations go under and many people lose their jobs, but no-one has ever been sacked for over-estimation.

In 2002 , the Guardian predicted that the world would face famine in just 10 years , and a few years later the UK Prime Minister went a step further and said we had only 50 days to save the planet.

Arguably these are just well meaning attempts at highlighting a serious problem that also illustrates how hopeless we are at predicting the future. However a climate of fear is never a good climate for clear eyed problem definition.

This is why fear of failure should not go unchallenged, as it ultimately becomes debilitating and either stops you innovating or leads you to make bad choices.

As Vicky says in our podcast – we are all risk managers and generally we do it very well. We manage risk everyday in our personal lives and we largely make the right choices.

We need to look for risk in the right places and make intelligent assumptions, constantly challenging ourselves to seek out new experiences and solve problems.

The future requires us to be cautious , yes, but also to be a lot less fearful.

 

Labcast , the new podcast from Bromford Lab , will feature special guests discussing the innovation and design challenges of our day, the big ideas and the bad ideas. 

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It’s available now. 

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Featured Photo by Hello I’m Nik 🍌 on Unsplash

How To Keep Focussed (And Remain Sane) In A World Of Complex Problems

In our heart, we know the solution does not lie in reforming silo by silo but in organizing our silos the way people organize their lives, so that the neighbourhood becomes our primary unit of analysis and change – Cormac Russell

I’ve spent two days this week with both the Connected Places Catapult in London and the Energy Systems Catapult in Birmingham. I’ve had long conversations about climate change, automation, the ageing society, housing shortages and technological disruption. And that’s before we got to health inequality, crime or poverty.

My brain is a little fried. 

We are faced with countless wicked problems in the world—issues so severe and so complex that finding answers almost seems impossible.

And yet right now as I write this there’s a politician on my TV claiming they’ll have ‘solved’ four or five of these by 2030. Good luck with that.

In truth every single one of this intractable problems will affect our organisations to some degree. How do we respond without going bankrupt (or insane) in the process?

First of all – let’s take a deep breath before we launch any new initiatives.

Earlier in the week I learned that for all the millions spent on smart metering and fuel initiatives precisely nothing has changed in our behaviours. We still use the same amount of fuel.

It’s valuable to look at the outcomes we are getting before launching something new.

The National Health Service we are told is the world’s best healthcare system.  Yet the NHS has a poor record on one fairly important indicator – actually keeping people alive.

We often hear that housing associations prevent homelessness , but in the 50 odd years since Cathy Come Home rough sleeping has increased from about 965 people each night to over 4000.

We have a ‘world class legal system’,  but most of our prisons are overcrowded.  By contrast the Netherlands has a shortage of prisoners. 

How can it be that so many sectors face such crisis at exactly the same time. Is it rising demand? Lack or resources? Or the impact of years of austerity?

Or is it something more fundamental. A deeper design flaw.

Perhaps we are too keen on firing magical silver bullets – that look like attractive ways to solve deeper problems.

As Chris Bolton has written – in organisational life the term Silver Bullet has come to mean anything new that can miraculously solve difficult problems. But as he says silver bullets should actually be called Silver Boomerangs, because they fail to address the problem and keep coming back. How to avoid them? Well, I’m with Chris , if something seems too good to be true, it probably is.

My reflections on this week is to return to themes that I, and many others, have written about before.

How much of our impact across the social sector is diluted by our lack of connectedness?

How much of our impact is wasted through by-passing the process of facilitating citizen-led discovery, connecting, and mobilisation? 

When all of the bullets are being fired by disconnected organisations at disconnected individuals it’s hardly surprising that most of them miss their target.

Why don’t we have seamless health, care and housing that isn’t compartmentalised, siloed and rationed across disparate organisations?

And how much of our collective resource is tied up in back office ‘management’ rather than pushing ourselves ever closer to the community?

What would it take to make such a radical shift?

In a provocative piece Adam Lent makes the case for a new law that would shift power from public institutions and into the hands of citizens. If institutions are reluctant to drop their paternalistic mind-set,  handing power and resource over to communities to solve their challenges themselves – why not force them to through legislation? 

Placing unconditional devolution and a duty to collaborate on local authorities and institutions may sound radical, but it shouldn’t be dismissed given the challenges we have.

Whether we legislate or not we need to see a transformation in leadership within our organisations. People simply aren’t prepared for a world requiring citizen led change. As I’ve written before, there are reasons for why we don’t collaborate, and our organisations are largely complicit with them.

To paraphrase Cormac  – it is time to awaken to the fact that we don’t have a health problem, nor a social care problem, nor a climate problem, nor a housing problem, we have a neighbourhood problem.

The worst two things you can do in a crisis is panic and throw money at the problem. Pausing, reflecting and doing some deep problem definition, could be the least exciting but most radical thing we could do right now.

 

Image via Straighten The Maze

The Social Sector Must Rebuild Trust Through Equal Partnerships

This is a edited version of an article originally written for Inside Housing

There is a growing realisation that many of our social institutions and public services have run their course.

Communities need something different from what’s currently on offer.

We could be at the tipping point, the moment when future relationships between citizens and institutions become placed in a wholly different context.

There are a number of factors that seem to be converging. There’s the post-Grenfell concerns about safety and cost cutting, there’s the global decline of trust in institutions, and there’s an increasingly vocal public discourse emerging that highlights individual social sector service failures.

Combine all this with a perception that many social sector organisations have become untethered from their roots in the community, and you have the perfect storm.

Tipping points are not reached by just one factor alone, rather a series of connected incidents that suddenly bring about widespread change.

It’s necessary to note that this is not just a crisis limited to the one individual sector. The Civil Societies Futures report outlines how the world has changed, with people becoming more unequal, more disconnected from power and more divided.

The message here is clear: if we do not respond to people and communities’ desire for power, we will lose our legitimacy and the essential foundation for everything we do.

Back in March I took part in a discussion hosted by Inside Housing with Lizzie Spring. There was a lot I took away from the conversation but it can be condensed into two main points.

Firstly, the language used by ‘professionals’ is damaging to relationships built on trust. 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. It implies a them and us, and reinforces an already unequal distribution of power.

Secondly, the core problem many organisations senior staff and Boards appear to struggle with is an entrenched inability to trust citizens. As Lizzie has said “I can’t consider trusting them, when my own intelligence, experience and expertise are discounted.”

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

Let’s not underestimate the extent of the change that the social sector must embark on to address this. To be trusted means being trustworthy – and to achieve that you can’t dodge the question about power.

As Simon Penny writes for Bromford Lab, there are important issues to discuss about the redistribution of power including greater transparency, collaboration, participation and accountability.

If we don’t talk about power we’ll just continue to address the symptoms, rather than tackle the root causes of mistrust. We risk encourage providers to seek comfortable solutions to things they should be doing anyway rather than address deep institutional dysfunction.

Hierarchical and status-obsessed cultures necessarily militate against relationships based on equality, empowerment and collaboration. These organisations don’t share power, they accumulate it.

There’s often no way for citizens to contribute or influence organisations other than ways set out by the organisation itself. When only one partner sets out the rules of engagement the game is set for a very unequal relationship.

The most important thing all organisations could do right now is simply demonstrate they see themselves as equal partners. Importantly that demonstration should only be through actions, not through a carefully coordinated communications campaign.  

There will be no silver bullet to these problems.

The answers may include exploring alternative models of management. They may include more radical models user involvement – perhaps using emergent technology to move to complete transparency, with people able to shape decisions at both local and strategic levels.

We are seeing change though. A conversation is beginning to happen on equal terms in shared spaces like social media. We need to take that conversation further into our communities and into our offices, not hidden away with one party excluded.

Traditional participation methods have failed us.

Involvement on the terms set out by the NHS, by social landlords, or even by Government, is no longer the only game in town.

 

How Complexity Kills Trust

Customers trust those who give them control — who put them in control — of their lives.

They distrust those who try to control them. – Gerry McGovern

Why do you trust the companies, organisations, and institutions you deal with?

Chances are it isn’t because they have a customer charter, seek to involve you in their decision making,  or publish their performance in a league table.

There’s a curious train of thought entering discourse across the social sector that seems to say “If we involve our customers more, we’ll be more trusted and more accountable”.

I’m sorry – but this is nonsense. The lack of trust in our organisations is driven by overly complex business models that fail to put the customer in any position of power. The idea that this will be solved by inviting them to read the minutes of your last Board meeting is, frankly, ludicrous.

We are in an era of ‘trust deficit’ – where more people distrust institutions than believe in them. Organisations have consistently chosen to ignore the warnings about public expectations about transparency & accountability in the digital age.

Trust is driven by something more basic than being open and honest: simple customer experiences.

Most of our organisations have failed to keep pace with the requirements of the digital age and remain hugely complex for customers to navigate.

We have complexity baked into us, and most users don’t see us as their problem solvers.

As Gerry McGovern has written: “Old model organizations thrive on complexity. Thirty years ago, a typical customer looked at something complex and said: “I must be stupid.” Today, people look at complexity coming from organizations and say: “They must be stupid.” 

It’s often frustrating for the social sector that people trust companies like Amazon more than public services – but the reasons why they do are obvious.

One reason for the huge success of Amazon is the fact that they solve problems for us that we need to be solved.  They solve them very simply too, and they almost always take the customers side in any dispute. When you solve real problems every single day and you make things simpler and easier for your customers, you build trust.

Most of our organisations do solve problems – but we solve them very slowly, or in ways that frustrate the customer.

The key to trust is to solve problems that matter to the customer and to put them in a position of control.  Too many old model organisations are trying to offer customers ‘influence’ – but this is mere window dressing in an effort to avoid giving up any actual power.

The NHS is a great example of an old model organisation. Whenever I deal with the NHS I usually get what I want in the end – and the people who I deal with are often excellent. However – it’s made very clear to me throughout that I’m not in control. Within the NHS the balance of power doesn’t lie with the frontline staff who understand patients’ needs and concerns, and it certainly doesn’t lie with the patient or their families.

The power is hidden within an old model based on a complex web of commissioning architecture, centralised groups, and specialist networks. It’s kept well away from the patient and the front line – as to cede any power to them would threaten the system itself.

If you’re a user of a housing association, the justice system, or local authority you may recognise this feeling of powerlessness, that the system sometimes works against your problems.

In one sense it’s a simple problem to fix. If your customers believe you’re giving them value, rather than trying to get value out of them, and if you come across as sincere, they’ll be more likely to trust your motivations and intentions.

However, deconstructing systems that have withheld power and influence from customers is anything but easy. It’s a lot easier to make a simple thing complex than it is to make a complex thing simple.

  • We need to feel that organisations are competent and have the ability to fulfill their commitments.
  • We need to believe they have the right motives, are benevolent, act fairly and honestly.
  • We need to see they are transparent, that they are learning from mistakes and failure.
  • We need to see they give us control and allow us to navigate their services on our terms

Transparency is good. Unequivocally so. But league tables, charters and involving customers only go so far. They create a lot of jobs for people but they don’t actually change anything.

Most of all we need our organisations to solve our problems in simple ways – and that requires a fundamental rethink of who we are, who we serve and how we operate.

 

Photo courtesy of Yuri Catalano via Pexels

The Case Against Digital Transformation

Something that’s being sold to you as more convenient may well be a lost social interaction that you’ll never get back – Ben Holliday, Convenience Isn’t Digital

Last week a friend of ours told me a story about trying to get some support for his partner who was ill. He was stuck in an impasse between the NHS, the Department of Work and Pensions, and Social Services.

He kept being told that either he, or the GP, or his employer, or her employer, had not supplied some piece of information. Two of the agencies blamed the NHS. The NHS blamed him.

The repeated interactions he was having with people and departments who wouldn’t, or simply couldn’t, speak to each other reminded me of the closing lines from I, Daniel Blake:

‘I am not a client, a customer, nor a service user. 

I am not a national insurance number, nor a blip on a screen.’

He described the slow progress he was making against systems seemingly designed to make it as difficult as possible for him to succeed.

What really made me think though was the resignation in his voice as he said – “They just don’t seem to listen to what I’m saying – they only believe what’s on their screens.”

Myth #1: Every part of an organisation should digitally transform.

Not every company, process, or business model requires or is benefited by digital transformation.

Perhaps it’s time to pause the relentless cheerleading for transformation and consider the cost of digitising everything.

What does society look like when each and every interaction with citizens has to be digitally verified?

Today in business it’s heretical to suggest that it’s sometimes easier just to pick up the phone and have a conversation with someone. Big consulting has been very quick to point out the inefficiencies of talking to people – the implication being that everything is cheaper and easier online.

Are we allowed to mention that cheaper is not always better?

The digital revolution has meant lots of things but there’s precious little evidence it has improved customer service. On the contrary, as Gerry McGovern writes in his latest post, customer experience is flatlining. Organisations have often used technology to boost short-term profits with none essential expenses (like people) being reduced, outsourced or replaced altogether by machines.

The rush towards technology implies everything can be made better when the meddling influence of people is minimised.  Even if that were true the data systems we replace them with are designed by people – and inherit many of our human flaws. We rarely ask to get a second opinion on what our data is telling us.

A better starting point might be considering the case against digital. Which part of your customer experience are you unwilling to automate and make more efficient?

First Direct – one of the UK’s first and arguably best online financial service – have deliberately made their telephone service easier to use than any other bank. That’s conscious design, deliberately adding cost to the business with the trade-off being improved customer experience.

A couple of years ago we did an experiment where we sent two colleagues out to meet with customers – devoid of any technology. What we perceived would be a huge barrier to the test turned into a net gain – the colleagues told us it enabled them to have a better conversation by not having to repeatedly look at screens. We liked the results so much we built an entire service around it.

Ultimately we have to change the leadership model, not the technology. Customer experience isn’t all about efficiency, systems and protocol. It’s letting people do what they do best — knowing customers, personalising service, surprising people with the unexpected.

Being a leader in the digital era means resisting the insistence for efficiency at all costs – and deploying digital methods where it actually improves the outcome and experience.

Rather than the continual celebration of change and transformation, we should spend more time considering its social cost.

What we are really transforming into – and why?

How Do We Know Our Organisations Are Really Succeeding?

Every day, organisations promise to make the world a better place.

How do we know they are really succeeding?

The National Health Service we are told is the world’s best healthcare system.  Yet the NHS has a poor record on one fairly important indicator – actually keeping people alive.

We often hear that housing associations prevent homelessness , but in the 50 years since Cathy Come Home rough sleeping has increased from about 965 people each night to over 4000.

We have a ‘world class legal system’,  but at the end of last year 77 of the 117 prisons in England and Wales were overcrowded.  By contrast the Netherlands has a shortage of prisoners , and is turning prisons into boutique hotels and temporary homes for refugees.

Perhaps it’s time to move away from soundbites and spend a little more time at the source of the problem.

 

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Health is an interesting one – there’s a big difference between quality and availability of healthcare and actual outcomes. The UK ranks only 23rd on the Bloomberg Healthiest Countries list.  Another report by the Nuffield Trust indicates that, compared with other countries, the UK’s healthcare system is no more than ‘better than average’.

Italy , with plenty of doctors in the country and a diet full of fresh vegetables. fish and lean meats, is the place to be. Maybe it’s easier to solve problems with pasta and olive oil?

The issue of course is that problems like health, housing and offending fall into the category of what Professor Horst Rittel termed ‘wicked problems’.

Wicked problems are difficult to define. Many possible explanations may exist. Individuals perceive the issue differently. Depending on which explanation you choose, the solution takes on a different form.

Tame problems, by contrast,  can be clearly written down. The problem can be stated as a gap between what is and what ought to be. There’s usually pretty easy agreement about the problem definition.

Tame problems might still need a high degree of creativity to approach – but they are ultimately solvable – often by one organisation acting alone.

Wicked problems on the other hand aren’t amenable to a single organisation with its top down instinct to define, analyse, dissect and process.

And that’s why more money for the NHS won’t make us any healthier, and more prisons won’t stop reoffending. And if you want to solve homelessness the worst thing you could do is create more housing associations.

Simon Penny (who I’m delighted to say is soon to join Bromford Lab) writes that many of our trickiest social issues can be thought of as wicked problems because of their complex nature – and this means that finding solutions to them often isn’t easy. Especially in a world where organisations and even internal departments act in isolation.

The chance of solving wicked problems whilst acting alone is virtually zero.

The issue we face is that many of our organisations are driven by top down metrics that attempt to solve things through quite a narrow lens. Because we don’t employ a rigorous process for understanding the dimensions of the problem, we miss opportunities to address the underlying strategic issues.

This gives our organisations the illusion of solving problems – but we rarely do. In fact we often create more problems for others.

Wicked problems are forever interconnected. You can’t solve them at organisation or even sector level.  The challenge is connecting the various players and closing the gaps.

Perhaps if we stopped thinking of people as problems to be solved we’d turn our organisations upside down.

There are problems in communities but there are even more opportunities.  Even if people do need ‘help’ they are just as likely to find what they need from a friend or a neighbour as they are from a ‘professional’.

Oh, and before you pack your bags and leave for Italy, consider that it too has failed to join up problems. Youth unemployment – at a staggering 40.3% – is twice the European average. It’s saddled with one of the world’s highest debt loads and most of those doctors that have kept the country so healthy are nearing, or even past, retirement age. The country is sitting on a time bomb.

The problem you are tackling today doesn’t start with your organisation,  and neither – so it seems – does the answer.

 

Photo Credit: Anton Nikolov

Is Your Organisation Making The Impossible Possible?

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2016 was the year the social media bubble burst. The year we woke up to the fact that – despite what Twitter and Facebook tell us – a lot of people think exactly the opposite to what we do. It was us, not them, who were in a bubble.

I spent New Year travelling – so only read a few of the “2016 sucked” type posts that swamped my feeds. My view is that 2016 wasn’t the end of days – but rather the necessary conclusion of a cycle that’s been playing out for years.  The new cycle is beginning and is open for us to shape.

I began writing this post on the early morning ferry from Tagbilaran to Lamu Lamu City in the Philippines – after a conversation with some Filipino commuters.

The Filipinos are blessed with breathtaking landscapes , astonishing waterworlds and true Asian megacities.  It’s also situated smack in the middle of the typhoon belt and the Pacific Ring of Fire. Storms and earthquakes are part of everyday life.

It’s one of the most beautiful countries I’ve been too – and it’s in an almost constant cycle of peril.

People have to continually rebuild, reuse and readapt.

There’s no time for navel gazing about change management programmes and cultural readiness for transformation. It’s transform or die. 

The Fili culture has a word for this mindset – “Bayanihan”.

The word came from the tradition where neighbours would help a relocating family by literally carrying their house and contents to a safer location.

More generally the word has come to mean a communal spirit that makes seemingly impossible feats possible through the power of unity and cooperation.

The term bayanihan has evolved over time – being incorporated in many projects that depict the spirit of cooperative effort involving a community of members.

In 2017 many of us have to rebuild our organisations to face challenges that may seem impossible. And we can’t do it alone.

Saving the NHS from implosion seems impossible, but 1.5 million people work for the health service. If that were a country it would the 150th most populous in the world – ahead of Estonia, Cyprus and Iceland. That’s a huge amount of skills and knowledge that if harnessed correctly could surely transform any system.

If you stop thinking of the NHS as an end in itself and start adding in the wider social sector you’ll have more than 5 million people – and that’s before you start untapping the skills and resources in communities.

The reality is that the health and social sector isn’t an untouchable thing of beauty.  It’s a clunky system built for another age. It’s been patched so many times that it’s astonishing it still works at all.

Whilst short term emergency funding may be necessary – it is in no way the answer.

We need to to invest in scaling up promising community based initiatives at the same time as scaling down paternalistic systems and bureaucracies that stifle innovation.

This , as Alex Fox has written, is the scaling challenge of the digital age.  Scaling down bureaucracies to be human and family sized again.

I’m lucky to be working with organisations who are actively exploring these concepts, some of which looked fanciful in 2012.

  • In 2014 they started to take shape and gather momentum. More people took interest and got involved.
  • In 2016 post-Brexit, post-Trump, post-truth it looked increasingly persuasive.
  • In 2017 amid a global implosion of trust  – moving our organisations from the reactive to the preemptive and challenging the whole system as we have known it – is now the day job.

In the Philippines it’s interesting that the spirit of bayanihan – of communities themselves doing impossible tasks – has not spread upstream into Government.

The cooperation that works so well at community or baranggay level has been stunted when it meets the inflexible institutions that supposedly serve it.

This is the big challenge for us.

Can we reshape our organisations to be more like people – or are our institutions the very things that are standing in the way of unity and cooperation?

Are we letting communities make the impossible possible – or are we the ones stopping it dead in its tracks?

 

Here’s to a challenging and productive year!

How To Fast Track Innovation

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If you speak at conferences about innovation you’ll almost always encounter some frustrated people.

They approach you at the end, or contact you a few days later. They often have one thing in common.

They, and others like them , have ideas that are being shut down because they don’t fit the system.

They tend not to be the loud ones, the self styled boat rockers and rebels at work, but just people who are quietly trying to make a difference.

They see a refusal to identify, create, embrace, explore, develop or adopt new ideas. They see missed opportunities for new products, better processes or different ways of doing business.

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This week we spoke at an event at Alder Hey Innovation Hub on the subject of fast tracked innovation.

  • The NHS is 68 years old.
  • Bromford is 53.

That means we have at least two things in common.

  1. We’re successful. Our vision and purpose has remained relevant across decades.
  2. We’re in danger. The average lifespan of a company listed in the S&P 500 index has decreased by more than 50 years in the last century, from 67 years in the 1920s to just 15 years today.  We shouldn’t really still be here.

If you’ve been around that long you’re going to have a huge amount of organisational wisdom. You’ve become very good at what you do.

However – older companies are really bad at innovation because they’re designed to be bad at innovation.

Older companies are designed to execute on delivery — not engage in discovery.

And this is where all those frustrated people come from. They are explorers locked in a system focused on repetition.

Smart organisations know that innovation has to happen by design. They know that you have to build non-linear processes that encourage purposeful deviation.

It’s project unmanagement.

Project management as in methodologies like PRINCE2 can be anti-innovation. It’s about defined steps to make something logical and organised. PRINCE actually stands for PRojects IN Controlled Environments.

Control.

Let’s be clear – I’m not dismissing the importance of controlled projects. However my experience of talking to a lot of frustrated people is that organisations are confusing control and exploration.

As I heard this week – “I just keep getting told to take my idea to the project team, but they don’t seem to get it”.

No. They wouldn’t get it.

NEVER take an idea to a project management team unless you want it come back with a risk log, a contingency plan and a Gantt chart.

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As this diagram from Tom Hartland shows – there’s a whole fuzzy front end to deal with first.

The conundrum we face is that the very processes that drive toward a profitable, efficient operation tend to get in the way of developing innovations that can actually transform the business.

Until organisations invest in a test and learn framework to accompany their efficiency models they are doomed to disappoint a lot of employees and see ideas go nowhere.

Creating a safe place for intrapreneurs to test ideas and gain supporting evidence so they can justify requesting funds is now necessary whatever the size of your company.

What’s the ROI?

A better question to ask is how you measure the return for an idea that does not yet exist.

The latest Lab slide deck is below. Thanks to Tom for the awesome illustrations.

Designing Out Problems Through Networks

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On Monday I attempted my swiftest ever return to work after a trip.

My plane from Zanzibar via Kilimanjaro and Doha landed at 6am. I was home by 8:30am, online by 9 and in work by 11.30am.

I felt like The Man Who Fell To Earth. I’d had 16 days without any problems. Now – they were back.

  • It started on the M6 – with our taxi driver talking of ‘six months of hell’ as new roadworks attempt to solve a perennially unsolvable problem.
  • It continued in work  as we talked of problems too big to take on at once – and the amount of resource needed to tackle them.
  • The media and the Twitter chat was all about big intractable social problems – health, housing and social care. The same big intractable problems we were talking about 5, 10, 15 years ago.

Here’s the interesting thing. In the 16 days previously I hadn’t encountered a problem – in circumstances where you absolutely might expect to find one.

  • My malaria meds arrived in time from an online retailer – supplied faster and more cheaply than the NHS could manage.
  • I took four flights that all took off on time and arrived ahead of schedule. The baggage, tracked digitally, arrived safely – as it always has with that carrier.
  • I stayed in four places booked online by Booking.com and Airbnb. Each one was expecting me, required no paperwork and I got exactly what I ordered.
  • I used about 10 taxi journeys and all of them arrived early – pre booked online or negotiated with local drivers who confirmed bookings through WhatsApp.

The only problem I had was that I bust my GoPro camera (human error) – but even this has been resolved and I have a new one just four days after I arrived back.

We can’t compare the problems of the UK and the social sector to a frivolous trip but there are lessons to learn.

  • New entrants are using the opportunities afforded by digital to step into the gaps and solve problems that have plagued people for years.
  • Smart organisations are reimagining their customer experience for a digital era rather than digitising existing services.
  • Platforms are replacing intermediaries – focussing on specialisms and performing the functions that organisations have traditionally found difficult.
  • Savvy entrepreneurs are spotting services ripe for disruption – introducing simple work arounds to turn distrusted services into trusted ones.
  • Communities are using technology to leapfrog the natural adoption cycle. In a village I stayed in most homes had no electricity or running water – and yet WhatsApp and mobile payments were common.
  • Additionally I observed the power of letting people solve their own problems – and shifting from the mindset of institutions as the default.

This is not a post about digital technology.  Although – everything that can be automated will be automated.

This is about networks. 

All of the things I have highlighted above have been improved by bringing in new entrants, building new relationships, forgetting the past and flexing business models.

Our organisations are not best placed to solve their own problems. They need help from a variety of sources – communities, entrepreneurs, technologists.

Any sector that has multiple players performing similar services is ripe for disruption. And right now multiple people are working on the biggest problems your organisation faces.

Organisations who fail to seize the opportunities will see someone else step into the gap and solve the problems for them.

Most of these people don’t work for you – and never want to.

The challenge is to bring these players into our  networks – reshaping our organisations with them.

Sitting around and waiting to see what they come up with is about the riskiest strategy we could adopt right now.

Can Working Out Loud Inspire Creativity and Inclusion?


Collaboration – for all the rhetoric – is much harder , and for many of us less preferable, than working in isolation.

Today we’ve woken up to find the  UK has made a historic choice. A choice that could be interpreted as a desire to go it alone rather than working with others. To seize ‘control’ rather than work within a large and complex network.

The biggest innovation challenge we have today and in the years ahead – is that we simply stop talking to ourselves. That we value inclusion and collaboration above all.

The opportunity afforded to us by digital networks was meant to open up a new era where organisations committed to improving people’s lives (that’s most of us, right?) commit to open learning, sharing and collaboration.

It won’t happen without a lot of hard work. Most organisations and sectors thrive on insularity. It’s the way we’ve been raised. Working with others is messier, less predictable and more complex.

The issue is , right around the world , people are working on solving exactly the same problems. Huge amounts of talent seeking to address, income and health inequality, lack of affordable housing, unemployment, ageing, digital exclusion and loneliness.

Yesterday I spoke at a conference led by Suzanne Rastrick. It was organised by the NHS – the single biggest employer across Europe. It filled me with a lot of hope for the future. I like the way that Suzanne and her colleagues are reaching out to other sectors to get their ideas. Reaching out to communities to provide a less paternalistic and more human health and wellbeing service.

Most of our challenging business issues, fall into the category of Wicked Problems. These aren’t amenable to the single organisation, top down instinct to define, analyse, dissect and process.

These issues are incapable of being explored through hierarchical corporate machinery, a single sector or even a single state. They need an open network of rebels and pragmatists, doers and doubters, idealists and investors. Only through truly open innovation will we tackle them successfully.

That means working out loud – something we’ve begun to do at Bromford but needs far more development.

  • It means opening up your organisational borders to fresh thinking , new partnerships and ideas.
  • It means moving away from intranets – the death of corporate innovation – where all your knowledge is locked away from those outside your organisation. (And often from many within it too).
  • It means stopping wasting money on conferences where sectors congregate to talk to themselves. Instead we need strategies aimed at purposive inflows and outflows of knowledge to accelerate internal innovation.
  • It means generously sharing your knowledge , successes and failures through blogs , accessible dashboards and other digital tools.

However it feels right now, we are much better connected. Digital technology means we can share and learn in ways unimaginable even 10 years ago.

We still have the opportunity before us to connect communities, businesses and sectors – boosting our capacity and capability for innovation and change.

We still have the opportunity to connect with others across real and imagined borders and form movements and partnerships that change things for the better.

In that respect – today I’m just as hopeful as I was yesterday.

It’s Time for Us to Unleash the Hidden Power in Communities

“It’s so tempting for those of us who provide services….support workers, housing providers, social workers, community workers, health visitors, GPs…to see ourselves as the ones with the gifts. The ones with the solutions. The superheroes ready to fly in and save people.

 Maybe there is already a superhero living on their street”  – John Wade 

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The typical story arc of the superhero is fairly predictable.

The journey to greatness begins with a background rooted in tragedy or potentially limiting life events:

  • The sudden death of family members (For example, Batman or Spiderman).
  • Being cast out alone into an unknown world where you are markedly different from everyone else (Superman or Thor). 
  • Troubled or abusive families triggering low self-esteem or even mental illness (Wonder Woman or Bruce Banner/The Hulk).

Having got us firmly rooting for the underdog the story unfolds, telling of the discovery of a hidden power or talent , and the difficulties of coming to terms with it.

This will be followed by a challenge to those newly found skills and a struggle against a society that wants to put the budding hero back in their place. This is usually represented through the introduction of a nemesis or villain. 

And finally the story will tell of the mastery of their talents – and an acknowledgement that with power comes a responsibility to help others fulfil their own potential.

I don’t think Jerry Siegel and Joe Shuster were thinking about asset based community development when they created Superman in the 1930’s. However the stories they wrote and inspired always trod a familiar path: the most unlikely people developing skills that others thought them unworthy or incapable of.

The potential for people to do amazing things.

This belief in people is evident all too rarely in the public sector. Indeed – it seems we are almost hard wired to think of people as problems.

If you don’t believe me – take a look around.

Clearly too much of our time is focussed on seeing the flaws and shortcomings, zeroing in on gaps and insufficiencies in every person, relationship or situation.

This deficit based mindset has profound implications, not least economically. Our organisational cultures will become trained to perceive people as problems – which will further distance them from communities they serve.

Adopting an asset based approach would help us tackle these ‘problems’ very differently:

  • Older people have wonderful skills and wisdom that we can now tap into for longer than ever before.
  • Young people have remarkable talents and capabilities – different ones than we did at that age.
  • Social housing tenants are not a breed apart but have often had their aspirations crushed by a system that celebrates need and dependency.
  • The NHS is an institution that people would fight for – and there’s an army of community connectors available to help it operate more effectively.

Judging by the conversations I see going on – things are changing.

I see a growing movement of asset based thinking and the rise of a community of connected care.

I see the role of social technology in helping us have more open and transparent conversations with communities about local decision making.

I see a move away from where ‘professionals’ cast themselves as the superhero capable of solving society’s problems.

As John says , there could be a hero living on your street – right now. It’s time for public services to reach out and begin their journey.

“Too many possibilities currently closed off to us would open up if we’re prepared to fail at being superheroes” – Cormac Russell

We need less talk about innovation and more about mediocrity

  “The only way to get mediocre is one step at a time. But you don’t have to settle. It’s a choice you get to make every day.” – Seth Godin

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In my last post I named innovation as the most overused word of 2014.

It’s consistently misapplied to things that really aren’t innovative at all. Plus there’s now a surfeit of Labs , Accelerators and Hubs that have turned innovation into an industry all based around – umm –  being innovative.

But as self serving as the innovation industry is becoming there’s a much bigger problem.

Ever since I made THAT comment about drones – I’ve been asked more about the return on investment of innovation than I have in the past 10 years.

So what makes us question its value? Why do we apply scrutiny to people working in innovation in a way we don’t to other functions like Operations, IT, Communications, HR or Finance?

Maybe it’s human nature to pay a lot more attention to new things whilst ignoring the waste we build up around us.  When things have been around forever we stop noticing there are almost always better ways of doing things.

Here’s an example:

Something new:

Bromford announce an Innovation Lab with a fairly modest investment (four full time colleagues at a cost of less than 1% of total surplus). But despite only being a few months old we’ve had calls to externally publish our business plan, targets, costs and outcomes. The leadership of Bromford has been called into question for allowing such apparent waste.

Something old:

There are 1700 housing associations registered in the UK. So that’s 1700 CEOs. And probably about 5000 boards as each HA seems to have at least two or three. That simply cannot be efficient. But no one questions it.

Now expand that thinking.

Across the NHS, which is at breaking point even though it employs more people than the entire population of Estonia.

Across Local Government , care  , support and the welfare to work sector.

Now include the funders , think tanks and all the industry bodies.

Virtually all of them will have their own network of offices with their own IT, Communications, HR and Finance functions. Most were built with pre-digital thinking and with little thought about collaboration.

And if we looked closely at those hundreds of thousands of organisations with their billions of pounds of funding we’d be able to deduce three things:

  • One third would be excellent – and have a high capability and confidence when it comes to innovation.
  • One third would be average – although they think about innovation they only occasionally transform thought into action.
  • And one third would be absolute rubbish.

So I’ve a plan. Let’s continue to challenge the self proclaimed innovators.

They should publish their outcomes and their costs.

They need to lead the way when it comes to transparency.

But why let mediocrity off so lightly?

  • Let’s start questioning the organisations that exhibit no commitment to innovation.
  • Let’s challenge the publicly funded bodies where innovation is not addressed in their strategy or values.
  • Let’s see what resources organisations are allocating to disruptive thinking.

And let’s ask them whose responsibility it is to act upon bright ideas from the public and their staff – and ensure they get explored.

Mediocrity isn’t an accident. Let’s declare war on it.

Do We Need A Manifesto for Social Change?

A really odd thing happened to me recently.
I agreed with something George Osborne was saying.

OK. I was on holiday and had experienced a bit too much sun. Probably a bit too much alcohol as well.

But something he said resonated with me.

Osborne had stated Europe was falling behind the continents in the south and east – including in innovation. The European share of world patent applications has nearly halved in the last decade.

Back in Vietnam – everything I saw around me confirmed this. The drive. The energy. The agility.

I’m lucky enough to have visited South East Asia three times in the past couple of years. The dynamic mix of optimism, work ethic and community spirit is intoxicating.

It’s connected too. WiFi is genuinely regarded as a utility. Pretty much every residence , every bar , every business is online. Kids with no access at home sit outside stores in pop-up community hubs.  The web coupled with a boom in cheap smartphones and tablets is fuelling a vibrant connected culture.

Certainly there’s a lot of tech innovation in Asia – each country wants its own version of Silicon Valley. But the future is about more than just Flappy Bird.  

What’s compelling about Asia is the community driven innovation. There’s a level of grass roots problem solving that I just can’t see in the UK.

And let’s face it. We have a few problems that need solving.

1.8 million on the waiting list for a home in an unloved sector not known for its innovation and creativity

A funding gap of 30 billion for the NHS – the fifth biggest employer in the world

An adult social care system faced with an ageing population that could lead to a shortfall of a quarter of a million carers.

Nearly 1 million unemployed young people – and teenage educational performance lagging behind that of many Asian countries

It’s going to take more than an app to solve this one.

In fact we need social innovation on a scale that we’ve never seen before.

And I mean BIG innovation that can challenge established delivery. After all – it’s no use complaining about the likes of A4e or Atos when we’ve failed to come up with a viable alternative.

One of the problems – of course – is our legacy systems. In Asia they can easily make a 21st Job Centre because they never had the 20th Century model.

In the time we have upgraded they will be onto Job Centre Version 10.2. Probably with robots in it.

By comparison most of our organisations are still running on Internet Explorer 6.

Is there any chance for us?

Yes. But it needs disruptive innovation that transforms sectors , not incremental change that will take 10-15 years. We simply don’t have the time.

What can we do?

  • Walls need to come down between sectors. It would be a failure if we are still debating the same issues at our sector specific conferences in two years time.
  • We need to accelerate the formation of ideas into delivery and fail fast. If our organisations think like they have for the past ten years we will be out of business in five.
  • We need to remove those with vested interests who create barriers and ask for another report before committing to action.
  • We need every organisation to publish a statement of how they are promoting disruptive innovation.

We need a new operating system.

We need a Manifesto for Disruptive Social Change.

Do you agree or disagree?

Note: The Manifesto for Social Change was created at Housing Goes Digital during a crowdsourcing session with delegates. Thanks to Thom Bartley for the great slide deck.