Tag: NHS

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