Category Archives: Uncategorized

Kittens are Evil – what happened in Wales?

Posted on by
Reply

In the world of public policy, saying that outcomes are bad is like saying kittens are evil. It’s heresy.*

I’ll grant you, it’s not ‘hang on a minute, the earth goes round the sun’ levels of heresy. Nor have I nailed pieces of parchment to the doors of Downing Street (although, there’s an idea…). All I’ve done is to say that “outcomes” can’t be used as a way to effectively manage the performance of people who deliver social policy interventions. It doesn’t work. And, worse, it forces good people to lie about what they do.

There is emerging evidence in the media (including the Guardian, Daily Record, Radio 5 and File on 4) that outcome based approaches (OBAs) are subject to organisations ‘gaming’ the system. The reports suggest that service providers (from all sectors) are falsifying data in a number of ways (including the falsification of signatures on training registers and encouraging the unemployed to become self-employed thereby removing them from the unemployed statistics).

 The organisations involved are clearly working under the impression that the benefits of meeting the specified ‘outcomes’ (and therefore getting paid) outweigh the risks of getting caught. This behaviour is so widespread as to suggest that it is systemic and therefore endemic in the ways in which public services are being contracted and delivered.

I’ve been talking about the findings of my research into Outcomes-Based Performance Management at ‘Kittens are Evil’ conferences, which we started in Newcastle upon Tyne. We started in Manchester, where we focussed on Payment by Results. Most recently, we went to Powys, in Wales, where we focussed on the Results-Based Accountability™ systems adopted by the Welsh administration.

We began by looking at the problems with the underlying theory of Outcomes-Based Performance Management. Firstly,  that “outcomes” aren’t actually measuring impact in people’s lives – they’re not outcomes at all. And secondly, that outcomes aren’t created by organisations or programmes, they’re the emergent properties of complex systems, which means you can’t hold people, or organisations or programmes accountable for ‘delivering’ them – you’re asking people to be accountable for things they can’t control.

We then looked at all the evidence of what happens when people try to implement this flawed theory. Outcomes-Based Performance Management has been shown to distort organisational priorities, forcing managers to game the system in order to appear to be doing a good job. Further, it undermines frontline practice by making workers focus on achieving targets, rather than building relationships with people and helping them with the problems they actually have.

The Welsh context is very interesting, because there are lots of people inspired by the Vanguard approach who are doing things differently. Rick Wilson, Chief Executive of  the Community Lives Consortium described how they’ve reworked their service to focus on the genuine needs of adults with disabilities, by abandoning the paperwork associated with personal planning and simply capturing people’s stories during their day to day activities. They’ve made a better, cheaper service by doing so.

North Wales Police vividly described how a target-culture had prevented them from doing a good job, and how they’ve re-organised to put expertise and the use of professional judgement back on the frontline.

The Supporting People Team at Powys County Council presented data to show how their relentless focus on helping people to get back on an even keel is reducing demand on their own service and on other public services. 

 Monmouthshire Social Care and Health Services showed what was possible when you abandon the nonsense of tick-box outcomes, and genuinely focus on the needs of the people who present to your service.

The clear picture that emerged from all the afternoon’s case studies was that in order to genuinely create outcomes, you need to abandon Outcome-Based Performance Management, inspire frontline professionals with  an authentic  purpose, then support and trust them to use their judgement.

Measure the impact you make, but use it to learn, not to make yourself accountable to others.

Accountability is a myth. It’s a comforting lie used by leaders to reassure themselves that they are making a difference. This is the paradox of Outcomes-Based Performance Management. The more you try and make people accountable for delivering a particular set of results, the worse results they will actually deliver for people on the ground. (Although, you’ll never know that as a leader, because all the data will be telling you the story you want to hear).

The truth about kittens and their evil ways spreads.

For more information about the problems with Outcomes-Based Performance Management, and Payment by Results in particular, visit www.saynottopbr.net 

The next Kittens are Evil events are in Fareham on 30 September and London on 28 October. More information can be found on www.saynotopbr.net

My paper on Outcomes-Based Performance Management can be accessed here:

http://www.tandfonline.com/doi/abs/10.1080/09540962.2013.785707?journalCode=rpmm20

It has been downloaded over 1,000 times, and is the most downloaded in the journal’s history.

By Toby Lowe, Visiting Fellow of KITE.

Twitter: @tobyjlowe

*And the truth is, it’s not that outcomes are bad – how could helping someone achieve something positive in their lives be bad? It’s when “outcomes” are used as a performance management tool – like in Payment by Results, or Results Based Accountability ™ – that the problems arise. 

 

 

Think family

Posted on by
Reply

It would seem that even the big television networks are creating programmes around the concept of ‘the family’.   From The Simpsons, Shameless, Rome, to the Tudors some very popular series have been made.  But why are they getting such great ratings?

Perhaps it’s because everyone can relate to the idea of a family.  But are families the bedrock of society that politicians believe?

One of my research themes that I work on with colleagues – James Cornford and Susan Baines – revolves around the family, and in particular how the government uses information system to ‘think’ family.

As we all know from our own personal lives: the idea of a ‘family’ – never mind the reality – can be very complicated.

Historically, under previous administration public bodies were asked to ‘Think Family’.

This has led to a number of government programmes that have encouraged services to integrate their facilities around families in order to co-ordinate support and intervention. This has led to a range of interests attempting to make sense of what to do about families.

Our research has shown that only when the government starts to grapple with the complexities of the ‘family’ will we really make progress with all sorts of families, including those who need the most support from our society. 

However, this is not a jigsaw where the problem has a boundary and is solved by integrating pieces together.

Different bits of the state see different versions of the family – and different things entirely for one department a jigsaw for another a crossword puzzle.

For instance: schools think family in terms of parenting; social services in terms of potential risk; child support agency in terms of fatherhood; and parts of the NHS in terms of genetics, the police in terms of crime and so on.

Rather like our own families it is the stories (often supported by artefacts such as family albums) and the changes that happen that potentially brings these strands together.

So when we come back to examining what the government is doing with its troubled family agenda, we might ask the questions: what interventions are being delivered, using which version of the family, to which of the family members benefit, and with what accounts?

It is clear that rather than families being the static structures we think about in terms the way a family trees represents them, they are lived projects (rather similar to real trees and their ecologies) which evolve over time. 

So in terms of family policy and practice those thinking about families need to have a more elastic idea of what families are to help those working with them and the families themselves to cultivate the best conversations they can have.

If you have a chance, you can read our recent research paper on the topic by clicking here

Dr Rob Wilson
Director of the KITE Research Centre and Senior Lecturer, Newcastle University Business School

If you cannot build a business around it, it doesn’t matter

Posted on by
Reply

A recent event held at Newcastle University Business School saw guest speaker, Todd Brinton, discuss needs-based innovation in the medical field.

Medical devices innovation that is patient-needs driven rather than being the result of a technology push, can be built into a sustainable business that benefits patients and makes money for the innovator.

How does one find real medical problems that need to be solved? Why do we call them needs?

Todd Brinton, MD, fellowship director of Stanford University’s Biodesign Program, cardiologist and bioengineer, presented a bootcamp and a master class in innovation to a mixed university and industry audience.

At Stanford University the Biodesign program teaches the needs-based innovation methodology to their fellows in a year-long program with the purpose of creating entrepreneurs – people with the skills needed to take inventions to market. In the 13 years of Biodesign, 29 companies have come out of the program, and over 100 fellows have graduated.

Teams aim to find a strategic focus, look for problems, and then turn those problems into more generalised needs.

Teams are key – they must include a partnership between people with clinical, scientific, engineering and business development skills; these teams are found to innovate the best.

The team must take a strategic focus on an area that it cares about, and then immerse themselves in the clinical field of interest.  Once they are there they need to observe; get dirty; get in to see actual clinical practise and take notice of frustrated people; use fresh eyes and ask naïve questions because there are many, many problems.

Each observed problem represents a need. Some of these needs affect many patients and, when this need, this opportunity, is thoroughly evidenced, the opportunity is ripe for innovation, invention and business development.

Written by Lucille Valentine

Dr Fiona Whitehurst reflects on the importance of being ‘civic’

Posted on by
Reply

Newcastle University aspires to be a world-class civic university delivering benefits to individuals, organisations and to society as a whole, so it was a delight for the Business School to host Professor John Goddard OBE, Emeritus Professor of Regional Development Studies and former Deputy Vice Chancellor of Newcastle University to speak about his recently published book The University and the City  co-authored with Paul Vallance.

John is a leading proponent of the civic university concept, arguing in a 2009 NESTA Provocation that all publicly funded universities in the UK have a civic duty to engage with wider society on the local, national and global scales, and to do so in a manner which links the social to the economic spheres.

John revealed three tensioned themes emerging from his research – passive local physical, social and economic impacts of universities (campus footprint, student purchasing power, employment generation) vis a vis their active engagement in the development of the city; economic vis a vis more holistic views of engagement with civil society and the ‘external’ civic role of the university vis a vis ‘internal’ processes within the university and state higher education policies that shape these external relations.

John’s distinguishing attributes of a ‘civic university’ are:

  1. It is actively engaged with the wider world as well as the local community of the place in which it is located.  This engagement is achieved through dialogue and collaborations with individuals, institutions and groups locally, nationally and globally.
  2. It takes a holistic approach to engagement, seeing it as institution wide activity and not confined to specific individuals or teams.
  3. It has a strong sense of place.  While it may operate on a national and international scale, it recognises the extent to which is location helps to form its unique identity as an institution.
  4. It has a sense of purpose – an understanding of not just what it is good at, but what it is good for.
  5. It is willing to invest in order to have impact beyond the academy.  This includes releasing financial resources to support certain projects or activities, or to ‘unlock’ external sources of funding.
  6. It is transparent and accountable to its stakeholders and the wider public.
  7. It uses innovative methodologies such as social media and team building in its engagement activities with the world at large.

Plenty of food for thought, especially for a Business School. What does a ‘civic’ business school look like and how well does Newcastle University Business School fit that description?

Those are questions for a later post, but as I was pondering them I came across an article in the Financial Times (15 April 2013) by Della Bradshaw on German Business Schools. She notes that while Germany is the fourth-largest economy in the world, the country has no world-renowned business schools or top-ranked MBA programmes. In the article Robert Wardrop, research fellow in sociology and finance at the Judge Business School, University of Cambridge, ascribes this to the stakeholder value model of German business, which is incompatible with the methodologies that drive most Business School rankings. The MBA rankings tend to have an emphasis on salary maximisation, the traditional US individualist justification for undertaking an MBA. So, another question, does the third of John Goddard’s tensioned themes – the external role of a civic institution vis a vis internal processes and state policies have an added dimension for Business Schools?

Do Business School rankings take sufficient regard of an institution’s ‘civic’ role? In a time of unprecedented societal challenges globally I would like to suggest they should.

Dr Fiona Whitehurst, Director of Accreditation