Beyond Command and Control – a Better Way of Contracting for Complex Services?

John Seddon is a highly original and interesting thinker, whose work over the years has often gone against the grain of conventional ideas about business and public services. When “shared services” was the trendiest concept in town, he warned that organisations were rushing into that model without really understanding the critical success factors – he always placed a lot of emphasis on the “service” element, arguing that a systemised and automated approach wasn’t likely to deliver happy customers or even real cost savings.

Some years ago, our then MD Peter Smith covered his thinking on “failure demand” (demand caused by a failure to do something or do something right for the customer) in the context of Birmingham council’s outsourcing of their call centre, and he has continued to be influential with his writing and consulting work around what he calls the “Vanguard Method.”

He has a new book out now, titled “Beyond Command and Control.” In it, he describes a different approach to buying complex services, such as social care, moving away from task- and time-based contracting to a methodology where the actual providers (at working level) have a lot more freedom to engage with service users and decide what is needed. That sounds worringly open-ended, but Seddon claims it has proved itself – he says that in one County Council ”the authority has underspent its adult services budget in successive years, and there has been a concomitant drop in demand into the service from 8000 to 3000 cases a year.”

Assuming that is accurate, then this ought to be rolled out across the UK as quickly as possible! And the approach has some read-across to other elements of the public sector, and even to private sector firms in terms of the focus on paying for outcomes, rather than for tasks delivered or time spent. It’s a good point to hold in mind when buying many management consulting services, for instance.

Anyway, back to the core topic, and here is an extract from the book, talking about social care commissioning. You can buy the book here if you want to read more.

 

Beyond Command and Control (extract)

“Government guidance advises commissioners to adopt a “commissioning cycle” in which it will “identify the benefit, decide how to achieve it, commission services and monitor them.” This sounds reasonable on the surface, but does it constitute a sound method?

What commissioners don’t do is study demand in the way we describe it in this book. They often tell us their work is solidly based on demand, but on investigation it always turns out that they mean historical provision (for example, the number of drug-treatment programmes provided last year), assuming, wrongly, that that tells us something about demand. Commissioners have no knowledge of the effectiveness of their service, and how ineffectiveness drives failure demand.

Government insists commissioners should focus on “outcomes.” Despite this, the “performance data” (KPIs) are typically the usual activity statistics. How many people have been assessed? Were assessments completed in target times? How many services were provided? Was the budget adhered to? By this sleight of hand “outcomes” come to be represented by the output of providers, not results experienced by those receiving the services.

Commissioners see their challenge as purchasing services while staying in budget. This means that price frequently becomes a determining factor in the choice of provider. In practice, the focus on price has two perverse consequences: mass-produced, standardised services that fail to meet the variety of needs, which also rules out a “thermostatic” approach (so you get 30 minutes regardless of whether 10 or 40 might have been better); and unnecessary volumes of activity (since that is how providers are paid).

The fact is that the way services are commissioned makes it almost impossible to do the job properly. The focus on price leads to services being commissioned on a time and task basis – a specified amount of time for a specified service. But commissioning specified services means telling providers what they won’t be paid for – things like cleaning, taking out the rubbish, shopping, lighting the fire, help with making friends, overcoming loneliness, improving the quality of life – since these are not care needs as defined in the contract. The providers’ rotas and specifications drive what care staff are allowed to do, taking away autonomy, judgement and initiative, having an adverse impact on morale. In many cases care staff do what matters, but “under the radar.’ Providers feel they put huge effort into providing the service but are dismayed by the feelings of failure and of not being able to truly help.”

 

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Voices (3)

  1. David:

    Seddon’s worn-out message on “failure demand” shows his lack of ability to find new theories. Regurgitating this message time and time again. You can do everything Seddon says and still go bankrupt by innovative products and services. But the UK’s love of bureaucracy (and queues) may help him sell some books to the gullible.

    1. John Seddon:

      I wonder what’s eating Dave

  2. Peter Lightbown:

    An excellent book outlining the way forward in business thinking. John has developed a method focused primarily on people-centred services but his thinking is based on the development of systems thinking from the early ’50s where Deming, Ackoff recognised that organisations and larger systems such as healthcare, economic development all sit within interacting complex systems. Importantly what was recognised was that analysis or reductionism (still used in most mngt thinking today) failed to aid the understanding of how complex systems interact. The why not How question!

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