Jon Harvey Associates: Players not pawns in the commissioning process

These are some thoughts about the application of whole system approaches to commissioning within the public services. My aim in writing this is to persuade you that such methods would be hugely beneficial to all the stakeholders involved. Moreover, it is my view that without such methods, the ambitions for commissioning within the public services will never be fully achieved.

I start with a commonly accepted definition: Commissioning is the process of specifying, securing and monitoring services to meet people’s needs at a strategic level. This applies to all services, whether they are provided by the local authority, NHS, other public agencies, or by the private and voluntary sectors. (Making Ends Meet, Social Services Inspectorate / Audit Commission 2003)

Within such an approach is an inherent complexity arising from not only the subtlety of the needs mentioned but also from the interaction of those needs which will often pull in opposing directions: what a particular user needs will not be same as nor necessarily compatible with the needs of the wider community (for example). A robust and effective approach to commissioning therefore needs to have the capability to ‘hold’ this complexity and work within it to make effective decisions about provision, procurement, and performance management etc. (There is much additional complexity in the provision of effective and efficient services as well, of course.)

Meeting all these needs and generating sustainable social outcomes requires ‘ownership’ from many key stakeholders, not least the supplier agencies. They will need to invest large amounts of their time in designing and maintaining structures, systems and practices to meet these needs within a very tight resource base. While the system will just about work if these actors feel ‘done to’, it will not work very effectively or efficiently as more resource will have to be invested by the commissioning bodies in monitoring compliance and performance. Likewise without the communities and politicians authorising the direction of travel, there is the risk that precious resources will need to be spent on ‘selling’ the plans made. With all these points in mind, I argue that stakeholder commitment is a vital ingredient in assembling and running effective and efficient commissioning processes.

Einstein once defined insanity is doing the same thing over and over again and expecting the result to be different. On this basis, there has been quite a lot of insanity in the UK public services in the past. Commissioning offers a good deal of hope for reforming how public services delivered so that new (and better) ways are found to deliver these services that will lead to better outcomes for all concerned. The regimens that commissioning requires of both suppliers and commissioners should help to yield innovation in how citizens are served, and thence helped to live more fulfilling lives. It should, but will it? Does it? There is an inherent risk in commissioning that unless the right conditions are built in, the key actors involved may well end up ‘playing safe’. The latter day version of ‘nobody got sacked for buying an IBM’ comes into operation, as it were. If the processes for implementing commissioning fail to foster creativity and innovation, a significant opportunity will have been lost.

In summary, my position is that for commissioning to work smoothly, we need decision making methodologies that can hold complexity, develop commitment and foster creativity. Of course most approaches to public service commissioning (as seen in the NHS and local government) aim to have these three ingredients in place. However, I would contend that the approaches used to install these three ingredients often fall short of the full potential.

For example the approach to complexity is often interpreted and conducted as detailed needs analyses where seemingly endless iterations of surveys, focus groups, research and expert input are channelled into large and turgid reports written by small project teams. Complexity is synthesised into a single executive summary where the rich diversity of perspectives is more or less left to one side. Attempts are made to manufacture commitment through road shows and glossy vision statements. While the need for creativity is proclaimed, the whole process is so ‘left brained’ & paper based that very little creativity sees the light of day.

This is where whole system approaches come in as they are designed to create the optimal conditions for handling complexity, developing commitment and fostering creativity. The essence of all WS approaches is that all they focus on enabling authentic conversations that lead to collaboration not fragmentation. They use methods that tap into people’s imagination and analytical functions so that both right and left brains are engaged. These approaches spend most time looking forward to the future so that heads lift up and energy is found to develop new solutions rather than pick apart what has not worked well in the past. And, critically, they aim to get the ‘whole system in the room’ so that everyone has he opportunity to meet the other players in the system and appreciate their perspectives. Such approaches would nurture the sense that commissioning is there to be harnessed actively by all involved to shape better futures, rather than succumb to them.

There are several ‘versions’ of such approaches (which have also been called ‘large group interventions’) and which have been used extensively in the NHS commissioning for example. These versions include:

Open Negotiation (where the key issues to be resolved are identified before a whole system event and then a process is created that enables these issues to be addressed in open forum between the key players)
World Café (where an ambient atmosphere assists people in focussing on a series of predetermined and emergent questions to identify a particular way forward for the matter in question)
Open Space (where key players are brought together by an overarching theme and discussions are organised from the floor up around what needs to get discussed and sorted)
Future Search (where stakeholders spend time identifying key learning from the past, clarifying the current pressures and shaping a new future for the system they represent)
Open Simulation (where a new way of working is tested in a model situation by the people who will have to make it work in reality so that glitches and advantages can be identified before the ‘go live’ date)

Each of these approaches involves preparation where four key ‘P’s are investigated and balanced:

What is the main purpose?
What therefore should be the process?
Which people need to be there?
What arrangements need to be made regarding the place?

Each event (or summit) is designed bespoke to the key question that needs to be answered at key stages of the commissioning process. The event(s) may well focus upon:

What needs and demands need to be built into our commissioning cycle?
As commissioners, what services do we need to source?
As providers, what services do we need to offer?
How should we monitor and manage the performance within this system?

And so forth... Naturally, events could be geographically based (eg the NW region), provision based (eg high security prisons only) or user based (eg women aged 18 to 25).

In addition to boosting creativity, commitment and the capacity to hold complexity, using these approaches would bring a range of significant benefits that are particularly needed at this time in the development of commissioning in the current climate:

These approaches will assist in building trust both between the agencies involved and in the commissioning approach itself.
By engaging a diverse mix of stakeholders in these approaches this will reduce the need to spend resources on educating about and ‘selling’ commissioning to people who need to be up-skilled or persuaded of the approach
These approaches will help make a break with the past and introduce some fresh flare into the delivery of public services where needed
Unlike more traditional ‘left brain only’ approaches, these WS methods will help to increase the sense amongst the stakeholders in the mixed economy of the ‘Big Society’ that they are players not pawns in shaping the future of the services involved.

In summary, I contend that whole system approaches have much to offer commissioning. These approaches will ensure the overall process delivers more effective, more efficient, more robust and more flexible services that will lead to dramatically improved outcomes for all concerned.

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