Monday, August 14, 2017
Demonstrating the impact and value of vision rehabilitation – a Report to the RNIB
Vision rehabilitation services are crucial to ensuring blind and partially sighted people remain as independent as possible. Now, new independent research commissioned by RNIB, with support from the Department of Health, has identified that the cost of providing vision rehabilitation services is dwarfed by the financial benefits.
Independent research by the Office for Public Management (OPM), based on a case study of services provided by Sight for Surrey has shown that the financial benefits of good vision rehabilitation services significantly outweigh the actual costs of delivering this service. In fact in the case study site, over £3.4 million of health and social care costs were avoided, reduced or deferred annually based on a service which cost an estimated £900,000 a year to deliver.
Building on the work of our See, Plan and Provide campaign, we are now working to ensure that commissioners or those making decisions understand the economic value of providing effective vision rehabilitation services and the long term costs avoided, reduced or deferred for the health and social care system.
Thursday, July 20, 2017
Case Study: Exploratory research project on the 1290 expulsion of the Jews from England for the Migration Museum Project
The Migration Museum Project (MMP) are planning a new London-based exhibition in September 2017 called “No Turning Back.” The UK charity, which aims to create a museum on migration for Britain, is working with volunteer researchers on six different moments of significance in Britain’s migration past and present to build their knowledge of these moments and develop a public exhibit that is accessible to all ages and a range of audiences.
OPM Group’s Corporate Responsibility Working Group (CRWG) volunteered to contribute to this exploratory research with the MMP. Research on one moment, “The 1290 Expulsion of the Jews from England” began in March 2017 and was completed in June 2017.
OPM Group provided a team of eight volunteer researchers to gather data and manage the collection of facts, images and stories relating to one of six moments the MMP will feature in “No Turning Back”. For the research, we also identified key artists and experts for the MMP to gain additional insight and resources. Volunteer researchers used Google searching and contacts established through the MMP to develop an initial scoping of extant information on the moment.
We then wrote an interim report for the MMP and received guidance on areas for further exploration from the its research and curatorial leads. Volunteer researchers completed additional research on the moment and a final report was submitted to the MMP in June 2017.
Our detailed and accessible report has allowed the MMProject to incorporate an exhibit on the 1290 expulsion of the Jews because of the information we collected. The MMP is pleased with the result of this voluntary work:
“Thank you so much for all your hard work on our account and for your beautifully presented and detailed document. It has helped us a great deal, saved us a huge amount of time and we would never have managed this without you. I hope we can do you justice in the final exhibition.” – Museum Curator.
Wednesday, July 12, 2017
Social Impact Bonds are not a magic bullet, but they can be useful
On 6 July 2017, we delivered a webinar on the Life Chances Fund (LCF) and Social Impact Bonds (SIBs) timed to raise awareness of the latest LCF call-out. As an independent public interest organisation, we are not in the market to “sell SIBs”. Instead, our mission is squarely on working with public services to enhance social impact.
Despite SIBs having been around since 2010, there is still a relatively low level of awareness. I have written elsewhere about how myths and misunderstandings abound in the context of a lack of transparency and limited, albeit improving, learning and sharing. I have also argued elsewhere that an innovation, such as SIBs, may be abandoned because of dissatisfaction with early versions of it, which may not have fulfilled the creative potential that may be on offer.
We maintain that SIBs are not a magic bullet. Nonetheless, we believe they have value particularly when considered as part of a wider suite of responses to financing and delivering public services.
Those interested in the LCF should not start with the position of: “I want to do a SIB”. If all we have is a hammer, then everything looks like a nail that needs pounding. We should start with clarity over the problem we are trying to solve. Work is then needed to explore whether the potential solution is amenable to outcomes contracting. Where the issue at hand lends itself to being tackled through an outcomes-based commissioning approach, we then need to consider whether social investment adds value or whether there are other more appropriate ways of financing and delivering an outcomes contract.
While not exhaustive, we present three reasons for why and when SIBs may make sense for commissioners.
- The space to innovate – When budgets are tight, there can be aversion to taking risk. New, untested, interventions may be overlooked as the risk of failure is high. Commissioners do not want to be seen as ‘gambling’ on things that prove not to work. Under a SIB model, the financial risk of failure is transferred onto social investors. Commissioners only pay for outcomes, and not for failure. In this way, SIBs can be seen as one way of protecting the space to innovate.
- Driving efficiency – With established services, there may be less inclination to adopt a SIB approach. There is, however, emerging evidence from evaluations that SIBs can drive higher levels of outcomes even for proven interventions. Of course, it is still too early to conclude that SIBs always drive higher performance, and more evaluations are needed. Nonetheless, if this early finding is true, then SIBs can be said to drive greater efficiency in existing interventions. Process evaluations report consistently that the SIB model, by aligning incentives, encourages commissioners, providers and social investors to work together and ‘pull in the same direction’. Where they work best, SIBs have been shown to have helped join up the ‘different worlds’ by breaking down institutional and cultural barriers to effective partnership working.
- Availability of top-up funds – At this point in time, the £80million LCF represents a time-limited window of opportunity for commissioners to tap into additional funds to help pay for outcomes. With top-up contributions from the LCF typically around 20 per cent of the overall financial value of outcomes, commissioners stand to ‘keep more of what they save’. This top-up contribution is obviously meant as a ‘sweetener’ for more commissioners to engage with SIBs. However, just to portray it as such is to oversimplify things. SIB funds like the LCF, its predecessor the Commissioning Better Outcomes Fund, and others, perform a more important function of helping to break down commissioning silos. There is clear recognition that many of the social issues that SIBs have been deployed to help solve are entrenched and cross-cutting. For example, tackling alcohol dependency not only has implications for the use of health and social care services, but also for housing, criminal justice agencies, etc. Working out ‘who pays and who saves’ can be hugely challenging, and can stand in the way of effective co-commissioning. Many have argued, nonetheless, that top-up funds like the LCF are not sustainable over the longer term. In the meantime, they do provide the opportunity for at least testing out different models of co-commissioning. It is of interest to note that there are already efforts underway to develop SIBs that do not rely on top-up funds. It will be important for learning from these efforts to be shared more widely.
In conclusion, I reiterate the importance of being clear about the rationale for developing a SIB. For commissioners, this is especially pertinent as there are a range of alternatives for raising capital, some more cheaply than others. There needs to be a clear case for using public monies under a SIB model, with effective communication around how SIBs can add value.
Dr Chih Hoong Sin, Director, Innovation and Social Investment
Additional video and interactive content is available via the Webinar Webex site here. Note – it is best to access using Chrome or Firefox.
Tuesday, June 20, 2017
Accelerated Non-Medical Endoscopist Training Programme – Year 1 Evaluation (Report to Health Education England)
The Office for Public Management (OPM) was commissioned by Health Education England (HEE) to conduct an evaluation of the Non-Medical Endoscopist (NME) accelerated training pilot. The NME training pilot aimed to recruit and successfully train 40 NMEs across two cohorts. The first cohort started the programme in late January 2016 and the second cohort started the programme in mid-April 2016.
The evaluation aimed to produce both formative and summative findings about the impact and effectiveness of the training pilot. The evaluation activities consisted of:
- A literature review to understand training outcomes and process learnings from comparable training programmes.
- Interviews with trainees, their supervisors and their mentors from across the two cohorts.
- A survey of Cohort 1 trainees and supervisors and mentors following completion of the NME programme.
- Face-to-face interviews with a sample of patients who received an endoscopy from a NME trainee.
- Analysis of management information and training data.
- Observation at various programme activities, including the second selection day in London, two of the taught study days held in London and Liverpool and a Basic Skills Course.
- Ongoing interviews with programme Faculty members and stakeholders involved in developing and overseeing the programme.
Monday, June 12, 2017
Smart Cities Need Smart Consultations
Future Glasgow. Smart City Bristol. Digital Birmingham. Pilot smart city projects are growing exponentially across the UK – and we’re barely keeping pace with the rest of the world (In 2014 India announced a plan to build 100 smart cities). However, while big data and small technology is enabling us to design our infrastructure to be more efficient, responsive, and environmentally friendly, it’s unclear as to whether we’re able to envision the social impact of these changes.
In many cases, Smart City planning is informed by the latest methodology in service design. Traditional methods of “let’s plan it and then ask what people think” have been replaced by human-centred design methodology and co-creation approaches. End-users are involved throughout the process. Nesta’s “Rethinking Smart Cities from the Ground Up” emphasises the need for collaborative technology and a focus on human behaviour. owever, these
In this sense, Smart Cities should be more people-centred than any other kind of urban planning previously undertaken.
However, while citizens may be involved in the design of a project, that doesn’t mean that there is a common understanding – or even any understanding – of what some of the overall impacts of Smart Cities and SMACT (Social, Mobile, Analytics, Cloud, Internet of Things) technologies might be in terms of quality of life and citizen well-being.
Those implementing and affected by traditional infrastructure and public policy projects are well-versed in communicating the balance of impacts of a project and asking for public feedback. Changes to health services, noise impacts from new roads, or threats to ancient woodland – while they can be complex – are familiar topics for people to digest and offer opinions on. In many ways, the whole idea of Smart Cities is to make all of these things better. If technology is enabling everything to be quieter, cleaner, and safer then what could the negative impacts be?
Nobody really knows the answer to that question, but we can take some guesses at what important considerations could be:
- Increased automation results in a reduction in day-to-day personal contact and increased isolation and loneliness;
- An unrelenting need for personal data in the name of responsiveness and efficiency leaves individuals and communities vulnerable to an erosion of personal privacy and self-determination and raises problems for democracy as a whole;
- Increased reliance on OS systems makes cities more vulnerable to sharp shocks – whether through systems failure, crime, or terrorism; and
- A departure from the creative chaos and diversity of organic cities that gives a city personality and identity. In the words of Adam Greenfield, author of Against the Smart City ‘it erodes the development of savoir faire; it eliminates the risk, but also everything wonderful, that arises in the confrontation with difference.’
These potential impacts are relatively intangible, and difficult to imagine, but we need to make more of a concerted effort to start doing that. While there are some sophisticated solutions (such as creating an interactive AI simulations for people to experience), it’s unlikely that these are going to be within the budget of a local authority any time soon.
There is a challenge for organisations passionate about embedding local voice within policy decisions and infrastructure development to shape the future of Smart City consultations. How might we best help city-dwellers understand how their lives could change in the next 10 or 15 years and articulate their opinions on that? How might we design creative, open engagement and consultation solutions which enable frank discussions around possible impacts? And how can we ensure that these comments and opinions are fed into the Smart City movement to ensure that our future cities are fully human, and not just “smart”?
These are some of the questions we enjoy wrestling with at the OPM Group. Through our work with the FLOURISH project on autonomous vehicles, with the Arts Council England on Envisioning Libraries of the Future and in the health sector with simulation of future events we’ve become ever more interested in considering how to engage members of the public in possible futures. We believe that evolving Smart Cities is the next crucial area for effective engagement and consultation.
If you’re interested in joining these discussions – get in touch! Drop an email to Lucy Farrow email@example.com
Tuesday, June 6, 2017
OPM Group is part of an exciting three year project to develop connected driverless vehicles in the UK for an ageing society
Thursday, May 25, 2017
Why, in whole systems, is it so hard to move from papers to action?
This is a shorter version – full version of the above is available here: full version.
One of the strangest experiences in whole systems change in the public sector is observing how much energy is spent writing papers that are not acted upon, attending meetings that don’t make decisions, and holding workshops that lead to elaborate diagrams but no agreement to proceed.
Ron Heifetz coined the phrase ‘work avoidance’ to describe the way leaders are distracted from the difficult conversations that need to take place if we’re to achieve ambitious outcomes in tough times. Work avoidance is quite the opposite of laziness, indeed to avoid the real leadership work we often exhaust ourselves with back-to-back meetings, and slave over hundreds of pages of data and vast action plans.
Work avoidance, says Heifetz, can take a number of different forms:
- Defining the problem as technical and apply a technical fix.
- Turning down the heat – deny the problem exists
- Taking options off the table
- Shooting the messenger
- Delegating the work to people who can’t do anything about it
- Creating a ‘proxy fight’ to avoid grappling with the real issue
It can feel discomfiting to talk about deep feelings and intentions when we are used to an impassive managerial style in our meetings. It can seem like ‘not proper work’ to discuss fears and worries. A flurry of meetings gives a reassuring sense of activity, while difficult conversations can get stuck, or go backwards for a while. But real leadership takes time and self-conscious effort – it involves telephone calls, and meetings in coffee shops, reflection and self-examination, looking into our own hearts to find our values and priorities. It can seem destructive to challenge work avoidance activity, since people are clearly working very hard. Finding ways to do so without blaming individuals is an important part of leadership. But, just as an experiment, if you suspect your ‘system’ is locked into work avoidance, try some of the following:
- Agree the outcomes you care about, identify the real risks and talking honestly about difficulties.
- Commit your own heart and soul: ‘What I really care about is – and I will work hard to make this happen.’
- Instead of suggesting that consultants or more junior staff in ‘work-streams’ solve a problem – get the right people round the table and try to do it yourselves.
- Name the underlying problems – make sure all the elephants in the room are identified!
- Sit with discomfiting truths – and find ways to talk about them.
- Create alliances – a phone call before or after the meeting: ‘ I wondered why you weren’t there – thought I’d let you know what happened’ – or ‘ did you feel that we got anywhere – what can we do between us to help make more progress?’
- Speak up if the right work is not being done – “We need to stop and think about this or we will create something that can’t be implemented’.
- Design creative spaces where many brains can help solve a problem – including front line staff and service users.
This is an extract from a longer article that can be found on our website. For more information about OPM’s work on system leadership – contact Sue Goss, Principal in whole-system change and integration – firstname.lastname@example.org, 020 7239 7800
 See, for example, Ron Heifetz: Leadership Without Easy Answers, Harvard University Press, 1994
Friday, May 12, 2017
Bake My Day!
I recently discovered a new facilitation tool. Bread making. When in doubt, if you’ve got a tricky subject matter, or disparate group of people, bake a loaf.
As part of Marmalade 2017, Arts at the Old Fire Station, Camerados, and Mayday Trust hosted a workshop called Bread and Butter Services. This workshop intended to explore the value of relationships in addressing problems caused by isolation and loneliness. There were about 45 participants; a mixture of organisations providing services for homeless people, service commissioners, and people with lived experiences of homelessness and times of crisis.
You can watch a film about the whole day here.
OPM Group’s “Dialogue by Design” team supported the design of the event, and facilitated the day. Aside from the endless supply of fantastic(ally awful) puns that come with bread baking as a workshop activity, there are a host of reasons why it really works. Here are my top 5:
1) It gives people something to do other than talk to each other. This may seem an odd thing to say when often successful workshops are built on the quality of the conversations that take place. However, sitting across a table from someone else, aware that you need to reach some sort of outcome by a certain time of the day, can produce a very forced conversation. This is especially true when working with a group of people who may find it difficult to interact with each other. Giving people an activity to do together takes the pressure off and allows people to interact more naturally. The conversations that need to happen can still happen, but in a much more relaxed way.
2) It builds trust. Providing an activity that has nothing to do with the subject matter of the workshop encourages people to see each other as people – not as their job titles. Power dynamics and tensions in the room quickly diffuse as people come together over a simple, fun activity, in which everyone can easily participate. As a result, conversations become more human, more honest, and more productive.
3) It introduces a little chaos. Not everyone is comfortable with highly formal, organised processes. While other elements of the day were more standard design-workshop style activities, the bread-making ensured there was always an element of unpredictability running throughout. This was reassuring for those for whom a workshop or conference-style environment was new and intimidating, and conversely was stimulating for those who may have been dreading the standard flip-chart and post-it-note workshop routine.
4) It doesn’t take over the day. At first, I did think we may have bitten off more bap than we could chew by trying to get to the end of the day with solid workshop outputs AND edible bread products. However, bread baking can really be timed around the other activities, and actually doesn’t take too long. Our participants probably spent a total of an hour on bread-related activities, and the time that was spent doing that was invaluable in terms of ensuring points 1 and 2 above happened early on in the day.
5) You can eat the output of your workshop at the end. Once we had finished for the day we brought in the baked loaves, with some jam and cheese and drinks, and invited everyone to enjoy what they had made together. This provided not just a great metaphor for collaboration and building positive relationships, but also facilitated exactly that.
The event was well received by all participants. Seven subject-specific outcomes were developed during the day, as well as five key behaviours to embrace (for more information see the event report produced by the Arts at Old Fire Station and this blog post from Lankelly Chase)- so the bread was certainly not the only positive product of the event. For more information about Marmalade, please get in touch with Arts at the Old Fire Station – and check out the video wrap up for this year. For information about the process design for the workshop, (bread making and otherwise) contact email@example.com
Dialogue by Design
Tuesday, May 2, 2017
The impact of learning and sharing on the development of Social Impact Bonds
In this third blog of my 2017 series inspired by my advisory visit to Japan, I reflect on the importance of international learning and sharing for improving Social Impact Bonds (SIBs). While honoured to have been an expert advisor to colleagues in Japan over the past three years, helping the country take its first steps to develop SIBs; I have also benefitted hugely from the opportunity to learn from them and others.
Here I reflect on the impact of international learning and sharing on two specific areas, based on my Japanese experience.
Role of government
In a previous blog, I argued that governments have key roles to play in supporting the growth of SIBs (and social investment more widely). As I shared the UK lessons during the Social Impact Forum at Yokohama City, I also heard from Australian colleagues who put forward a similar view. What was notable was the fact the New South Wales Government in Australia has actually issued a social investment policy committing to two SIB transactions per year. While the UK Government has been hugely supportive of SIBs, the support has been enacted in different ways. We do not have a specific policy committing us to a specific number of SIBs per year. As Australian colleagues noted, this policy really focusses minds and has mobilised everyone to work together. The machinery of government has been aligned to support this, for example by building in evaluation; by developing policy reviews and analyses; by assessing the effectiveness of known interventions in priority policy areas, etc.
Japanese colleagues, reflecting on their (still very recent) experience, observed that while the Japanese government has made certain overtures indicating interest in SIBs, they have been far less proactive and engaged in stimulating growth, compared with Australia and the UK. It has been very challenging to engage with central government, leaving local governments and their non-profit organisation partners to try lobbying for change while attempting to make things happen on a very small scale.
This comparative approach enabled us to work closely with Japanese colleagues to share specific recommendations for engaging with central government, while also drawing in lessons from related developments and how these have successfully captured the imagine of governments, such as Climate Bonds.
The purpose of SIBs
Another area where the comparative approach surfaced important issues for scrutiny is the motivation behind SIBs. While much of the discourse in the UK, US and Australia is underpinned by a strong ‘savings’ narrative, Japan seems to be more minded to develop SIBs that are focussed squarely on improving wellbeing even when this may not lead to any discernible savings for the public purse.
In challenging the dominant discourse around SIBs, Japanese colleagues tapped into a creative seam of thinking around constructing SIBs on a very different foundation. We were able to share specific models of how this may be done, proceeding to advise Japanese colleagues about the implications for outcome metric selection and outcome modelling. At the same time, this re-focussing enabled us to build a stronger narrative and practice around more meaningful user-defined outcomes in the UK, counter-balancing the more dominant system-defined outcomes approach. I have certainly woven this into my work with Northern, Eastern and Western Devon Clinical Commissioning Group on their SIB to tackle alcohol dependency.
One of the downsides of working in the SIB field is that although we all assert that “things change very quickly”, we have yet to demonstrate willingness to share experiences, learning and data. Indeed, I have often encountered strong opposition towards sharing, under the guise of “commercial and/or political sensitivity”.
At the same time, we all call for transaction costs to be reduced as the current high costs make it difficult for SIBs to be sustainable. Surely one of the ways to bring down transaction costs is for better sharing of information and experiences so that others do not have to reinvent the wheel every time a new SIB is being developed. This glaring contradiction does not escape me and many others. It is time that we have the courage and humility to learn and share more widely.
Dr Chih Hoong Sin, Director, Innovation and Social Investment
Thursday, March 23, 2017
How should health services listen better?
OPM Group has been working with health organisations and patients for many years. We support patients to have a say in decisions that affect them and how services are designed for them. We support health providers with complaints analysis, consultation analysis, engagement activities, research and evaluation. Here is a summary of our services and examples of our work. We hope you will contact us to discuss how we can help your organisation to listen better.