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 [1]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:

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:

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 – sgoss@opm.co.uk, 020 7239 7800

[1] See, for example, Ron Heifetz: Leadership Without Easy Answers, Harvard University Press, 1994

 

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.

Conclusion

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

Monday, March 20, 2017

Commissioning for Outcomes – The role of social finance

Can social finance help with the challenges that public commissioning faces?

This paper is intended as a provocation to government, commissioners, providers and investors to begin a richer conversation that doesn’t assume we already know the answers. OPM’s experts in commissioning for outcomes (Sue Goss) and in social finance (Chih Hoong) draw on their learning about systems leadership, experience of teaching commissioning programmes and our work in evaluating social investment experiments.

Monday, September 19, 2016

Health and social care integration in Kirklees

Background

We have worked to develop collaborative leadership across health and social care systems in a number of localities. In Kirklees we were asked to support the creation of a integrated mental health commissioning system as an exemplar from which the whole system could learn.

What did we do

A very senior group of leaders worked together over a number of sessions to develop a shared set of principles and goal – and a series of practitioner workshops began to flesh out what this would mean for front line services. Recognising that success would depend on the strength of relationships between staff in different organisations, we designed and delivered a ‘Skills for Systems Leadership Programme’ for the public health, social care and CCG senior teams – agreeing key health outcomes and providing the skills and techniques that enabled cross-organisational teams to develop shared approaches to changing behaviour and tackling long-standing problems.

Outcome

The programme built a strong network of organisations and individual leaders, a shared understanding of systems pressures and agreement about the way forward. The work included providing individual coaching and support to key leaders, facilitation and team coaching sessions for top managers and partnerships. The final stage of the programme was to create a dramatic ‘future scenario’ event for fifty or so participants including the voluntary and community sector, from which partner organisations developed a set of principles to guide future shared direction.

Thursday, June 23, 2016

Not waving, but drowning… in data? Managing data and Social Impact Bonds

This is the third blog in the series that summarises key points in a speech I delivered at the 2016 Social Investing and Corporate Social Responsibility Forum, held at Meiji University in Tokyo. Here, I reflect on the following issue:

The importance of data

SIBs are outcomes-focussed. In the first blog of this series, I wrote about outcome metrics, and I think it’s sufficiently appreciated that outcome measurement is critical to the successful of SIBs. It is also widely reported that the ‘data burden’ of SIBs can be considerable. Our first interim evaluation report of the Essex County Council SIB, for example, pointed out that “information and reporting requirements of the SIB have felt onerous for all partners”.

While outcomes are vital, SIBs require more than outcome data to work. If stakeholders are not careful, they may find themselves in a position of expending disproportionate amounts of time and resources in collecting, analysing and reporting data.

We should not, however, simply accept this at face value as a ‘fact’ of SIBs. If we are to take the outcomes-focussed principle to its logical conclusion, then we must surely also be clear about the desired outcomes for data collection and its use. Starting with this helps streamline data collection and use, ensuring that we know why we are collecting certain types of data, and how we are going to use them.

As SIBs involve multiple players, each must develop clarity about data for their specific needs. In addition, the different players need to work together to minimise duplication and ensure that information is shared and that there are systems in place to support collaborative interpretation and scrutiny.

Shared approaches to data categorisation and collection

Different though SIB stakeholders may be, their approaches to data categorisation and collection is surprisingly similar.

When categorising data there are particular ‘headings’ that data relate to. Data can be categorised as regular performance management data, process data, impact data, and cost-benefit data. This points to the fact that delivering a SIB effectively requires parties to monitor ongoing operational matters; constantly assess and review the implementation of the intervention(s); ascertain the degree of which implementation may be leading to the desired outcomes; and assurance that transactions represent good value for money.

Indeed, different SIB players often collect and/or require similar, if not identical, data. This immediately alerts us to the fact that the various players need to work collaboratively to ensure they do not duplicate efforts; share data where relevant; and streamline processes to reduce the overall burden of collecting, analysing and reporting data. Not doing so can lead to unintended additional costs for all parties, as our second Essex SIB interim evaluation report has shown.

Different stakeholders use data differently

While data required can be identical across the various players, the use of the same data can be quite different.

Outcome payers scrutinise data as part of due diligence, which can be heightened in the case of SIBs. They need to show that they have undergone robust scrutiny of the data to justify paying out to investors. They also look at data from the point of view of assessing performance against the original business case for the SIB, and to see how the SIB way of doing things compare with more conventional ways of commissioning services.

Service providers look at the data in terms of understanding the effectiveness of implementation and the efficacy of the intervention. This may be particularly true if they are not delivering a strongly evidence-based intervention, and/or if their intervention is flexible and adaptive. In addition, service providers will wish to be clear about the true cost of delivering a service under a SIB model and how it compares with other ways of ‘selling’ services. They may be interested in ‘going to market’ more widely through a SIB model, and such information is therefore crucial in helping to price appropriately and competitively. Needless to say, most if not all service providers have a strong focus on outcomes for their service users.

Social investors, from our experience, tend to look at data with an eye on what can be improved. They are always looking at how they may redirect resources, adjust inputs and the approach to give it the best chance of success. After all, payment is linked to success. They also look at the data to assess return on investment, and how it compares with other forms of investment, and also how it compares with their investments in other SIBs.

Evaluators, of course, look at the bigger picture in terms of what the impact of the SIB has been and whether it adds values, over and above the operational concerns of individual SIB players. This is where I would encourage evaluators of SIBs to place emphasis on understanding the impact of the SIB, as opposed to the impact of the intervention per se. There is a real gap in our collective knowledge base in terms of how and whether SIBs add value; and whether particular models of SIBs may be more or less effective in different contexts, policy areas, or target groups.

Reflection

Just as SIBs are focussed on outcomes, the exercise of collecting and analysing data for a SIB should equally be outcomes-focussed. Many commentators have noted that SIBs can be overly complex, and data requirement is often part of this complexity. Equally, commentators have pointed out that in order for SIBs to flourish and to achieve the desired degree of spread and scale, it is vital for us to work together to find ways of simplifying and streamlining core SIB components so as to reduce transaction costs.

There will always be a degree of bespoke tailoring required in specific contexts, but there are core generic components that may be simplified or made consistent. The information collection and reporting requirement seems to be one of these ‘design features’ of SIBs, using the terminology from Bridges Ventures, that may be amenable to this, thereby contributing towards reducing the transaction costs of SIBs.

Thursday, June 16, 2016

Social impact bonds in Japan – it’s not always about saving money

In the previous blog in this series, I shared some key messages from a recent speech I delivered at the 2016 Social Investing and Corporate Social Responsibility Forum, held at Meiji University in Tokyo. In this blog, I summarise some of the thinking shared with Japanese colleagues on a second topic they had asked me to touch on:

Can you structure outcome metrics in a way that is not motivated directly by budgetary savings but by social wellbeing?

Level of outcomes

We can look at outcomes at the individual level, the group level and the system level. At the individual level, outcomes are obviously about achieving and improving individual wellbeing. At the group level, we may aim for improving social wellbeing. At the system level, there can be policy or political priorities that focus on social wellbeing. There can also be economic benefits that are being aimed for, and also budgetary ‘cashable’ savings.

Meeting the priorities for outcomes at one level may not always lead to (or support) achievement of priorities at another level. Outcomes for individuals, for instance, may not always lead to savings for the system. An intervention aimed at reducing the social isolation of a socially excluded group may uncover previously unmet needs, resulting in these people being put in touch with other services. While this is a good thing, it does mean there is a direct service use cost, at least in the immediate short term, that was not previously there.

Wellbeing, rather than savings, as a driver

If we are to take an approach that prioritises the achievement of individual/social wellbeing as opposed to the achievement of budgetary savings, there are different ways for structuring outcome metrics in support of this goal.

(a) Taking a wider definition of outcomes and accounting for their value: This recognises that there are different perspectives of the value of the same outcome. For example, when we talk about the ‘cost of crime’, members of the public do not really think of the cost of policing, the cost of incarceration, etc. Instead, they are likely to think about the economic, social and emotional harm inflicted on the victim and communities experiencing crime. A wellbeing perspective will therefore need to take these into account, over and above the system costs.

(b) Acknowledging public ‘willingness to pay’: The public can value things even when the financial implications of those things may not be clear. This ‘willingness to pay’ is underpinned by what we as a society think of as ‘right’ and ‘of value’. It can be influenced by cultural, ethical or moral norms. For example, there can be a strong moral case for supporting war veterans.

Public ‘willingness to pay’ is subjective, contextual, and can change. For example, prior to the UK Government announcing its Comprehensive Spending Review (CSR) at the end of 2015, there was widespread expectation that the government would cut policing budgets significantly. In fact, the government had hinted this will happen. The CSR took everyone by surprise when it was announced that policing budgets would be protected. Why had this happened? In a nutshell, the global terrorism threat had become increasingly significant. Public expectations around policing and security have gone up the political agenda, and it would have been untenable politically to cut policing budgets in such a context.

How may this look like in terms of structuring outcomes

First, there can be situations where the primary outcome metric that triggers payment is savings related, but there are also a range of other wellbeing outcomes being monitored and tracked. For example, in the Essex County Council SIB, the primary outcome metric that triggers payment is ‘care days avoided’. There are a range of secondary outcomes, such as strength of family functioning, emotional wellbeing, educational outcomes, etc. Data on all of these are analysed and discussed by the Programme Board on a regular basis. The seriousness to which the various players consider outcomes holistically is demonstrated by the fact that the social investors have committed to re-contacting the families who have received Multi-Systemic Therapy some time after the intervention has ended to check whether a range of outcomes are sustained over and above the duration for formal outcomes monitoring required by the SIB.

Second, there can be outcome payers who are prepared to pay for outcomes even when they are not linked directly to savings. These outcomes may be paid for as stand-alone outcomes. One of the outcome metrics that triggers payment in the Lisbon Junior Code Academy SIB, for example, is ‘logical thinking’. Logical thinking, obviously, is not something that leads directly to budgetary savings, but is a life skill that will serve an individual well throughout his and her life and can operate in very different situations.

Third, rather than to pay for stand-alone wellbeing outcomes, these may be blended in with other types of outcomes that may be more savings-related. The New South Wales, Australia, Benevolent Society Social Benefit Bond shows how this may be done. Payment is triggered by the Performance Percentage. Performance Percentage is a weighted average of three separate measures. This provides a model for how wellbeing outcomes can be woven in with others to create a composite outcome that triggers payment.

Reflection

As many of the initial SIBs are underpinned by a savings logic, it is easy to think that SIBs can only be structured with this objective in mind. The outcomes focus of SIBs should challenge us to be clear about ‘outcomes for whom?’ Shifting the gaze away from system-level outcomes onto outcomes for others requires us to think of different ways to identify and structure outcome metrics to support the achievement of individual and social wellbeing.

Thursday, June 9, 2016

Japan in Spring: the budding potential for Social Impact Bonds

I was flattered to have been invited back to Japan in April to speak at the 2016 Social Investing and Corporate Social Responsibility Forum, held at Meiji University in Tokyo. Japanese colleagues specifically asked me to touch on the following issues:

  1. How do the various Social Impact Bond (SIB) players identify and structure outcome metrics?
  2. Can you structure outcome metrics in a way that is not motivated directly by budgetary savings but by social wellbeing?
  3. What data do the various SIB players need to collect, and how do they analyse and use the information?
  4. What are some lessons that OPM have learned from evaluating SIBs?

This is the first, in a series of blogs, summarising some of my key messages.

 

How do the various SIB players identify and structure outcome metrics?

There are a number of factors to consider when identifying metrics for SIB-funded programmes. However, this is an art not a science and it should support – not obscure – the achievement of meaningful outcomes.

The ‘3 Ms’

I work to three key principles called the ‘3 Ms’, namely, metrics should be:

Meaningful

a) While SIBs are focused on outcomes, for contracting purposes, the duration of SIBs has to work for the outcomes payers, social investors and service providers. Hence, metrics are usually some form of intermediate or proxy indicators. There should be a compelling rationale to believe that if these intermediate/proxy outcomes are generated, then it is plausible that the longer term desired outcomes are likely to be achieved.

b) Metrics should be easily interpretable. What does it mean if an indicator goes up, stays the same, or comes down? Take ‘reporting of crime’ as an example; if crime reporting goes up, is it because there is more crime (which is bad) or is it because people are getting better at reporting crime (which is good)?

Measurable

a) Can the outcome be measured consistently and robustly? Where it is not already collected routinely, what are the resource implications for collecting the data, and are there tools and processes for collecting the data well.

b) Do we have the systems in place to support good measurement?

Monetisable

As SIBs are based on the ability to pay for stated outcomes, there needs to be some mechanism for pricing those outcomes. It is common to find outcomes being priced based on some projected savings resulting from those outcomes being achieved, but outcome pricing does not always have to stem from budgetary savings.

Roles in identifying and structuring outcome metrics

Social investors, outcome payers, service providers and intermediaries are all very diverse and have different motivations, so it can be hard to generalise. Crudely speaking, their roles and significance of their roles can vary depending on the type of SIB.

Outside of the UK, individually-negotiated SIBs are most common. This type of SIB means that the outcome payers often work very closely with service providers and sometimes with the help of external intermediaries to help them define and structure outcome metrics.

In the UK, we similarly have individually-negotiated SIBs (for example, the Essex SIB that OPM has been evaluating). However, UK is unique because we have many SIBs developed through an Impact Bond Fund model (e.g. the Innovation Fund, Fair Chance Fund, Youth Engagement Fund). Under this model, government departments (as outcomes payers) spent a lot of time analysing data and came up with what is known as a ‘rate card’ that specifies the different outcomes that the government is interested in, how the outcomes should be measured, and the maximum price that the government will pay for each outcome.

There are now SIBs that are developed by service providers and sometimes intermediaries. In these cases, the service provider or intermediary led the development of the outcome metrics. For service providers, it is usually because they have a long history of delivering a specific intervention and have been measuring its effectiveness in a particular way.

Structuring outcome metrics and payment

Crudely speaking, this is done at the individual level or at the group level. At the individual level, outcomes are specified for the individual participant/beneficiary. It may be one outcome per participant, or could be a series of outcomes for that person. This is the approach used in the Impact Bond Fund SIBs. In the first round of the Innovation Fund, the rate card issued by the UK Department for Work and Pensions specified that one of the desired outcomes was ‘improved behaviour at school’. This outcome was to be measured by ‘letter from teacher’. The achievement of this outcome for the pupil triggers a payment of up to £800.

In comparison a group-level approach can be structured in two ways. First, you focus solely at the intervention group and define the number or the percentage within that group that needs to demonstrate the outcome. This is the approach used in Germany’s SIB which specified that at least 20 individuals out of the group of 100+ must experience the outcome for payment to be triggered.

Alternatively, you can compare the intervention group against a control group. In these scenarios, there are often thresholds set for outcome levels. For example, the Peterborough SIB structured its outcome metrics in a way that supported two different payment triggers. The first is when an intervention cohort demonstrates at least 10% reduction in reoffending compared with the control group. If this condition is not met, a second way for triggering payment is if all three intended cohorts have an average reduction in reoffending of at least 7.5%.

Reflection

It strikes me that while the principles underpinning outcome metric selection are clear, the act of identifying and structuring them in support of SIBs is as much an art as it is a science. There is no single approach that works in all cases. I think it is important that we do not get lost in the technicalities and forget about what is really important. Instead, we must always keep a clear eye on outcomes and make sure that we identify and structure metrics in a way that supports meaningful achievement of those outcomes.

 

Tuesday, May 17, 2016

Evaluation of the Reducing Social Isolation and Loneliness Grant Programme

Social isolation and loneliness in older people is a widespread issue that has gained much attention in recent years. We know that being isolated and lonely can impact on a person’s quality of life and lead to more intensive use of health and social care services.  

In Manchester the three Clinical Commissioning Groups provided grant funding targeted to reduce social isolation and loneliness amongst Manchester residents aged 50+. Grants were awarded to voluntary sector organisations to deliver 27 projects across the city. The Programme ran from September 2014 until March 2016 and was managed by Manchester Community Central (Macc).

OPM was commissioned to evaluate the Grant Programme. The evaluation sought to demonstrate outcomes and provide evidence around ‘what works and why’.

This presentation was delivered at the final Programme celebration event attended by representatives from the CCGs, other North West CCGs, Manchester City Council, Macc, local research organisations, plus VCS leads and volunteers from across the city. It presents the headline findings from the evaluation and showcases two projects in depth. Our final evaluation report will be available in the coming months.

Click here to download the presentation slides.

Tuesday, May 17, 2016

Evaluation of the Reducing Social Isolation and Loneliness Grant Programme

Social isolation and loneliness in older people is a widespread issue that has gained much attention in recent years. We know that being isolated and lonely can impact on a person’s quality of life and lead to more intensive use of health and social care services.

In Manchester the three Clinical Commissioning Groups provided grant funding targeted to reduce social isolation and loneliness amongst Manchester residents aged 50+. Grants were awarded to voluntary sector organisations to deliver 27 projects across the city. The Programme ran from September 2014 until March 2016 and was managed by Manchester Community Central (Macc).

OPM was commissioned to evaluated the Grant Programme. The evaluation sought to demonstrate outcomes and provide evidence around ‘what works and why’.

This presentation was delivered at the final Programme celebration event attended by representatives from the CCGs, other North West CCGs, Manchester City Council, Macc, local research organisations, plus VCS leads and volunteers from across the city. It presents the headline findings from the evaluation and showcases two projects in depth. Our final evaluation report will be available in the coming months.

Monday, July 27, 2015

Systems Leadership in Complex Cities

How OPM recently worked with Vietnamese civil servants to explore the role of systems leadership in complex city challenges.

With a population centre of more than 10 million people, London is the UK’s one and only megacity. Whilst the city plays a dominant global role, there is no doubting that its sheer volume of people, communities and businesses creates unique social, economic and environmental challenges.

Much of OPM’s change and transformation work seeks to address complex and uncertain situations like these through systems leadership thinking.

This sort of leadership has been defined as “the collaborative leadership of a network of people in different places and at different levels of the system creating a shared endeavour and cooperating to make a significant change.”

Systems leadership will therefore be crucial in meeting the challenges of megacities, and so we were delighted to host a delegation of planning and investment civil servants from Vietnam earlier this month to explore the role of systems leadership in the context of complex city challenges.

The event, organised in conjunction with the University of Southampton’s business school, explored systems leadership through a case study on 9 Elms. 9 Elms is a key regeneration initiative in the centre of London that will create among other things, 18,000 new homes; 25,000 new jobs; 2 new tube stations and a new linear park.

Whilst the regeneration efforts will contribute to local economic growth, there are already concerns around a lack of affordable housing, the long term viability of local independent businesses and the balance between commercial and civic space.

After learning more about systems leadership, the delegates were tasked with identifying the potential problems that may arise as the project progresses and the systems leadership skills and behaviours that would be required to overcome these problems.

The feedback from each group was remarkably similar. The project’s success will require the cultivating of positive and honest relationships between partners across the public and private sector, while the tension between profitability and creating a pleasant living environment will have to be managed sensitively throughout the process. Those involved in leading the regeneration efforts will also need to be brave enough to confront difficult conversations when interests conflict or risk stalling the progress of the project.

OPM would like to thank Dr Stefan Cantore from University of Southampton’s Business School for jointly facilitating the event and the NCVO for providing the venue for the day.

For more information on OPM’s experiences around systems leadership, you can download our recent paper, “Systems Leadership: A view from the bridge.”