Being efficient is not half as effective as conventional management would like to think.
Working across health, the criminal justice system, mental health, housing, social care, or education requires us to take a whole person view of someone. It requires us to be bespoke.
Typically though, we offer a top down approach, where the citizen has to navigate the pathways we have set before them.
Quota’s, waiting lists, KPI’s, 10-minute appointments, rules and protocols can encourage, even necessitate, a fractured view of a human being – where we focus only on a persons deficits and the problems that need to fixed by the system.
This results in a series of ‘interventions’, by a number of different administrators and professionals. It’s quite possible that one person is receiving multiple service interventions from many differing organisations. And of course, we know that generally housing doesn’t talk to health who don’t talk to justice who don’t talk to education who don’t talk to social care. Somewhere in that complex maze of transactions, appointments, assessments and referrals resides a real person.
And it’s largely reactive, as Donna Hall describes here “We wait for John to come to A+E or we wait for John to try to take his own life. Then we wait for all these services to assess him. And that’s where we spend most of our time: assessing John. We found that 80% of our time was spent assessing someone before referring them onto somebody else”.
Last week I attended a session on Radical Place Leadership specifically to hear more about the work of Mark Adam Smith who in Gateshead has promoted “a liberated method” that has just two rules:
1 – do no harm
2 – stay legal
Rather than spending time trying to to assess people, they simply try to understand them. They can bespoke what they do next based on this – just as long as they observe the two rules.
{Note: I’ve linked the video to this at the bottom of this post. If you don’t have an hour to spare I’d recommend you just hear Mark’s talk from 5:00 to 28:00 minutes}
By way of example Mark shared with us nine years of John’s history. They found that over this time they had a minimum of 3500 interactions with John. “Three and half thousand opportunities to get to know him”. He’d had over 1000 interactions with the health and criminal justice system alone. He was the number one attendee at A+E.
“Throughout that period, when a minimum of £2million was spent on him, his addiction to alcohol got worse, his mental health got worse his physical health got worse and his relationships became either non existent or toxic”. By understanding John rather than assessing him they got to the root cause of the problem. “He’s in recovery now. He’s sober, he’s got community around him – that’s an important word. His consumption is declining as welfare is increasing. “
“What we did was worked with him bespoke based on a relationship and what we found is a whole bunch of things that matter to him that weren’t very doable within the constraints of the current system’“
In most of our public services, actually starting with people and listening to them is radical. As Gateshead Council say, “when you start with people and work outwards from them, things don’t look like services anymore. They look like things we would recognise when we go home (if we’re fortunate). They look like family, agency, community, relationships and understanding. They look like things humans are good at.”
It’s something similar to what we’ve tried to implement at Bromford with our coaching model whose principles included:
We believe in adult – adult relationships
We believe in the strengths and abilities of others
We do more listening than talking
We don’t judge other people’s choices
We don’t see people as needing to be fixed
We think community not services
When we launched the model we were laughed at for increasing the spend on the number of our Neighbourhood Coaches at the same time that other organisation’s were removing staff and going ‘digital by default’.
It’s more efficient to do everything online, right?
Well, efficiency is dreadfully overrated.
Efficiency can inadvertently overshadow the importance of effectiveness.
An organisation fixated on efficiency may sacrifice innovation, employee morale, and customer satisfaction. In the quest for immediate gains, the long-term strategic vision or purpose can be obscured. Effectiveness, on the other hand, is a holistic approach that prioritises achieving goals and delivering value, even if it involves a higher initial cost.
The next time someone comes around rattling the efficiency tin, instructing you to shave another bit of your budget off, remind them that relationships aren’t very efficient. But we can’t live without them.