Author Archives: Good Practice Exchange

About Good Practice Exchange

Good Practice Exchange at the Wales Audit Office - encouraging public service improvement through shared learning and knowledge exchange. Y Gyfnewidfa Arfer Dda yn Swyddfa Archwilio Cymru – annog gwelliant yng ngwasanaethau cyhoeddus trwy rannu dysgu.

Episode 4: Behaviour Change Insiders

More details are available at the Wales Audit Office, Good Practice Exchange Podcast Page

In Episode Four:

Professor Dave Snowden explains his ‘Nudge Not Yank’ approach to behaviour change. Using narrative to identify where people are currently, their disposition to change and small nudges that will help then move. (2.45 – 8.15 minutes)

Andy Middleton talks about Minimum Viable Competency in key areas as a requirement for decision makers involved in trying to implement behaviour change as part of the Wellbeing of Future Generations Act. (8.20 – 21.10 minutes)

Professor Dave Snowden explains his Ritual Dissent Method.  Used to rapidly develop robust solutions that will stand up to examination in the real world. (21.15 – 27 minutes)

How ambitious could you be?

data_speechAlice Turner @YLabWales has blogged for us following our latest Digital seminar ‘Inspiring public services to deliver independence and wellbeing through digital ambition’. Read on to find out more about her experience of the day and how Y Lab can help support you if you were inspired by our event…

We spent the morning at #WAODigital18, learning and sharing from organisations in Wales that want to bring more digital innovation to their delivery of public services.

Shirley Ayres @shirleyayres from Connected Care Network said ‘No one sector has all the answers to the wicked problems. Public services should be leading the way.’

It was inspiring to hear stories and examples from different sectors, with lots of common challenges identified. As Shirley said, this is the start of the journey, so what is the next step?

Y Lab is the public services innovation lab for Wales – we develop capacity for innovation, support new ideas and research how and why public services innovation happens.

If you were inspired by the seminar and left full of ideas, we are currently accepting applications to Innovate to Save, a £5.8m programme of blended finance and tailored support to organisations that want to try something new.

Over the last year, we have supported eight organisations (including Innovate Trust, who were part of the plenary panel speakers and presented a workshop at the event) to test and research their idea to see if it worked. The next stage for those projects is now underway, with an interest-free loan to scale and implement their idea.

What would you try? If you have an idea that might create cashable savings and deliver better services, we encourage you to get in touch and talk to us about it. Come along to a talk and see what else is out there. The programme is open to all organisations delivering a public service, including local government and third sector organisations. How ambitious could you be?

In June and July, we are hosting a number of free talks aross Wales from innovators including Futuregov, Behavioural Insights Team, Welsh Government and Citymart, who will demonstrate and explore best practice and new developments in the delivery of public services. Why not join us?

Adverse Childhood Experiences: Knowledge is Power

The ACE Support Hub @acehubwales has blogged for us ahead of our ACEs: Small Steps, Big Change webinar on June 12th 2018.

Wales has big ambitions to become a world leader in tackling, mitigating and preventing Adverse Childhood Experiences (ACEs). To achieve this, we must all be aware of ACEs, what they mean for us as individuals and everyone around us, and understanding our unique role in tackling them, both in our professional and personal lives.

The Resilience film tells us: “Once you give people the information, they will find creative solutions,” and we’ve already seen this start to happen in the way that some organisations in Wales have responded to learning about ACEs, changing ways of working to become ACE informed. For example, focusing on relationships, and people, not process.

The ACE Support Hub has co-produced a Skills and Knowledge Framework that will help all of us in Wales to understand our part in tackling and preventing ACEs. It will help us to challenge ourselves to think, “What can I do differently?”, and recognise what we’re already doing. The framework relates to everyone, not just frontline workers and practitioners supporting people affected by trauma, to recognise that the impact of ACEs is widespread and affects people at all ages, across all walks of life.

The Framework isn’t yet finalised, and The ACE Support Hub has collated feedback through engagement sessions with professionals across Wales. The feedback has been varied; with some thinking it’s great, and others who are familiar with the concepts. The Hub is now looking to combine it within existing frameworks.

We know that just having training alone doesn’t mean that change will happen. The ACE Skills and Knowledge Framework will underpin activity by describing the knowledge and skills required by individuals, and their organisations, to create the environment for change.

So, what does it mean to be ACE-informed?

ACE-informed individuals build relationships with people, looking beyond symptoms and behaviours and demonstrate kindness, compassion and understanding. They recognise indicators of ACEs throughout the life course, knowing that it’s about “What’s happened to you?” rather than the “What’s ‘wrong’ with you?” They understand that behaviour is communication, we need to take time understand this rather than blaming them for their behaviour. They appropriately support, signpost or safeguard. They use a psychologically informed approach when supporting people; they explore what is important to that person and what support would help them build on their strengths, skills and resources.

ACE-skilled people are reflective practitioners and demonstrate their own role in tackling ACEs. They identify and access as necessary their own support mechanisms and contribute to continuous improvement in relation to their own practice.

The draft ACE Skills and Knowledge Framework sets out the knowledge and skills for three levels of the workforce.

  • The ‘ACE-Informed’ level describes universal knowledge and skills which underpins everything else. ACE-Informed people understand what ACEs are and know the impact they have throughout life. They understand how to communicate effectively and know when they need to seek advice and support.
  • The ‘ACE-Skilled’ level described applied knowledge and skills. ACE-Skilled people are ACE-Informed and have more detailed and comprehensive knowledge and skills around understanding the impact of ACEs. They can critically appraise issues and use skills and knowledge to support people.
  • The ‘Influencers’ level describes principles for developing and sustaining organisational culture and systemic support that enables informed and skilled people to flourish and give their best. ACE-Influencers are people with a leadership and/or a strategic role. They are ACE-Informed, enable others to become ACE-Informed and ACE-Skilled and ensure appropriate workforce support is available and accessed. They ensure an ACE-informed approach to managing services and teams. Most importantly, they set the culture that acknowledges ACEs as a common, systemic issue requiring a quality response.

SK Framework V1a

The ACE Support Hub is looking for opportunities to pilot the Framework within organisations in Wales. Please contact Kelly McFadyen if you are interested in being involved in this work.

How ambitious could your organisation be in using technology to deliver better public services?

Paul Taylor @PaulBromford, from Bromford Housing, has blogged for us ahead of our ‘Inspiring public services to deliver independence and well-being through digital ambition’ seminar on 5 and 14 June. Read on to find out more about digital change, the cultural barriers and breaking free from the shackles…

We live in exceptional times.

For £50 or less you can buy an Android tablet at your local supermarket. It won’t be the most sophisticated bit of technology on the market – but it will give you access to an internet supporting half the earth’s population.

Over 3 billion people are online, sharing news, forming new communities, chronicling the history of our planet, and shaping its future. Yet, public sector organisations are still relatively slow at adapting to the opportunities of digital technology.

So if people can change their lives with a piece of kit costing £50, why are organisations spending huge amounts of time and resources on ‘digital transformations’ that often don’t achieve their objectives?

The problem is that digital change requires a completely different mindset not just skill-set. Today our customers are bombarded with thousands of pieces of information every single day, and their attention span has deteriorated rapidly.

Redesigning our services around them is more cultural than technological. It means we need to adopt different organisational behaviours.

I see a few cultural barriers we need to get over if we are to keep up with the expectations of our citizens and communities:

  • Organisations are still over-thinking digital and being cautious – waiting for the landscape to settle before they decide what they do. Arguably this ‘wait and see’ option is more ‘wait and die’.
  • Sometimes we are simply taking existing ways of working and digitising them – effectively just transferring today’s problems to another platform.
  • Some are resisting change because they think talk of artificial intelligence will upset their staff or their users – as if somehow their staff and users live in a parallel universe where Siri, Alexa, Cortana and Google don’t exist.
  • And there are those who see digital purely as an opportunity to cut costs. Short term thinking rather than seeing it as an investment in your future.

It sounds simplistic – but a lot of these barriers could be negotiated if we just started with the user and shaped our digital offer around the relationship they need.

At Bromford we have launched an approach that we call Neighbourhood Coaching. It’s the result of all the testing , piloting and exploring we’ve been doing over the past seven years. The learning from all these pilots has brought us to an overriding conclusion: we can have the most impact with our communities when we truly get to know them and are freed from the shackles of how we used to do things.

Those shackles include silo working, restrictive policies, a reliance on contact centres and customer relationship ‘management’ software.

The opportunity for us is to support the right relationship with the right technology – where digital becomes an enabler to a greater purpose. For us that’s less about Bromford as the end destination and more as Bromford as a platform for connecting people to achieve what they want.

Some of this will be achieved by digital tools and some of this won’t. Our learning has been the approach is best formed by just getting technology into the hands of our colleagues and customers and trying things out in a low cost, low risk way.

Most of us can’t tell if we like something or not by reading about it. We need to see it, feel it and experience it. That’s why we focus on what we call ‘tests’. Tests are typically time-limited, minimal resource and therefore low risk. An example might be mocking something up, like a web page, and asking customers what they think, or giving them access to Amazon Alexa and seeing what they get out of it. The whole principle is to get things in front of people as soon as possible to reduce spending time and money on expensive failures.

How ambitious could your organisation be in using technology to deliver better public services?

The answer is with your customers and users – and it will probably be a lot less complicated than you imagine.

Moving from outputs to outcomes

Mark Jeffs @markjeffs75, from the Wales Audit Office, has blogged for us ahead of our Moving from outputs to outcomes webinar on May 16.  Read on to find out more about what matters, rearranging the deckchairs and evil kittens…

Everybody loves outcomes.  We all want them. Well – we want good ones at least.  So if we all want them, what is the problem with getting them and focusing public services on delivering them?

This blog offers some personal thoughts on these issues ahead of a webinar that the Good Practice Exchange is hosting in May.

The context – why do we need to shift from outputs to outcomes?

It is a complicated story but broadly, the mid 90s onwards saw a growth in the use of targets to manage the performance of public services.  Generally, these targets were set centrally and based on measures of outputs (how much we do) and how quickly we do it.

Since then, there has been something of a backlash. Many critics argued that the targets had ‘perverse incentives’.  That is, they encouraged people to do what was necessary to meet the target rather than do what was necessary to improve the lives of the people using services.  Also known as ‘hitting the target but missing the point’.

Against this backdrop, the last decade has seen increasing calls for a shift towards ‘outcomes’: to focus public services on ensuring they make a real difference for people.

There is a big value for money issue at stake.  Can it be ‘value’ for money if we spend a lot of money delivering outputs that don’t make people’s lives better?  The true ‘value’ of public service ultimately lies in improving people’s lives. With austerity set to continue to define the public service landscape, the shift to a focus on outcomes can help to move our discussions from doing more with less to making more of a difference with less.

The opportunity: really transforming our services based on ‘what matters’

The great opportunity of shifting from ‘outputs’ to ‘outcomes’ is not about measures at all.  It is about changing our thinking and the way we deliver services.  To shift towards a model that starts with people, the lives they lead and the lives they want to lead. In short – real ‘people centred’ services.

There are reasons to be optimistic. The language of ‘what matters to people’ is increasingly common in public service. Not least in the context of Wales’ approach to social services which is based around the notion of personal outcomes and what matters to people.  More broadly, if you look here in Wales at legislation such as the Social Services and Well-being Act and the Well-being of Future Generations Act, alongside a range of policy documents on public service reform, a new vision of more personalised, user-focused public services is emerging. It involves:

  • Rethinking the relationship between frontline staff and service users (co-production) to focus on improving people’s lives
  • Reshaping the relationships between services / departments (real collaboration around people to give holistic support)
  • Developing the management/ leadership thinking to see the role as enabling the learning and change needed to improve lives, rather than monitoring numbers/ performance

The issue of what outcomes to measure is secondary to the underlying behaviour, cultural and systemic shifts implied by this vision.  If we start with understanding what matters, we can then work out how collectively we can organise ourselves (as public services working with individuals and communities) to help people achieve the things that matter to them.  From there, we can identify ‘outcomes’ measures that are rooted in the lived experience of people’s lives, rather than abstract idealised imagined conditions of wellbeing.

That is not to say that this is easy.  There is a big technical challenge around how you measure personal outcomes and make them consistent and meaningful at different levels (service/ organisation/ nation).  By their nature, personal outcomes are . . . personal.  They are different and inconsistent.  I worked on the Auditor General’s Picture of Public Services 2015 report. In that report we flagged the approach developed by the Scottish Joint Improvement Agency: a framework for linking personal outcomes through consistent categories that are tailored to individual circumstances.  The Joint Improvement Agency gives examples of how these can be aggregated through different levels from the individual to national outcomes.

The risk: superficial changes (or rearranging the deckchairs)

There is a risk that public services respond to the pressure to focus on outcomes by doing the bare minimum. The simple way to shift to outcomes is for public sector leaders to replace existing output targets and measures with a new set that uses more ‘outcomey’ language.

There are many reasons to be sceptical about an approach that is essentially the result of a discussion about measurement amongst a relatively small group of senior leaders.  The questions I would pose to those adopting such an approach are:

  • What is the evidence that these are the right outcome measures – how do you know they really reflect the things that matter to service users and to the wider public?
  • What are the links between new measures and the plans to change the real experience of providing and receiving services?

For me, the biggest risk of this approach is that it does not lead to the kinds of changes we need to see.  Instead, we get superficial changes.  The new outcome measures form part of a new ‘strategy’.  There will be a new overarching delivery plan, departmental action plans and underpinning service delivery plans.  Frontline staff may look at all of this paper once (at most) and then get on with the business of providing services much as they always did.

The other big risk is that changing from numerical output targets to numerical outcome targets risks creating the same perverse incentives and behaviours.  Instead of chasing outputs, service providers chase numerical outcomes with unintended consequences. This concern is articulated in Toby Lowe’s ‘kittens are evil’ critique.

The baby and the bathwater

It is essential to emphasise that the shift from outputs to outcomes is one of emphasis.  There should be no sense that output, activity and timeliness measure no longer matter. They do.  They are vital for understanding demand and capacity and planning the delivery of services and systems.  Nobody could argue that we should stop measuring and caring about how many people come into and out of hospitals and how long they wait for treatment.  The issue is how much emphasis we place on these measures and how much they should drive behaviours.

So what are the key messages on shifting from outputs to outcomes:

  • The shift to outcomes is about so much more than measures and indicators – it is a different way of seeing and providing public services that starts with people’s lives and what matters to them in their lives.
  • As well as service delivery, shifting to outcomes means a shift in the role of management as enabling and leading practical changes rather than monitoring numbers and chasing targets.
  • When it comes to measures, the idea of a shift ‘from’ outputs to ‘outcomes’ may miss the point – it is about the right balance of information to understand both what is happening in the system and how well the system is doing at making the lives of people and communities better.

 

 

“Action more than words is the hope for our future generations”

Sophie Howe, Future Generations Commissioner for Wales, has spoken many times before on why the Well-being of Future Generations (Wales) Act 2015 is an opportunity for us all to measure what matters, not merely what can be counted. Sophie blogs ahead of the ‘Moving from outputs to outcomes’ GPX webinar…

The title of this blog is the latter half of a now well-quoted sentence said by Nikhil Seth, United Nations, on the passing of the Well-being of Future Generations (Wales) Act as law in 2015. I use it often in speeches and presentations, as the full quote suggests that Wales is world-leading in adopting such pioneering legislation. But it is “action more than words is the hope for our future generations” that really strikes a chord with me.

For decades, we have been stuck in ‘reaction’ mode, dealing with crises in the here and now. At the sharp end of providing public services, this is understandable in keeping people and organisations safe. It has followed that we measure what we have done – count the people seen, record the number of people dealt with, and place arbitrary timescales and pressures on ourselves – if only to make things happen…to create action. But is it time we question if these actions have been the right ones to take?

People often tell me that the Well-being of Future Generations (Wales) Act has given them permission to question what we have always done. Placing the sustainable development principle at the heart of what we do as a public sector in Wales means thinking differently and acting in a way that allows current generations to meet their needs, without compromising the ability of future generations to meet their needs. To do this, we must think long-term, considering the impact of what we do now on future generations, working together in a joined up way as we seek to prevent problems from occurring or getting worse and involving people in our communities in working towards the seven national goals.

Measuring our impact in a traditional way is not going to allow us to do this. In order to do things differently, we must measure different things. Traditional performance measures are often what are imposed on public bodies by others and rarely reflect the nub of the issue or help us to understand how to prevent the issue from occurring in the first place. Behind the measures to provide a statutory assessment within 5 days, to respond quicker to a call or to deal with an issue in a month’s timescale are real people, just like us and our families. We have lives intertwined with many public services, we have several factors influencing our well-being and too often, we face a confusing negotiation of complicated thresholds and conditions to access services. Many of which are driven by the measures public services have set themselves. Rarely do we ask ‘What matters to you?’ Or ‘What would help you the most?’ Rarely do we measure how well we have done in improving someone’s well-being.

In my recent report, Well-being in Wales: the journey so far, I have given my reflections on how public bodies are moving from doing simple things to leading the way in sustainable development. The guidance to the Act says sustainable development must shape what you do, how you do it and how you communicate (via reporting) the difference you are making. In reviewing the first well-being statements published in April 2017, it is not yet clear how organisations are making sense of their duties and how this relates to other legislation, their corporate objectives, business planning and day-to-day business. An annual report should be integral to the work of the organisation and the sustainable development principle should not be ‘bolted on’.

Communicating this change is important. In annual reports and future well-being statements, public bodies must explain how far they have taken steps to meet their objectives, how effective these steps have been, how they are tracking progress and how they are adopting or adapting new ways of demonstrating progress. Outsiders to organisations, like you and I, need to understand what have they done so far? What does it mean for me? Where do they want to be on this issue in the next 5, 10, 25 years and beyond? How are they going to get there? How will I see improvement in my local area or life?

Many public bodies and public services boards (made up of Chief Executives and leaders of the local public sector collaborating together) are now considering how they communicate the change they are making. This will take time, but I am encouraged to see an exploration of different way to define impact and monitor progress. Action definitely speaks louder than words and my advice would be to measure what matters, not merely what can be counted.

The Future Generations Commissioner for Wales has published ‘Well-being in Wales: the journey so far‘ to complement the Auditor General for Wales’ report ‘Reflecting on year one: how are public bodies implementing the Well-being of Future Generations (Wales) Act 2015?

Behaviour Change Insiders Podcast: Episode 3

More details are available at the Wales Audit Office, Good Practice Exchange Podcast Page

In Episode Three:

Rachel Lilley from Aberystwyth University talking about changing how people think about energy use at home with Ymlaen Ceredigion. (1.43 – 9.20 minutes)

Matt Stowe from Cartrefi Conwy explaining the environmental improvements at Parc Peulwys Housing Estate and how they changed behaviours and help gain a Keep Wales Tidy Green Flag award. (10.30 – 25.30 minutes) 

Links to resources mentioned in the Podcast:

National Energy Action Cymru details of working with Ymlaen Ceredigion in partnership with Ceredigion County Council and Aberystwyth University including a link to a report from Rachel Lilley.

Parc Peuwlys Management Plan 2015-2020, produced by Cartrefi Conwy.  Report from BBC Wales on Parc Peulwys acheving the Keep Wales Tidy Green Flag award.

Procurement: The spotlight’s on Wales

Sophie Howe, Future Generations Commissioner for Wales, has gone on record on many occasions about the vital role sustainable procurement has in underpinning the well-being goals. Sophie blogs ahead of the Good Practice Exchange’s forthcoming Sustainable Procurement webinar

It is estimated that over the next decade, Welsh public services will spend over £60bn in procuring a range of goods, services and works. If this money was being spent to buy things and improve the economic, social, environmental and cultural well-being of people and communities in Wales – imagine what would that mean? Wales has a great opportunity now to think about how and where to spend that money in the interests of future generations.

Up until now, procurement is something that has been done in a certain way, often seen as a blocker rather than an enabler, a transactional rather than a transformational process. Tension remains between striving for the lowest cost rather than achieving wider benefits, with a perception that sustainable procurement can cost more at least in the short-term, even if it offers long-term savings.

As a world-leading, game-changing piece of legislation, the Well-being of Future Generations Act has the power to change the way we do things in Wales today, for the future. This is not just a nice thing to do, but a statutory obligation to ensure we are acting in the best interests of our future generations by improving the social, economic, environmental and cultural well-being of Wales. Crucially, all four aspects of well-being are seen as important as each other, and there are seven well-being goals that help public bodies maximise their contribution to the Act. Procurement has a vital part to play here.

So the spotlight is truly on Wales.

I believe there is a need for a much simpler, holistic and co-ordinated approach to what procurement can achieve, through a framework which offers clarity, not further confusion, and the Act provides this.

Stronger leadership is needed, from within every area of our public sector, and commitment in stepping up these efforts. Procurement is so often seen as one area, in its own silo, but if we are to do this properly our approach to procurement must consider the whole system, not just one area in isolation. Now is an opportunity to ensure procurement is fit for the future.

Public bodies now have a duty to think about the long-term; over 10 years ago the UK Sustainable Procurement Task Force showed that sustainable procurement, when seen as an organisational priority which questions the need to spend, cuts out waste, seeks innovative solutions and is delivered by well trained professionals will reduce rather than add to public spending in both the short and the long run.

We know saving costs in a time of continued austerity is still important. Austerity makes it even more important to seek different solutions, and reduce demand that achieve longer term benefits not just short term cost savings.

Solutions like:

  • procuring good quality local food, which can have a positive impact on health and support local businesses as well as reducing carbon footprint;
  • requiring the reuse and recycling of furniture or construction material; or
  • thinking of long term cost and carbon savings by procuring electric fleet or replacing lighting with LED bulbs.

In Preston public bodies have increased their spend with local organisations by 13.2% or £74.8 million (between 2012/13 and 2016/17) showing that you can support local economic development even during times of austerity. We have the infrastructure in Wales via our Public Services Boards to do the same.

We also have a duty to consider the unfair amount of debt and an empty bank of world resources that we are placing on future generations – at over 7 billion people we are depleting the Earth’s resources at rates that are not sustainable. At the heart of the Act is the idea of intergenerational equality – that future generations should not pay the price of our decisions today.

There are clearly pockets of good practice in Wales – the 21st century schools programme which is building the kind of schools Wales needs for the future, with low-carbon, resilient buildings and environment, as supporting the development of skills for the future. When they procured furniture for their new offices, Public Health Wales saved 41 tonnes of waste from landfill, and in total the project saved around 134 tonnes of CO2, enough to fill 804 double decker buses.

Caerphilly County Borough Council have trained their tenants as part of the process of learning about what makes a good quality home through their Quality Homes Standard showing that involving suppliers and end-users in the procurement process can be done. Swansea Community Energy Scheme increased employment of local people by developing a new model for procuring community benefits through renewable energy for council buildings, and encouraged the low-carbon vision of prosperity we are striving for. And by listening to the voices and views of their conscientious pupils, Cathays High School went on to buy Fairtrade school uniforms – a more ethical option that supports the well-being of our global communities.

So, why not join the Wales Audit Office’s, Good Practice Team’s Sustainable Procurement webinar on Wednesday 18 April, between 12-1.30pm. This will be an opportunity to hear from an expert panel and get involved by posing live questions to the panel. Helping to encourage a mind-set shift so public services can start to work differently to ensure that they make the most of the £60bn spent in Wales and help deliver the Wales we want.

You can register here.

Behaviour Change Insiders Podcast: Episode 1

More details about the podcasts are available on our Behaviour Change Insiders Podcast Page on the Good Practice Exchange Blog.

square_bciIn episode one:

Rupert Moon – on working with rugby players at Rugby Gogledd Cymru to develop behaviours that went beyond the playing field (1.30 – 15.20 minutes)

Professor Judy Hutchings – on the KiVa anti bullying programme in schools. Learning from Finland on how taking a whole school approach can change behaviours and reduce bullying (15.25 – 27.10 minutes)

Links to resources mentioned:

Wales Audit Office, Good Practice Exchange Podcast Page.

Bangor University KiVa Programme

Rupert Moon on sport and improving well being

Behaviour Change Insiders Podcast: Episode 2

 More details at the Wales Audit Office, Good Practice Exchange Podcast Page.

In Episode Two:

Chris Subbe  explaining the Wee Wheel introduced to reduce acute kidney injury for hospital patients (1.45 – 7.30 minutes).

Olwen Williams on the ‘Test no Talk’ approach to improve sexual health screening (8.00 – 21.30 minutes).

Links to resources mentioned in the podcast:

Chris Subbe blog, An audible patient voice and 1000 Lives Wee Wheel page

1000 Lives Compendium of Outpatient Improvement, report by Olwen Williams on : Self triage innovation in sexual health services – Test no Talk.