Category Archives: Behaviour Change

Episode 2: Behaviour Change Insiders

wee wheel.PNG

In Episode Two, we speak to Chris Subbe, who explains the ‘Wee Wheel’ (pictured), introduced to reduce acute kidney injury for hospital patients (1.45 – 7.30 mins). Then, Olwen Williams speaks on the ‘Test no Talk’ approach to improve sexual health screening (8.00 – 21.30 mins). Have a listen below:

Links to resources mentioned in the podcast:

Chris Subbe blog, An audible patient voiceand 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.

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

It’s good to talk – Universities joining forces to put the Well-being of Future Generations Act into practice

Part of the role of the Good Practice Exchange team is to build relationships with a wide range of organisations and to share some innovative or interesting knowledge. We have been working with the Higher Education Future Generations Group (HEFGG) for a few years now.  They are very keen to work collaboratively with the wider public services and want to share their knowledge they have gained to benefit public services and ultimately the people of Wales.

When the idea of this event emerged it made complete sense for us to work in partnership. Particularly in relation to their approaches of how they are contributing to the Wellbeing of Future Generations Act.

To explain a little more about the upcoming event, here’s Dr Einir Young, the chair of the group, sharing her aspiration of the day… 

My name is Einir Young, I’m Director of Sustainability at Bangor University and I also chair Wales’ Higher Education Future Generations Group (HEFGG), representing every HE in Wales[1]. On behalf of the group I’d like to introduce our new joint venture and invite you to get involved. This is the first in a series of blogs leading up to two conferences coming up, one in Bangor in September and another in Cardiff in November – plenty of time and information to decide whether you want in or not.

Having worked together as a group for some time we decided that it was time to put the theories of the WFGA into practice, in particular the five ways of working, asking ourselves the following questions:

  • What is the long term contribution of the group? What’s the point of us meeting every so often, and exchanging our ideas? What happens to those ideas? What can we show for our efforts?
  • Just meeting to tick a box is not a worthwhile activity so how can we prevent inertia and stagnation and make our group relevant?
  • Collaboration is something that we aspire to but too often our institutions are in competition with each other and as someone said ‘collaboration is the suspension of mutual loathing in search of further funding’. That produced a laugh, because we all recognised a grain of truth. How could we then truly collaborate.
  • Integration is another aspiration – integrating what we do rather than pursue our own goals in silos. How could we do better?
  • Involvement is another word that carries a lot of weight but is difficult to achieve. Who should be involved? Who should do what? When? Where?

As we were pondering these questions as a group at the Wales Audit Office’s Behaviour Change Conference in Aberystwyth in April 2017, Yvonne Jones from Swansea University, the last person standing from the secretariat of the original RCE Wales challenged us to revive and revitalise the RCE to reflect our new thinking and the thinking behind the WFGA. And here we are, 18 months later about to re-launch RCE Cymru in its new guise, ready to contribute actively to an international network of more than 160 similar groups who are busy putting global sustainability objectives into a local community context, with an emphasis on the well-being of current and future generations.

The RCE networks have rules of engagement and the two golden rules are that i) an RCE has to be led by a University and ii) it must engage with the wider community. So we have brought together a tiny group of three people to act as a Secretariat to deal with reporting but the rest is fluid and open to suggestions.

Currently we’re developing several circles of interest and are looking for interested participants. So far the following groups have emerged:

  • The circular economy (co-ordinated by Dr Gavin Bunting, Swansea University)
  • Healthy Universities and Colleges (co-ordinated by Chris Deacy, Cardiff Met)
  • Regeneration (co-ordinated by Dr Sheena Carlisle and Tim Palazon, Cardiff Met)
  • Teaching and Learning (co-ordinated by Dr Caroline Hayles, UWTSD)
  • Communication is a cross-cutting theme and is co-ordinated by my team in Bangor.

Other circles are starting to brew:

  • Social Prescribing (co-ordinated by Nina Ruddle, Glyndŵr)
  • Language and Culture (co-ordinators to be confirmed)
  • Sounding boards for the Public Service Boards (Nina Ruddle and Dr Einir Young – in the north of Wales initially)

So to answer our original five questions, this is where we’re at:

Our long term vision is to create a truly collaborative structure (we think the RCE set up will facilitate this) to provide ‘thinking space’ for circles of interest to explore their theme-specific challenges, in their own time and their own way. It is up to each group to decide how they organise themselves and measure success.

The circles of interest will provide a two way dialogue between the core RCE group and the circles generating a constant flow of new ideas and providing opportunities for cross-fertilisation of ideas between the circles. The meetings will be organised as required by the participants thus aiming to avoid ‘meeting fatigue’.

Collaboration has to be based on trust and this is an opportunity to explore, with no strings attached, how the whole can be greater than the sum of the parts. There is no funding to squabble over, there are no targets to dispute. There is no pressure to join and no shame in failing – we are here to learn together.

There are many initiatives associated with all the circles of interest and many attempts to force institutions to work together before the necessary foundation of mutual trust has been built. We hope that the voluntary nature of the RCE Cymru relationships emerging through the HEFGG will facilitate greater integration and sharing of ideas breaking down the protectionist ‘us v them’ barriers.

The good news is that anyone and everyone can be involved if you want to. This is not an exclusive club. The main requirement of involvement is an open mind, a can-do attitude, creative thinking a willingness to take risks (where failing might be an option) and a commitment to have a go.

Watch this space for the forthcoming blogs explaining the aspirations of each of the circles of interest in turn.

I am ready and waiting for comments and feedback to flow like a Tsumani. Let the fun begin!

[1] Originally the group was called the Education for Sustainable Development and Global Citizenship group but morphed into our new form in response to the Welsh Government’s Wellbeing of Future Generations Act (Wales) 2015 which became law in April 2016.

About the author:
Einir YoungDr Einir Young is Bangor University’s Director of Sustainability. Her Sustainability Lab team are centrally located in the University’s Department of Planning and Governance reflecting Bangor’s commitment to sustainability and well-being of future generations.

She has extensive experience of collaborating with business and institutions who are disillusioned with a ‘one size fits all’ approach. She relishes the challenge of finding effective solutions to complex ‘sustainability’ issues, focusing on generating prosperity through respecting people and living within the resource boundaries of the planet. In her opinion the days of ‘old power values’ with its top down command and control style are over and welcomes the fluidity and energy offered by ‘new power values’ of crowd-sourcing, radical transparency and trusting people.

In her spare time she is passionate about walking. Current projects include the Wales Coastal Path and the Snowdonia Slate Trail; she recently walked around Malta – every destination is judged by the quality of its walks. Wales wins.

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.

 

 

Episode 6: Behaviour Change Insiders

In Episode Six, Diana Reynolds, the Sustainable Development Change Manager at the Welsh Government, talks about an extensive programme to change how Civil Servants in Wales behave and work in connection with the Well-being of Future Generations Act. (2.50 -21.40 mins)

Then, Anna Sussex from WEDFAN (The Welsh Emergency Department Frequent Attenders Network) follows this with an example of where she has worked with an individual to reduce his A&E visits and keep him out of prison. (21.40- 31.40 mins). Have a listen below…

[powepress]

Behaviour Change Insiders

BCI_final

Listen to Chris from the Good Practice Exchange chat with behaviour change insiders in our brand new podcast series!


Listen now:

Episode 1: Professor Judy Hutchings & Rupert Moo

Episode 2: Doctors Olwen Williams & Chris Subbe

Episode 3: Rachel Lilley & Matt Stowe

Episode 4: Professor Dave Snowden & Andy Middleton

Episode 5: Barod’s Jargon Busters


These podcasts have been created from three behaviour change festivals that we helped deliver at Bangor, Swansea and Aberystwyth Universities during 2016/17. We also worked closely with Good Practice Wales and the material from the behaviour change festivals is available here on the Good Practice Wales website. We want to share what we learnt about behaviour change.

In these podcasts, Chris Bolton will be chatting with some of the most influential and knowledgeable people involved in behaviour change.

NB: This is a pilot of a new way of working for us. Please expect things to change as we as we go along, as well as some learning from our mistakes! If you have any feedback on the pilots, please let us know in the comments section.

 


Mewnwelediad Newid Ymddygiad

BCI_final


Gwrandewch nawr:

Episode 1: Professor Judy Hutchings & Rupert Moo

Episode 2: Doctors Olwen Williams & Chris Subbe

Episode 3: Rachel Lilley & Matt Stowe

Episode 4: Professor Dave Snowden & Andy Middleton

Episode 5: Barod’s Jargon Busters


 

Dyma’r cyntaf o chwe phodlediad rydym yn eu treialu ar newid ymddygiad mewn gwasanaethau cyhoeddus.

Mae’r podlediadau wedi’u creu o gyfres o wyliau newid ymddygiad rydym wedi helpu i’w cynnal ym Mhrifysgol Bangor, Prifysgol Abertawe a Phrifysgol Aberystwyth yn ystod 2016/17.

Ein nod yw defnyddio rhywfaint o’r hyn a ddysgwyd am newid ymddygiad er mwyn rhannu gwybodaeth.

Bydd y rhan fwyaf o’r siarad gan y bobl sydd wedi cyflawni newid ymddygiad, yn arbenigwyr yn y maes, neu’r ddau.

Cynllun peilot yw hwn, nid ein ffordd arferol o weithio. Disgwyliwch i rai pethau newid ar y ffordd a byddwn hefyd yn dysgu o’n camgymeriadau. Os oes gennych unrhyw adborth ar y cynlluniau peilot, rhowch wybod i ni yn yr adran sylwadau.

Episode 7: Behaviour Change Insiders

In this final, concluding episode of the Behaviour Change Insiders podcast series, Chris  meets with Clover Rodriguez from the Welsh Local Government Association, to talk about the key findings and messages to take home from the Behaviour Change Festivals.

This episode is ideal if you would like to hear a short summary about Behaviour Change science, whilst also hearing directly from Chris about the running of the events and shaping the programme.

BCI_iTunes

We’d love to hear your feedback on the podcasts, as this was a pilot project for us. We’re really enthusiastic about new ways of reaching out and sharing the learning. We would love to hear if you’ve learnt something new from these podcasts.