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presentation on public service innovation for IME (MSc) course in Manchester 2010

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public service innovation

  1. 1. Service Innovation Course Innovation in public services IAN MILES [email_address] MIoIR, University of Manchester
  2. 2. Drawing on (and other MIoIR work)
  3. 3. Why is this important? <ul><li>Public sector is a huge area of expenditure, employment, etc. – and under heavy political pressure and facing challenges of social change (e.g. ageing). Innovation is vital for increasing efficiency , for delivering new and better quality services </li></ul><ul><li>Important market for innovative products (goods and services) from across economy – impact of public procurement on innovation systems </li></ul><ul><li>Important demonstrator of scope for new services, infrastructures and standards </li></ul>
  4. 4. Public Services (innovation) in Crisis? <ul><li>Funding crises </li></ul><ul><li>New challenges </li></ul><ul><li>Governance </li></ul><ul><li>Regulatory reform </li></ul><ul><li>Modernisation </li></ul><ul><li>Inefficiency </li></ul><ul><li>Throwing money at problems </li></ul><ul><li>Initiative overload </li></ul><ul><li>Tech fixes… </li></ul>MPs demand transparent government IT projects Select Committee calls for an end to 'appalling waste of public money‘ Bryan Glick, Computing 22 Jul 2004 MPs are calling for much greater openness on government IT projects to prevent an 'appalling waste of public money and distress caused to thousands of people‘ … Seven in 10 government IT projects fail 17 May 2007 Seven in 10 government IT projects have failed, according to the chief information officer of the Department for Work and Pensions. Joe Harley called for projects to be completed at a lower cost to the taxpayer, and said the government wanted to reduce the number of project failures to just one in 10.
  5. 5. Just this week <ul><li>File on 4 - broadcast on BBC Radio 4 on Tuesday, 2 March 2010, at 2000 GMT, repeated Sunday, 7 March, at 1700 </li></ul><ul><li>“… Chancellor Alistair Darling said NHS spending which was not front line, such as parts of the IT project, should be shelved in the coming round of spending cuts. </li></ul><ul><li>Digital case notes The ambitious scheme, which aimed to make patient records digitally available to every surgery and hospital in England, is years behind time. Originally planned to be completed in 2006, 2015 is the latest estimate for full implementation. </li></ul><ul><li>Tory policy would seek to halt the two main contracts and dismantle its central infrastructure. The Liberal Democrats would like to scrap the programme. </li></ul><ul><li>Shadow health minister Stephen O'Brien told File on 4 that Whitehall is trying to reset these contracts within the next four weeks, which could make it harder for whoever forms the next administration to cancel them…” </li></ul><ul><li> </li></ul>
  6. 6. NHS reply: <ul><li>“ The recent File on Four programme on BBC Radio 4 largely focused on a small number of negative issues in relation to the NHS National Programme for IT. </li></ul><ul><li>In a programme of the size, scale and complexity of the National Programme for IT, it is to be expected that there will be issues and difficulties and we have been open about that. This kind of activity can be disruptive. But we do not believe that there should be a poverty of ambition and the current situation - where hundreds of different, and often ageing computer systems, do not link up - is not right for a modern health service. </li></ul><ul><li>The issues that the BBC has reported must be seen in the wider context of a significant amount of progress that has been made to date. Up and down the country patients and clinicians are benefiting from new computer systems. </li></ul><ul><li>8,800 GP practices (28,000 GPs) are daily using the Quality Management Analysis System that pays GPs £600m pa based on quality outcomes. </li></ul><ul><li>227,239 users registered for access to the NHS Care Record Spine </li></ul><ul><li>1,246,528 prescriptions transmitted using Electronic Transmission of Prescriptions (ETP) system - live (on time) since February 2005 </li></ul><ul><li>401,827 Choose and Book electronic bookings - live (on time) since July 2004. Now exceeding 7,000 bookings per day. </li></ul><ul><li>28,092,700 digital images are stored using Picture Archiving and Communications Systems (PACS) - live in 31 NHS sites </li></ul><ul><li>175,624 registered NHS secure E-Mail users, over 79,000 of whom use the system daily. </li></ul><ul><li>14,538 National Network (N3) secure broadband connections, including 9,912 GP locations (practices and branch surgeries). </li></ul><ul><li>… .” </li></ul>
  7. 7. Public Service Innovation <ul><li>This sort of case certainly shows that there can be ambitious innovation programmes </li></ul><ul><li>It also demonstrates that there can be substantial problems (this applies to all sectors) and that these can become highly politicised and debated in media (this is less common, though not unknown, in private services). </li></ul><ul><li>Many commentators conclude that public services face particular problems. </li></ul>
  8. 8. Contrasting Private Services  Public Services <ul><li>Markets as external selection mechanism: consumer choice of services/suppliers </li></ul><ul><li>Competition between firms: marketing, sales, etc. Scope for transnational competition - and also self-service alternatives. </li></ul><ul><li>Customer Relationship and Supply chain management </li></ul><ul><li>Regulation often higher in services than manufacturing </li></ul><ul><li>Flexibility, e.g. in employment terms and work organisation; Rewards </li></ul><ul><li>Profit-driven: strong incentive </li></ul><ul><li>Rents on innovation </li></ul><ul><li>Public policy driven services, sometimes heavily influenced by public attitudes, media coverage. </li></ul><ul><li>Some forms of competition and” coexistence, with private and voluntary sectors and individual self-service. </li></ul><ul><li>(Nominally) strong emphasis on equity and related issues, plus ethics and privacy issues. </li></ul><ul><li>Bureaucratic systems and admin. Employee lobbies </li></ul><ul><li>Personal and professional incentives </li></ul><ul><li>Public goods </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul>
  9. 9. Public Sector Reform <ul><li>“ New public management” </li></ul><ul><ul><li>Features: quasi-markets </li></ul></ul><ul><ul><li>Indicators and targets </li></ul></ul><ul><ul><li>Performance measurement </li></ul></ul><ul><ul><ul><li>Acted upon! </li></ul></ul></ul><ul><ul><li>Outsourcing </li></ul></ul><ul><li>Key Assumption (here): competition drives innovation </li></ul><ul><ul><li>Learning (esp organisational innovation?) </li></ul></ul><ul><ul><li>Individuals will be motivated </li></ul></ul><ul><ul><li>Organisations will be motivated </li></ul></ul><ul><ul><ul><li>Use instruments like IPR </li></ul></ul></ul>
  10. 10. Is Reform enough? <ul><li>Reform without considering impacts on innovation may be problematic. </li></ul><ul><li>Thus we see various efforts to stimulate innovation in new ways alongside general reform and modernisation efforts. </li></ul><ul><li>E.g. NHS Institute for Innovation and Improvement </li></ul>
  11. 11. (earlier) NHS Modernisation Agency <ul><li>Est. 2001 to support NHS and partner organisations in modernising services and improving experiences and outcomes for patients. </li></ul><ul><li>Focused on four areas: </li></ul><ul><ul><li>improving access, </li></ul></ul><ul><ul><li>increasing local support, </li></ul></ul><ul><ul><li>raising standards of care, </li></ul></ul><ul><ul><li>capturing and sharing knowledge widely. </li></ul></ul><ul><li>“ 10 high impact changes”: </li></ul><ul><ul><li>Treat day surgery as the norm for elective surgery </li></ul></ul><ul><ul><li>Improve access to key diagnostic tests </li></ul></ul><ul><ul><li>Manage variation in patient discharge </li></ul></ul><ul><ul><li>Manage variation in patient admission </li></ul></ul><ul><ul><li>Avoid unnecessary follow-ups </li></ul></ul><ul><ul><li>Increase the reliability of performing therapeutic interventions through a Care Bundle approach </li></ul></ul><ul><ul><li>Apply a systematic approach to care for people with long-term conditions </li></ul></ul><ul><ul><li>Improve patient access by reducing the number of queues </li></ul></ul><ul><ul><li>Optimise patient flow using process templates </li></ul></ul><ul><ul><li>Redesign and extend roles </li></ul></ul>
  12. 12. “ Public Sector Modernisation”
  13. 13.
  14. 14. Confronting the received wisdom: Geoff Mulgan
  15. 15. What do we know? <ul><li>Numerous essays on why public services might have an innovation problem… </li></ul><ul><li>On why the solution might lie in introducing new public management and/or market principles </li></ul><ul><li>Various studies of public service innovation start off from this perspective </li></ul><ul><li>Even PUBLIN only examined public services </li></ul><ul><li>But there is one comparative study, which tells a different story.. </li></ul>
  16. 16. Earl’s Canadian Comparisons Earl, L. (2004) An historical comparison of technological change, 1998-2000 and 2000-2002, in the private and public sectors Ottawa: Statistics Canada (also see Earl 2002)
  17. 17. <ul><li>How do we define PUBLIC SERVICES? </li></ul><ul><li>Public versus non-market: only those provided by the state? What definition of state provision? </li></ul><ul><li>Only those in services sectors (not all nationalised industries) with large levels of state ownership? Or at least with traditionally large levels in most countries? </li></ul><ul><li>Huge variety cross-sector, cross-country, in modes of governance and organisation </li></ul><ul><li>NACE sections L to O – an ACTIVITY grouping (not governance) – </li></ul><ul><ul><li>Public administration, defence; compulsory Social Security 11.4% </li></ul></ul><ul><ul><li>Education 10.0% </li></ul></ul><ul><ul><li>Health and social work 14.3% </li></ul></ul><ul><ul><li>[Other community, social and personal service activities 7.0%] </li></ul></ul><ul><li>Among the market activities here are - driving schools, broadcasting, cinema, hairdressing; education and health services supplied through the market. Also voluntary organisations e.g. social care.? </li></ul>Back to Basics % of EU employment 2000
  18. 18. Boundaries may not be so clear… <ul><li>This may mean scope for learning across sectors – thus voluntary sector may pioneer new approaches (e.g. hospices) </li></ul><ul><li>May be a competitive force, too </li></ul><ul><li>Different types of public service with different rationales, can be expected to vary – broadcasting as compared to education, for example, even though these are both very much about information-processing and delivery </li></ul><ul><li>Scope for learning across different public services – and also cross-nationally </li></ul>
  19. 19. <ul><li>SERVICES INNOVATION: </li></ul><ul><li>Beyond technological innovation </li></ul><ul><li>Beyond classic product and process innovation (delivery, interfaces) </li></ul><ul><li>Policy innovation, organisational innovation, and more </li></ul><ul><li>Innovation versus change </li></ul>
  20. 20. Manchester PUBLIN (health) results <ul><li>Concept of innovation recognised and people can work with it (to some extent) in interviews, but the actual term “innovation” often was not employed – many other terms used. </li></ul><ul><li>“ Innovation” often seen as fashionable jargon – or as ‘new technology’ or problem-solving </li></ul><ul><li>Or as a matter of adoption of top-down guidelines, meeting targets (important procedural innovation). </li></ul><ul><li>Often incremental developments, often hard to establish boundaries between innovation and replication. </li></ul><ul><li>Huge number and range of developments, not subject to much direct recording/compilation in databases… Though some recording through incentive schemes, and through efforts to impose IPR models… </li></ul>
  21. 21. Some examples of innovation… <ul><li>Genetic screening </li></ul><ul><li>Intraocular lenses </li></ul><ul><li>Health informatics </li></ul><ul><li>Electronic patient records system – huge scale, clear benefits (and professional risk perception) </li></ul><ul><li>NHS Direct: “most radical innovation” in recent history of health service” </li></ul><ul><li>NICE </li></ul><ul><li>Tier Two – reduced waiting lists through appropriate secondary care rather than using hospitals </li></ul><ul><li>Creation of new mental health trust – specialisation </li></ul><ul><li>Pilot “out of hours” link with Aus/NZ consultants </li></ul><ul><li>Modernisation Agency </li></ul>
  22. 22. Services Innovation <ul><ul><li>Intangibility (issues of transport, storage, coterminality) </li></ul></ul><ul><ul><li>Interactivity (Production and consumption often intertwined) </li></ul></ul><ul><ul><li>Information-intensity (Much specificity as to service, client) </li></ul></ul><ul><li>Need to relate service product and production process to service client – often extended affair, degree to which individual details involve specialised or customised production varies immensely. Affects scope for innovation of various kinds. </li></ul><ul><li>Public services have to confront the variety of human characteristics with the dictates of large systems and bureaucratic rationality . </li></ul>
  23. 23. Are there Specific/Stronger Obstacles to Innovation? <ul><li>Would expect issues to arise concerning regulations, large technical systems, workforce issues (esp. professionalism and status conflicts), reward structures, etc. </li></ul><ul><li>Also (like other services) some strategies to deal with intangibility etc (e.g. targets, tests, credentials) and some to deal with “public” characteristics – esp marketisation , competition , consumer-centric, cosnumer choice… </li></ul><ul><li>Some results from PUBLIN health… </li></ul>
  24. 24. IT project failures Government IT projects July 2003 Report 200 “ • Difficulties with IT delivery occur in both the public and private sectors. However, the public sector has specific issues to address, including long procurement timescales, high publicity, the need for accountability and the political environment. • There are some factors which can lead to particular problems with IT, such as rapidly changing technology, difficulties in defining requirements and high complexity. • Much government IT is now delivered by external suppliers, so government needs to be an intelligent client. Departments require a range of skills to scrutinise bids, keep up to date with technology, be realistic about what systems are likely to deliver, understand commercial drivers and actively manage suppliers. • Breaking projects down into smaller parts increases the chances of success and makes contingency planning easier, but requires considerable time and effort. • It is important to include the final users in project development and provide time and resources for training.”
  25. 25. Specific/Stronger Obstacles to Innovation? - from PUBLIN Health <ul><li>Internal diffusion / roll-out repeatedly a major issue - much effort now being spent on identifying, codifying and spreading good practice, new procedures. Lack of structures and mechanisms for organisational learning seen as major issue – efforts being made here. But… </li></ul><ul><li>Initiatives to diffuse good practice seen as “short-lived” – reorganisations lead to loss of corporate memory </li></ul><ul><li>Infrastructural and procedural/occupational heritage and legacy, entrenched practice and procedures are commonly experienced. </li></ul><ul><li>‘ Professionalised’ resistance – e.g. clinicians, ambulance service form “disconnected hierarchies”, some self-governing professionals, others “quasi-military” forces. Lack of common command and control structures – conflict with established roles, politics, “empires” </li></ul><ul><li>In particular lack of commitment to consumer orientation was often cited as a major issue (mirroring political rhetoric in UK). </li></ul><ul><li>Public resistance to reorganisation – though public seem very open to new ways of operating </li></ul><ul><li>Lack of “ownership” of innovation – top-down initiatives – </li></ul><ul><li>… and IP issues </li></ul>
  26. 26. Specific/Stronger Obstacles to Innovation? - more <ul><li>Resistance to ‘out of the box’ thinking plus risk aversion (generic issue in public sector – related to nature of service (large-scale and severe risks) and to political cycles. High public/political profile plus blame culture, accountability and risk of litigation (but US?). </li></ul><ul><li>Pace and scale of change (NHS in particular) – shifting targets and absence of opportunity to reflect/asses consequences </li></ul><ul><li>Very complex organisation – composed of multiple tiered interlinked systems with - Huge staff numbers; Many occupations; Many organisational arrangements; Many service processes </li></ul><ul><li>Lack of “patient information connectivity” between actors in system </li></ul><ul><li>Lack of dedicated budgets for innovation at relevant (local, Trust) level. </li></ul><ul><li>Some areas (mental health) not high profile priority for investment (cf. surgery) </li></ul><ul><li>Requirement to consult, lack of clear picture of all eventual effects </li></ul>
  27. 27. In our studies, the innovations exciting management were: <ul><li>Those more at the strategic/management level </li></ul><ul><li>Organisational: governance relation changes, new agencies, etc </li></ul><ul><li>New roles, responsibilities, new ways of operating (need for knowledge management capacity), role in training </li></ul><ul><li>Technical and technological (huge) – some systemic, esp.IT-based, </li></ul><ul><li>New specific practices e.g. round pharmaceuticals, clinical practice, techniques, devices, etc. Huge range of artefacts involved. Again, much IT impact. </li></ul><ul><li>Often technological innovation closely tied to further organisational/process change/innovation </li></ul>
  28. 28. Public Sector Opportunities? <ul><li>High level of staff expertise, creativity, problem solving </li></ul><ul><li>Strong public spirit ethos, motivations beyond personal financial rewards </li></ul><ul><li>Controversial shifts underway (e.g. competitive framework of Foundation hospitals) believed by proponents to increase innovation by: </li></ul><ul><ul><li>Allowing for flexibility and experimentation within target culture and common standards </li></ul></ul><ul><ul><li>Incentivise staff (and management) financially, status-wise, and through improved service quality </li></ul></ul><ul><ul><li>Improve patient choice (will drive resources as money follows patients) aand “consumer” feedback into innovation process </li></ul></ul><ul><ul><li>Management draws on external sources for “directed creativity” and organisational innovation and knowledge mananagement… </li></ul></ul><ul><li>Conscious efforts at innovation management (under various guises) </li></ul>
  29. 29. Mulgan again: sources of innovation
  30. 30. Policy Challenges <ul><li>Research Policy – bringing in the public sector where it is absent, taking better account of it where it is present… </li></ul><ul><li>Public sector policy – governance, regulatory reform, efficiency, modernisation… Building innovation into public policy… Assessing innovation processes and impacts to guide policy, validate expenditure </li></ul>
  31. 31. Discussion and Exchange
  32. 32. Many major initiatives with innovation implications <ul><li>Could we have innovation audits? We have yet to measure public service innovation and impacts systematically (several partial attempts)! </li></ul><ul><li>Can we do better in assessing costs and benefits of attempts to impose certain “private sector models” on the public sector – are there other elements of innovation management that should be engaged with (first?) </li></ul>
  33. 33. Policy for innovation?
  34. 34. Mulgan again: innovation checklist
  35. 35. Innovation Unit <ul><li>Research, Consultancy, facilitation for gvt, local gvt, CSOs, etc. </li></ul><ul><li>Esp. education </li></ul>
  36. 36. Implications for Research <ul><li>Many commonalities – many ideas and instruments can be borrowed – can we use innovation models (PLC etc)? </li></ul><ul><li>Different selection processes internally and externally. Processes of diversity generation too. </li></ul><ul><li>Much is public-private mixture (many kinds) </li></ul><ul><li>Public services highlight areas where innovation studies are weak </li></ul><ul><li>Explore new innovation strategies </li></ul><ul><li>Some </li></ul><ul><li>efforts </li></ul><ul><li>underway </li></ul>
  37. 37. MePIn – Copenhagen Manual <ul><li>Working Party of National Experts on S&T Indicators (NESTI): methodological guidelines for measuring S&T activities (Frascati, Oslo Manuals) Task Force </li></ul><ul><li>Centre for Educational Research and Innovation (CERI) measuring innovation in education and training </li></ul><ul><li>OECD Public Governance and Territorial Development Directorate Government at a Glance (2009 and 2011) + various activities on innovation in public governance </li></ul><ul><li>OECD Health Division performance indicators for health systems, ICTs in health </li></ul>
  38. 38. Public Service Innovation… <ul><li>… is a topic crying out for research </li></ul><ul><li>Policymakers desperately want good knowledge </li></ul><ul><li>Innovation studies themselves can benefit from looking at this </li></ul><ul><li>Its important for public expenditure, social well-being, and innovation across the economy… </li></ul><ul><li>Must not be a ghetto! </li></ul>
  39. 39. End of presentation