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Developing Capable Health and Social Care Organisations: Commissioning and Procurement in Context A Systems Approach to Commissioning Change in a Problematic world
Commissioning v Procurement: Competing Process or Synthesising Design?
What are the benefits of Commissioning? Stating that >90% of problems are due to the design of the “System” and not to people avoids blame. Note that people are integral part of an open adaptive system. In others words, it should be recognised systems are social, economic, technological and not just linked processes and activities How does Commissioning help us with the issues of procurement?
The Continuum between Hard & Soft Systems Approaches (What is the balance point?) Hard Approaches Things dominate the problems and its setting Soft Approaches People dominate the problems and its setting A continuum exists between these poles A critical question is. What is the balance point from which to Commission AND what is the level of system or subsystem Maturity, Culture, Learning AND Which Procurement Procedure and Model of Competition will work?
What is a Commissioned System? General Systems Model - A simple view of a System .
What is the System of INTEREST?
Actors, Players, Owner & Customers
Purpose(s) can be several depending on world views
A system is a construct or collection of different elements that together produce results not obtainable by the elements alone. The elements, or parts, can include people, hardware, software, facilities, policies, and documents; that is, all things required to produce systems-level results. The results include system level qualities, properties, characteristics, functions, behaviour and performance. The value added by the system as a whole, beyond that contributed independently by the parts, is primarily created by the relationship among the parts; that is, how they are interconnected (Rechtin, 2000). Outputs Controls/ rule set Feedback
The Existing Procured System closed – deterministic and no concept of subsidiarity or decision making derogation) Activity Flow Inputs Pull Flow Waste / 7 Mudas Demand Customers Outputs Feedback
The rule set determines (e.g. a specification) the:
How the systems /process works
The feedback loop can change the rule set (e.g. change the specification)
……………… .. Note the rules set lies WITHIN the systems boundaries
Controls/ rule set System Boundary
Closed – Deterministic System Closed systems models involve recursive patterns of feedback Viability depends on maintaining identity and stability Self-construction limits feedback and stifles feedforward In the “closed” systems perspective, a system is analysed in terms of its own information and perspective Boundary is regarded as closed Organisational meaning: Emphasising stability, group loyalty, security, clear boundaries and tight controls Sources: Bateson, Beer, Maturana, Varela
An Open Commissioned System Open systems models shows dynamic relationships between the organization and the environment Viability depends on maintaining critical interchanges between system and the Environment Sources: Emery, Miller, Rice, Trist The open systems perspective emphasizes exchanges of information and energy with the environment. The Boundary is regarded as porous and may be diffuse. Organisational meaning: Emphasising flexibility, collaboration, consensus building and authentic communication.
Multiple Perspectives A viable Systems View – How does optimising processes at an operational level help development of capability?
What are the Issues we are addressing? A Messy Unbounded Problem? Is Procurement the answer? It is not a simple cause and effect problem it is about the relationship between Decision Making Cycles
“ Messy/Wicked Problems” Diagnosis Analysis Tame problems may be quite complex, but the lend themselves to analysis and solution by known techniques, for example: Six Sigma, Lean Sigma, TPS, TQM and TPM methods
What is the System of Interest to be Commissioned?
What's in, what's out?
What's the boundary?
External Environment STEEPV Determines the context in which the system of interest has to operate System 2 System 3 System 5 System 4 System 9 System 5 System 7 Containing System Sibling Systems System of Interest – local context System Boundary Interconnections Relationships & Emergent properties External Systems 1 External System …n
Commissioning Perspectives Whose System of Interest? what's in, what's out? The Procurement view Operations View Finance View
February 19, 2010 Start with Systems maps and rich pictures Complexity and multiple Relationships and scenarios (story boards) Can be added later If required, schematics and one line diagrams can be produced at a detailed level Overall System Architecture Initial Capability Model System of Interest 1 st Resolution Model Process Logic
Likeliest Intervention for Performance Improvement Tame Problems are suited to low level procurement procedures “ Messy/Wicked Problems” Including “special causes” Note; innovation often falls into this area and requires high end permissions and procurement procedures Clarifying the Problem? What is the systems of interest? Tame problems may be quite complex, but the lend themselves to analysis and solution by known techniques. Complex behaviour can be based on simple rules Rule Set Complex Many Value Analysis to understand sources of value, cost and performance Diagnosis to understand relationship between sources of value (context) and value chain; determine and set boundaries. Rule Set: Simple /Few Simple Analysis to understand cost and performance, e.g. Six and Lean Sigma, BPR More complex end-to-end Process Analysis needed to construct value chain and understand, cost, value and performance Process Complexity Simple Process Complexity Complex
What is wrong? Will competitive process address this?
How long have we had the symptoms? Are the existing perverse incentives?
Does everyone agree that these symptoms are a problem?
How does this problem constrain us?
What will happen if we do not fix this problem?
What is the worst example of this problem?
Have we tried to fix this problem and, if so, how?
What has caused or contributed to the problem?
Who else is affected by this problem?
Whose problem is it?
Is the problem too large to solve?
Have we the resources to solve this problem?
Are we solving the right problem?
Where do we make the intervention? Clarifying The Problem? Where do we Start? At what level do we start? How do we set scope and boundaries How we identify airs of concern?'
Where do we make the intervention?
At what level do we make the intervention?
What is the systems of interest?
Systems Level, e.g. Viable System Model -Supply Chain Transactional level A la “lean thinking”, e.g. Order Entry
What elements of the Landscape do we have to Change to Achieve:
What we deliver
And / or
The behaviours we need to exhibit
Can Requirements Management (procurement) be applied to people services?
High dependency of tacit knowledge and experience
How do the public/recipients directly influence on the rule set
Variable decisions action cycles (OODA loops)
How do we pace, match and lead delivery partners
Team goals and organisational KPIs
What is the trade off between relationships and end services
What are we Commissioning: Innovation and Continuous Improvement? Customer focus – long term market growth – customer retention Initial payback and long term social dividend Performance Criteria People, process, culture Usually technology Orientation Usually spread Can be high Risks Conventional know-how's and state of art Conventional know-how's and state of art Stimulus Collective Select few with know how Approach Everybody Select few with know how Involvement Incremental Intermittent Change Slow small steps Fast – big steps Pace/time frame Long term – long lasting Short term - dramatic Effect Continuous Improvement Innovation (Breakthrough)