In 2009 Team Sky announced its arrival onto the professional road cycling circuit. In 2010 it was granted a wild card entry into the Tour de France and only two years later it dominated the race with a British 1, 2 in Bradley Wiggins and Chris Frome. Under the same leadership, British Cycling has also enjoyed a string of victories – to the point that the British team not winning a single gold medal in the recent World Championships was a headline news item over the weekend.
This remarkable success is much attributed to meticulous focus – from senior management down – on ‘the little things that make big things possible’. It comes from an understanding that performance management is made up of an array of variables, some of which can – to varying degrees – be controlled (such as athletes’ equipment, training programme and race schedule) and others which cannot (such as illness, poor weather conditions and the performance of competitors).
Data about these variables are monitored constantly: tracking athlete performance in training and on race day; creating feedback loops that help them and their coaches refine training regimes or equipment set up, and evaluating the success of wider development and talent identification systems so that sport’s results-based funding is sustained.
Unlike gold medal winning elite sports, performance management and system design in public services persistently fail to recognise the ‘little things that make the big things possible’ mantra. Opportunities are lost to make small changes that could make a big difference, which mean budget cuts bite deeper and the ‘system’ crumbles under the weight of its own complexity and mismanagement – sometimes, as in Mid-Staffs and Rotherham – on a huge scale to devastating effect.
At other times opportunities to manage demand or reduce delivery costs are overlooked as ‘more hassle than they’re worth’. As one GP said to me as we kicked off a new OPSN project on mental healthcare, “Even though they’re more efficient and cost-effective, we don’t get paid for telephone consultations so there’s no incentive for us [to do them].” Patients, clinicians and taxpayers all suffer as a result. It needs effective data at a system level for managers and policy makers to understand real costs. It also needs data for patients to understand ‘which services are best for me?’; ‘how do I change my GP?’ or ‘how do I request to see and share my Care Plan?’
Increasingly public services rely on data for regulating minimum service standards, holding providers to account and enabling public service professionals to drive up quality. But data isn’t just a bit of bureaucracy. It allows people to amplify their voice and participate in the system. As I’ve argued previously, it’s therefore a critical enabler of what the RSA calls ‘Power to Create’.
The Power to Create means people become masters of their own destiny, harnessing their sense of agency at the level of the individual and community. In health and social care it is not just about ‘no decision about me without me’ – which could be just an exercise in passive consultation. Instead it is about empowering patients to engage with the ‘system’, driving up outcomes and ensuring accountability from the bottom up. Instead of relying on punitive top down regulation that can stifle professional creativity and motivation, it gives professionals and patients the kind of ‘new power’ tussling with old style approaches in organisations.
As Heimans and Timms (December 2014) explain in the Harvard Business Review: “Old power models tend to require little more than consumption. A magazine asks readers to renew their subscriptions, a manufacturer asks customers to buy its shoes. But new power taps into people’s growing capacity—and desire—to participate in ways that go beyond consumption…New power norms place a special emphasis on collaboration, and not just as a way to get things done or as part of a mandated “consultation process.”
One member of the project group, representing a third sector organisation, summed up the scale of the challenge in mental health in reflecting on common patient feedback: “They just don’t listen to me.” The power of data enables people to have real voice, to be heard and create a renewed sense of personal agency.
OPSN’s project on mental health, with thanks to Cabinet Office funding, considers how we can empower service users, commissioners and providers with new and clearly communicated data. Are GPs under- or overprescribing particular drug therapies? Why, for example, don’t we have more data on older people’s services and dementia care? Can we rate Clinical Commissioning Group (CCG) areas by the degree to which they promote self-care and patient empowerment?
In mental health small changes to how we incentivise, deliver and manage performance could create huge gains.
Genuinely collaborative, patient-led approaches to care will improve outcomes and manage down costs. Let’s dare to dream to make the big things possible.