Radical Models Of Commissioning And Regulating Care/Public Services

By Andy Brogan and originally published on Easierinc.com

This blog is the third of a short series inspired by a recent #NextStageRadicals event held in London on March 19th 2019 (more details here). Throughout this series I’ll be sharing presentations, insights and reflections from the event.

Context

I’ve written before on this blog about the pernicious effects of accountability on the psychology of work. Nowhere does this loom larger than in the spheres of commissioning and regulation (and the trickle down effect they have on how performance is managed).

Organisations (and individuals) should be accountable and, for many types of work, regulation should exist but leading from these places creates fear, which has predictable and undesirable effects on behaviour.

Insights

Speaking on these things at the recent #NextStageRadicals event, were Toby Lowe (Senior Lecturer in Public Management and Leadership at Newcastle Business School) and Kathryn Caley (Operations Director at SK Nurses) who both addressed the theme of Radical Models of Commissioning.

Picking up the baton and carrying their lessons forward into the theme of Radical Models of Regulation was Jeremy Cox who, until just a few days before the event, was Director of Quality at the Care Quality Commission (CQC).

You can watch Toby, Kathryn and Jeremy speak in the videos below.

Inspiration

Hearing each of these speakers brought to mind one of my favourite quotes, taken from The Tiger That Isn’t: Seeing Through a World of Numbers by Michael Blastland and Andrew Dilnot:

“Numbers, pure and precise in abstract, lose precision in the real world. it is as if they are two different substances. In maths they seem hard, pristine and bright, neatly defined around the edges. In Life we do better to think of something murkier and softer…. Too often counting becomes an exercise in suppressing life’s imprecision”

For too long our organisations have laboured under a tyranny of results – so much so in fact that we sometimes forget the difference between our performance and our results. In reality, performance is an emergent quality that exists beyond the results we use to describe it – or better, that we use to help us make sense of it.

Accountability – so often operationalised as accountability for results – is destructive because it makes people and organisations responsible for their results but not for their performance. This has 2 effects:

1. It leaves them constantly off-balance and fire-fighting.

2. It engages our fear response, inhibiting our ability to think clearly, learn and improve.

The lesson is obvious enough: if we want great performance then we need to lead from somewhere other than fear, creating psychological safety and through that, responsible practice.

To do that we need to beware the trap of how and when we ‘hold to account’ (and what we hold to account for). In the real world, where humans live, we do better to think of accountability as consequence but not cure; the ‘nuclear option’, available to us when and if our diligent attempts at learning, nurturing and acting from mutuality have failed.

Action

If you want to find out more about the issues explored in this blog here are a few things you can do:

If you want to learn more about Toby’s work on Radical New Models of Commissioning…

consider reading his recently published report. It’s stellar and provides practical advice and inspiring examples to light the way. You can find it here.

If you want to learn more about what it means to treat accountability as consequence but not cure…

consider reading my previous blog on the subject. It contains a couple of resources that are useful for engaging others in thinking about this issue and which are also useful as a conscience for marshalling our own actions. You can find the blog here.

If you want to find out more about the event that inspired this blog (including updates on and videos of the other speakers)…