- 1. Service Innovation CourseInnovation in public services IAN
MILES[email_address] MIoIR, University of Manchester
2. Drawing onhttp://www.step.no (and other MIoIR work) 3. Why is
this important?
- 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 increasingefficiency ,
for deliveringnew and better quality services
- Importantmarketfor innovative products (goods and services)
from across economy impact of public procurement on innovation
systems
- Importantdemonstratorof scope for new services, infrastructures
and standards
4. Public Services (innovation)in Crisis?
- Throwing money at problems
MPs demand transparent government IT projects Select Committee
calls for an end to 'appalling waste of public money Bryan
Glick,Computing22 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 ZDNet.co.uk17 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. Just this week
- File on 4 - broadcast on BBC Radio 4 on Tuesday,2 March 2010,
at 2000 GMT, repeated Sunday, 7 March, at 1700
- 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.
- Digital case notesThe 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.
- Tory policy would seek to halt the two main contracts and
dismantle its central infrastructure.The Liberal Democrats would
like to scrap the programme.
- 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
- http://news.bbc.co.uk/1/hi/health/8543328.stm
6. NHS reply:
- 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.
- 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.
- 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.
- 8,800GP practices (28,000 GPs) are daily using theQuality
Management Analysis Systemthat pays GPs 600m pa based on quality
outcomes.
- 227,239users registered for access to theNHS Care Record
Spine
- 1,246,528prescriptions transmitted usingElectronic Transmission
of Prescriptions (ETP) system- live (on time) since February
2005
- 401,827 Choose and Bookelectronic bookings - live (on time)
since July 2004. Now exceeding 7,000 bookings per day.
- 28,092,700digital images are stored usingPicture Archiving and
Communications Systems (PACS)- live in 31 NHS sites
- 175,624registered NHS secure E-Mail users, over 79,000 of whom
use the system daily.
- 14,538National Network (N3) secure broadband connections,
including9,912GP locations (practices and branch surgeries).
http://www.connectingforhealth.nhs.uk/newsroom/news-stories/fileonfour300506
7. Public Service Innovation
- This sort of case certainly shows that there can be ambitious
innovation programmes
- 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).
- Many commentators conclude that public services face particular
problems.
8. Contrasting Private Services Public Services
- Markets as external selection mechanism:consumer choice of
services/suppliers
- Competition between firms:marketing, sales, etc.Scope for
transnational competition - and also self-service
alternatives.
- Customer Relationship and Supply chain management
- Regulation often higher in services than manufacturing
- Flexibility,e.g. in employment terms and work organisation;
Rewards
- Profit-driven: strong incentive
- Public policy driven services, sometimes heavily influenced by
public attitudes, media coverage.
- Some forms of competition and coexistence, with private
andvoluntary sectors and individual self-service.
- (Nominally) strong emphasis on equity and related issues,
plusethics and privacy issues.
- Bureaucratic systems and admin.Employee lobbies
- Personal and professional incentives
9. Public Sector Reform
- Key Assumption (here):competition drives innovation
-
- Learning (esp organisational innovation?)
-
- Individuals will be motivated
-
- Organisations will be motivated
10. Is Reform enough?
- Reform without considering impacts on innovation may be
problematic.
- Thus we see various efforts to stimulate innovation in new ways
alongside general reform and modernisation efforts.
- E.g.NHS Institute for Innovation and Improvement
http://www.institute.nhs.uk/
11. (earlier)NHS Modernisation Agency
- Est. 2001 to support NHS and partner organisations in
modernising services and improving experiences and outcomes for
patients.
-
- increasing local support,
-
- raising standards of care,
-
- capturing and sharing knowledge widely.
-
- Treat day surgery as the norm for elective surgery
-
- Improve access to key diagnostic tests
-
- Manage variation in patient discharge
-
- Manage variation in patient admission
-
- Avoid unnecessary follow-ups
-
- Increase the reliability of performing therapeutic
interventions through a Care Bundle approach
-
- Apply a systematic approach to care for people with long-term
conditions
-
- Improve patient access by reducing the number of queues
-
- Optimise patient flow using process templates
-
- Redesign and extend roles
webarchive.nationalarchives.gov.uk 12. Public Sector
Modernisation 13.
http://www.dius.gov.uk/innovation/public_sector_innovation 14.
Confronting the received wisdom: Geoff Mulgan 15. What do we
know?
- Numerous essays on why public services might have an innovation
problem
- On why the solution might lie in introducing new public
management and/or market principles
- Various studies of public service innovation start off from
this perspective
- Even PUBLIN only examined public services
- But there is one comparative study, which tells a different
story..
16. Earls Canadian Comparisons Earl, L. (2004)An historical
comparison of technological change, 1998-2000 and 2000-2002, in the
private and public sectorsOttawa: Statistics Canada (also see Earl
2002) 17.
- How do we define PUBLIC SERVICES?
- Public versus non-market:only those provided by the state?What
definition of state provision?
- Only those inservicessectors (not all nationalised industries)
with large levels of state ownership?Or at least with traditionally
large levels in most countries?
- Huge variety cross-sector, cross-country, in modes of
governanceand organisation
- NACE sections L to O an ACTIVITY grouping (not governance)
-
- Public administration, defence; compulsory Social
Security11.4%
-
- Health and social work 14.3%
-
- [Other community, social and personal service activities
7.0%]
- 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.?
Back to Basics % of EU employment 2000 18. Boundaries may not be
so clear
- This may mean scope for learning across sectors thus voluntary
sector may pioneer new approaches (e.g. hospices)
- May be a competitive force, too
- 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
- Scope for learning across different public services and also
cross-nationally
19.
- Beyond technological innovation
- Beyond classic product and process innovation(delivery,
interfaces)
- Policy innovation, organisational innovation, and more
20. Manchester PUBLIN (health) results
- 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.
- Innovation often seen as fashionable jargon or as new
technology or problem-solving
- Or as a matter of adoption of top-down guidelines, meeting
targets (important procedural innovation).
- Often incremental developments, often hard to establish
boundaries between innovation and replication.
- Huge number and range of developments, not subject to much
direct recording/compilation in databasesThough some recording
through incentive schemes, and through efforts to impose IPR
models
21. Some examples of innovation
- Electronic patient records system huge scale, clear benefits
(and professional risk perception)
- NHS Direct: most radical innovation in recent history of health
service
- Tier Two reduced waiting lists through appropriate secondary
care rather than using hospitals
- Creation of new mental health trust specialisation
- Pilot out of hours link with Aus/NZ consultants
22. Services Innovation
-
- Intangibility (issues of transport, storage,
coterminality)
-
- Interactivity (Production and consumption often
intertwined)
-
- Information-intensity (Much specificity as to service,
client)
- 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.
- Public services have to confront the variety ofhuman
characteristicswith the dictates of large systems andbureaucratic
rationality .
23. Are there Specific/Stronger Obstacles to Innovation?
- Would expect issues to arise concerning regulations, large
technical systems, workforce issues (esp. professionalism and
status conflicts), reward structures, etc.
- Also (like other services) some strategies to deal with
intangibility etc (e.g. targets, tests, credentials) and some to
deal with public characteristics espmarketisation ,competition
,consumer-centric, cosnumer choice
- Some results from PUBLIN health
24. IT project failures Government IT projects July 2003 Report
200 http://www.parliament.uk/post/pr200.pdf 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. Specific/Stronger Obstacles to
Innovation? - from PUBLIN Health
- 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
- Initiatives to diffuse good practice seen as short-lived
reorganisations lead to loss of corporate memory
- Infrastructural and procedural/occupational heritage and
legacy, entrenched practice and procedures are commonly
experienced.
- 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
- In particular lack of commitment to consumer orientation was
often cited as a major issue (mirroring political rhetoric in
UK).
- Public resistance to reorganisation though public seem very
open to new ways of operating
- Lack of ownership of innovation top-down initiatives
26. Specific/Stronger Obstacles to Innovation?- more
- 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?).
- Pace and scale of change (NHS in particular) shifting targets
and absence of opportunity to reflect/asses consequences
- Very complex organisation composed of multiple tiered
interlinked systems with - Huge staff numbers; Many occupations;
Many organisational arrangements; Many service processes
- Lack of patient information connectivity between actors in
system
- Lack of dedicated budgets for innovation at relevant (local,
Trust) level.
- Some areas (mental health) not high profile priority for
investment (cf. surgery)
- Requirement to consult, lack of clear picture of all eventual
effects
27. In our studies, the innovations exciting management
were:
- Those more at the strategic/management level
- Organisational:governance relation changes, new agencies,
etc
- New roles, responsibilities, new ways of operating (need
forknowledge managementcapacity), role in training
- Technical and technological(huge) some systemic,
esp.IT-based,
- New specific practices e.g. round pharmaceuticals, clinical
practice, techniques, devices, etc.Huge range of artefacts
involved.Again, much IT impact.
- Often technological innovation closely tied to further
organisational/process change/innovation
28. Public Sector Opportunities?
- High level of staff expertise, creativity, problem solving
- Strong public spirit ethos, motivations beyond personal
financial rewards
- Controversial shifts underway (e.g. competitive framework of
Foundation hospitals) believed by proponents to increase innovation
by:
-
- Allowing for flexibility and experimentation within target
culture and common standards
-
- Incentivise staff (and management) financially, status-wise,
and through improved service quality
-
- Improve patient choice (will drive resources as money follows
patients) aand consumer feedback into innovation process
-
- Management draws on external sources for directed creativity
and organisational innovation and knowledge mananagement
- Conscious efforts at innovation management (under various
guises)
29. Mulgan again: sources of innovation 30. Policy
Challenges
- Research Policy bringing in the public sector where it is
absent, taking better account of it where it is present
- Public sector policy governance, regulatory reform, efficiency,
modernisationBuilding innovation into public policyAssessing
innovation processes and impacts to guide policy, validate
expenditure
31. Discussion and Exchange 32. Many major initiatives with
innovation implications
- Could we have innovation audits? We have yet to measure public
service innovation and impacts systematically (several partial
attempts)!
- 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?)
33. Policy for innovation? 34. Mulgan again: innovation
checklist 35. Innovation Unit http://www.innovation-unit.co.uk/
- Research, Consultancy, facilitation for gvt, local gvt, CSOs,
etc.
36. Implications for Research
- Many commonalities many ideas and instruments can be borrowed
can we use innovation models (PLC etc)?
- Different selection processes internally and
externally.Processes of diversity generation too.
- Much is public-private mixture (many kinds)
- Public services highlight areas where innovation studies are
weak
- Explore new innovation strategies
37. MePIn Copenhagen Manual
- Working Party of National Experts on S&T Indicators
(NESTI): methodological guidelines for measuring S&T activities
(Frascati, Oslo Manuals) Task Force
- Centre for Educational Research and Innovation (CERI) measuring
innovationin education and training
- OECD Public Governance and Territorial Development
DirectorateGovernment at a Glance (2009 and 2011) + various
activities on innovation in public governance
- OECD Health Division performance indicators for health systems,
ICTs in health
http://www.mepin.eu/ 38. Public Service Innovation
- is a topic crying out for research
- Policymakers desperately want good knowledge
- Innovation studies themselves can benefit from looking at
this
- Its important for public expenditure, social well-being, and
innovation across the economy
39. End of presentation