public service innovation

1. Service Innovation CourseInnovation in public services IAN MILES[email_address] MIoIR, University of Manchester

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

Funding crises

New challenges

Governance

Regulatory reform

Modernisation

Inefficiency

Throwing money at problems

Initiative overload

Tech fixes

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

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).

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.

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

Rents on innovation

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

Public goods

New public management

Features: quasi-markets

Indicators and targets

Performance measurement

Acted upon!

Outsourcing

Key Assumption (here):competition drives innovation

Learning (esp organisational innovation?)

Individuals will be motivated

Organisations will be motivated

Use instruments like IPR

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/

Est. 2001 to support NHS and partner organisations in modernising services and improving experiences and outcomes for patients.

Focused on four areas:

improving access,

increasing local support,

raising standards of care,

capturing and sharing knowledge widely.

10 high impact changes:

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

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..

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%

Education 10.0%

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.?

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

SERVICES INNOVATION:

Beyond technological innovation

Beyond classic product and process innovation(delivery, interfaces)

Policy innovation, organisational innovation, and more

Innovation versus change

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

Genetic screening

Intraocular lenses

Health informatics

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

Modernisation Agency

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 .

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

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

and IP issues

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

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

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)

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

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?)

Research, Consultancy, facilitation for gvt, local gvt, CSOs, etc.

Esp. education

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

efforts

underway

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

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

Must not be a ghetto!

Business

public service innovation