Designing a new system

Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ 27th August 2013 ￭ New Zealand Ministry of

Health, Auckland

Achieving sustainable change

Moments when system can be redesigned are full of wonderful opportunities and enormous risks.

Positive Negative

Rapid policy and large scale changeBreakthroughs in flexibility and awareness of entitlementSystem was financially sustainableAvoided undue reliance on brokerage

Development of complex RAS, eroding trustSupport planning industryIncreasing levels of bureaucracyFailure to engage providers effectivelySystem now abused to help with 33% cut in care

recent changes in England

NB Systems do nothing. People do things. Systems simply create an environment of rules, incentives, information and values which can influence human behaviour. Good system change makes it more likely that humans will make good choices.

Put simply...

...people can do bad things in even the best system, people can do good things in the worst.

It is important to look at the whole system

self-directed support is at best just one factor in a much wider social system

Significant positive change is inevitably organic and gradual. [Rapid change is inevitably artificial and shallow.]

1. Realisation - Leaders emerge who try to pull off radically different patterns. They often need protection. These early leaders often go unrecognised but are a potentially powerful resource.

2. Inspiration - As a new pattern begins to be seen as valuable by some then there is often polarisation, fear and excitement. Its important to use this energy but not to fall into the trap of tribalism or blaming.

3. Simplification - A successful innovation proves its worth by offering multiple benefits to growing numbers. But the system often resists by trying to treat it as an ‘add on’. This process should include competition, rationalisation and evolutionary development - work, not dogma.

4. Integration - The most profound innovations are integrated into the background system - they almost ‘disappear’.

It is not just the system that ‘resists’ - advocates can often undermine their own goals.

1.Sterility - Lots of talk, no action. No leadership emerges, no risks can be taken.

2.Shallowness - Initial enthusiasm, lots of training, consultancy, planning, and pilot projects.

3.Compromise - The adaptions to the old system are accepted and not questioned and challenged.

4.Dogmatism - The new system is not seen as part of a greater whole and becomes despite the need for more profound change.

The conservative paradox - the most radical change doesn’t force people to change.

Vision must combined with humility, peer support and a genuine willingness to test and learn.

1.Diversity - Enable multiple opportunities for leadership, testing and learning.

2.Community - Build an inclusive community of learners, willing to inspire without blaming or attacking others.

3.Models - Publish a central model, but one which others can test adapt and challenge (versions)

4.Reform - Provoke wider conversations about the meaning of these changes and the policy and social enviroment in which they are emerging.

If you found these slides interesting you might like to read...

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