In recent decades, many governments around the world have embraced a service delivery mindset inspired by management practices from the private sector. By examining the evidence of what works and what doesn’t, designing services based on this understanding, and managing those services efficiently, the logic runs that we are likely to achieve better outcomes for citizens.
The delivery mindset holds that citizens can be thought of as customers of public services, and the same tools of process optimisation can be applied to a welfare service, for example as to a bank.
But now a different mindset is emerging in many innovative governments and public agencies around the world. Rather than focusing on improving services directly, this approach aims to cultivate the conditions from which good solutions are more likely to emerge. The emphasis is on enablement rather than delivery.
As part of our Future of Government project, we have been exploring this shift towards enablement and its implications for how the public sector can achieve the outcomes that matter to citizens through public services. Over the past twelve months, our project on legitimacy has also shown us that governments need to consider more deeply the impact that public services have on people and those working to provide them at the frontline.
While this might sound like a small shift of perspective, it makes a profound difference to how we conceptualise what government is trying to achieve and how it goes about it.
Neighbourhood care in the Netherlands
Take, for example, the Dutch system of neighbourhood care in which nurses support people in their homes. In the 1990s, like many public services around the world, a series of management reforms was implemented with the aim of improving efficiency. Best practices were identified, products and services carefully defined, and performance metrics put in place. Some services were outsourced to the private sector.
[epq-quote align=”align-right”]”Best practices were identified…performance metrics put in place. Some services were outsourced to the private sector. The result…costs doubled in 10yrs…service quality fell.” #CTRLshift2019[/epq-quote]
The result was that costs doubled in 10 years while service quality fell. Patients would be seen by a procession of different providers, each of whom was responsible for a different aspect of their care, none of them spending more than a few minutes in their home. Patient satisfaction declined, and the nurses themselves became increasingly demotivated.
In 2006, a new model was proposed that handed control to small, self-managing teams of nurses. Each team takes responsibility for 50-60 patients in a community and can decide how best to organise themselves. There are no targets or best practices imposed from above, instead, the focus is solely on the needs of patients.
The results have been impressive. Buurtzorg, which means ‘neighbourhood care’ in Dutch, has achieved far higher patient and staff satisfaction than the previous approach and is no more expensive. The Buurtzorg model has been replicated internationally by teams in Sweden, Japan and the United States.
The enablement mindset
The Buurtzorg story is emblematic of a change that is taking place across a range of services in many different parts of the world. From schools in Helsinki to family services in Auckland, the traditional service delivery model is increasingly being challenged by an enablement mindset. Three important shifts are taking place.
First is the concept of subsidiarity; the idea that decision-making rights should reside at the lowest possible level in a system. Recognising that much of the information about how to improve a system is embedded in the system itself, it follows that we should push authority to information and not the other way round. In public services this implies that, wherever possible, local actors should be empowered to shape solutions including frontline professionals such as teachers, doctors and social workers.
Subsidiarity is closely linked to the second shift towards localism which stresses the importance of local accountability mechanisms and decision rights. Around the world, people have far greater trust in government bodies that are closer to them, because they have shorter accountability loops and can develop more locally appropriate solutions. In addition to representative democratic mechanisms, participatory mechanisms that open up deliberation and decision-making, can also flourish far more easily at the local level.
All of which emphasises the third shift, the importance of place as the dominant organising principle rather than hierarchical service silos. So-called ‘place-based’ solutions start with an understanding of the assets, stakeholders and relationships in a locality and build from there, recognising that how success is defined and pursued might look very different in different places. Indeed, that is the point.
We might describe the delivery mindset as envisaging the state as a giant machine ready to be optimised. By contrast, the enablement mindset would view public systems more like a garden that requires cultivation rather than control.
At CPI, we’ve been exploring how the enablement approach compares to more traditional methods. This table describes some features of a delivery as against an enablement mindset.
A moment of transition
Given that ideas such as subsidiarity have been around for centuries, why is interest in the enablement mindset on the rise? There are several reasons to believe that we are now at a moment of transition.
Firstly, the nature of the challenges that the public sector is trying to address is changing. For example, mental health is now a major public health crisis in many developed countries and is linked to other problems such as substance abuse, domestic violence and unemployment. In other words, this is a complex and varied problem that is being poorly addressed by existing approaches.
Secondly, just as the internet has disrupted almost every industry, it is now disrupting the public sector. By making more information more easily accessible than ever before, it is democratising knowledge and upending hierarchies. For example, teachers can collaborate to share and improve lesson plans with colleagues around the world, rather than waiting for national guidelines. Similarly, patients can pool their knowledge about rare conditions, so that they become better informed than their doctors about the treatments available or the side-effects of certain combinations of medication.
Thirdly, respect for ‘the establishment’ is in freefall in many countries, with a suspicion that experts and other elites don’t share the values of the populace. Deference to hierarchy is being replaced by demands for more autonomy and self-determination. Localism is on the rise. Young people, in particular, are challenging old hierarchies, power structures and mindsets. They no longer just want to be customers or consumers but instead, be active participants able to shape services to their needs and play a part in their delivery.
These trends are advancing rapidly and seem unlikely to be reversed, and governments around the world are beginning to ask what it means for them.
Why governments might achieve more by letting go
This has profound implications for those politicians and public servants sitting at the top of hierarchies with a mandate to improve outcomes. It could really be true that the less they control, manage and measure, the better the outcomes will be.
For example, large, centrally-run programmes are unlikely to succeed when applied to complex systems. Even when deployed with the best of intentions, as with the No Child Left Behind Act in the United States, central programmes can quickly deteriorate into box-ticking exercises that lack the support of those who are essential to their success. They can also be costly to administer and frequently fail to deliver, even on their own terms.
[epq-quote align=”align-right”]”The enabling mindset…challenges us to raise our expectations about what can be achieved through collaboration and cooperation.” #CTRLshift2019[/epq-quote]
Similarly, centrally-set performance targets and KPIs imply that ‘the centre’ understands which outcomes are most important and that they can be measured by simple metrics. As well as disempowering lower levels of the system, there is mounting evidence that such targets, especially when linked to incentives, risk encouraging perverse behaviours such as creaming (focusing on the easiest cases), gaming (for example, lowering standards to improve pass rates) and data manipulation (such as the underreporting of unfavourable results).
To be clear, this is not to argue against the value of data but rather that it should flow horizontally within a system, informing practice and improvement in situ rather than from on high. By moving away from high-stakes testing and audit, the true value of the information can be used to help services continuously improve, while avoiding the distortive and counterproductive effects of centralised performance regimes.
The enabling mindset represents a radical shift in authority, accountability and agency from those at the top to those lower down the system. It argues for humility about what can be achieved when power is aggregated, and challenges us to raise our expectations about what can be achieved through collaboration and cooperation. It suggests that systems can become self-improving rather than relying on top-down management and control.
We are exploring and debating the implications of enablement as part of our Future of Government project and we are looking for more case studies of enablement in practice. Contact us at email@example.com if you work in the public sector or in government and would like to contribute your thoughts and reactions to this debate or suggest more case studies we should explore.