Louise Tibbert, President of the PPMA explains the importance of understanding the true costs of providing a good service, and how performance should be managed…
The perception of the public sector is that we do not focus on performance in the same way that perhaps the private sector does. Whilst this may still be true in a minority of councils, the reality is now very different. The double whammy of budget cuts and demography pressures has acted as a significant catalyst for change over the last few years.
The integration of some NHS services with those social care services delivered by councils and commissioned partners to elderly or disabled people, is one example where innovation and customer centric focus is dramatically shifting the approach. Accountability will also sit more with front line workers who will become multi skilled and will be trusted to make the right decisions quickly for the people they support – rather than waiting for a remote manager to give their sanction. Empowerment will be much stronger and so will outcomes for people. This is the holy grail of joined up, preventative and person centric care. Performance is likely to be assessed on the outcomes of the whole system. How many people were admitted or re-admitted to hospital? What is their quality of life? How does this compare to the ‘old’ approach in terms of outcome and costs? How does support for families help create better outcomes for children – to give them a better chance of a prosperous and happy life rather than becoming the next generation of service users?
The way that externally provided services are commissioned is also changing to become more outcome based, whilst not losing the cost imperative. Market shaping through procurement and partnership working is emerging as one way of addressing this need and the performance management of contractors is also changing as a result.
Local councils are run by locally elected councillors who are now held much more to account by the public through the ballot box and through increased transparency of their decision making and spending. Changes to service design and delivery are supported by business cases and delivery is monitored via performance indicators and reporting, so far so good. But they too will need to think about what good performance looks like in a more complex landscape. The shift of Public Health services from the NHS to councils in April 2013 is now enabling a joined up approach centred on preventing later demands on services. So everything from preventing teenage pregnancies, to mental health, to obesity awareness and through to more strategic approaches to housing and planning decisions are designed to have an impact over the longer term. Well-being is a key component now of how strategies are being developed. It is not the job of your local council to make people happy, but they do have role in helping people to make themselves happy.
There is much discussion about workforce productivity and how to achieve this in a service, rather than a production based culture. Approaches like ‘lean’ and an understanding the true costs of providing a service are paramount. But the key to performance is good employee engagement. Most council’s recognise this now and measure and report on employee engagement. A few link it through to measures of organisational performance. Great leadership around the basics like appraisals, is now much more prevalent and programmes to multi skills or re-skill workers are becoming common place. Increasingly pay or ‘contribution’ is also being linked to performance of the organisation, department, team and individual. People are clearer about what is expected of them and of the impact they make to those who use public services. Most people working in the public sector are highly committed and our job is making sure we do not gradually break down that commitment through poor people management practices. Moreover, we need to harness it as a force for good and to leverage all the creativity and compassion that is undeniably there for the taking.
Research has shown that poor standards of care in hospitals or care homes are very much linked to employee engagement levels and culture, as well as how services are designed. Actually involving workers at all levels in the design of services is the way forward – they often have the insight and commitment to high quality services that is needed and will own the new approach. Leadership is also crucial, particularly in modelling the required values and behaviours.
So, great organisational performance is all about people and culture. It is about getting the best from people and supporting them to reach their full potential, whilst allowing them space to make the right decisions. Cross sector integrated working means that a single culture focused on the needs of the service user will be crucial. This is no easy task and will need careful handling by Organisational Development (OD) specialists to help shape ownership, behaviours and outcomes.
At the recent annual PPMA Seminar in Leeds, one speaker, who also happened to be an accountant, stated that ‘culture eats strategy for breakfast’. I couldn’t agree more. Turning the massive challenges in the public sector into opportunities that make a real difference to real people is all about culture and workers – who are real people too.
Head of HR & OD, Hertfordshire County Council