How traditional funding would ruin something good

I've been doing some work looking at how we support people who experience domestic violence or abuse, and how we might improve that support.  

During this work, I've gotten to know a fantastic local place that helps women who've broken free of domestic abuse to stay free.  Don't take my word for how great it is – here's what some of the women I spoke with there said about it:

• "Of all the services I've dealt with, this is the only one that works."
• "You are actually helped and understood.  They treat you as a person as a whole."
• "It's welcoming, and you are listened to.  It's like a family working together."
• "When you experience domestic abuse and leave the relationship, you don't know what you don't know.  They take you through it one step at a time.  They help with all the applications."
• "You get peer-to-peer support.  It's compassionate, and survivor led."
• "It's informal.  There's lots to be said for a cup of tea and a chat."
• "They pull out every stop for the children.  They helped get my child diagnosed for ADHD."

They don't turn people away because of thresholds.  No one completes an assessment form.  They don't work to targets, KPIs, or other metrics.  They build relationships with people, understand what really matters to them, and support them in achieving what matters.  The support is 'bespoke-by-default', responding to each person as an individual.  They have a network of friends and volunteers on hand with all sorts of skills – a handyperson, locksmith, experts on the law, housing, immigration, benefits, etc.  The support isn't time limited, and some of the women have been coming for years.  Many turn their experiences in to 'gifts' they can support their peers with, or have become volunteers themselves.

They've created a safe, welcoming, compassionate, and supportive atmosphere.  There's a real sense of community among the women – at times I struggled to work out who were volunteers or paid workers, and who weren't.   

And it works!  In five years none of the women they've supported have returned to the abusive relationship. 

How might traditional funding ruin it?

In my naivety, I asked one of the people who runs it "Do you get any funding – from the council or health or anyone else?"  The answer was a resounding "No".  The place is funded unconditionally by a charitable organisation, through local donations, and through the work of its friends and volunteers.  

I started to speculate on how this place might be ruined if they were commissioned or funded in the traditional and prevailing way.

• Traditional commissioning starts from an assumption that competitive markets work for public services, giving greater choice and efficiency.  To understand why this assumption is so flawed, read this book chapter from Kathy Evans, Chief Executive of Children England.  
• This means, in practice, the focus is on price.  To compete and compare on price, the service needs to be specified.
• Specification means a standardised service response.  This is where things really start to go wrong.  People are people shaped – they don't fit in to neat little boxes.  A standardised response cannot cope with the huge variety of people's need.  As Mark Smith writes in his blog, "[Standardisation] takes away an opportunity to apply judgement and nuance, borne from experience and an appraisal of what matters to whomever needs help"
• Once you standardise you have functional specialisms or silos.  Each service or provider is commissioned to only do specific things, and therefore won't do others.  The people who come to that service are looked at and labelled through the lens of whatever that service is commissioned to do.  Then they're referred or 'sign-posted' to the next service, who repeats the process again. 
• When providers are commissioned only to do certain things, they introduce thresholds or assessment criteria – essentially gate-keeping.  The thinking here is there's only a scarce resource available, so you need to ration what you do.  
• But, when people get turned away (or referred, or sign-posted), it means they either present elsewhere in the system, or come back later when their needs are higher.  Thresholds can be a false economy, as when people get worse they are more expensive to support.  
• Instead of building trust and relationships with their partners, commissioners and funders are typically interested in accountability (which is a nicer way of saying management by fear).  It means providers becomes concerned with external approval, which undermines intrinsic motivation and responsible practice.   
• To hold providers to account, commissioners use monitoring and performance management.  They ask for detailed information about how workers are spending their time, what activities they're doing, or if they are working to the standard.  A damaging example is 'time and task' commissioning in homecare services.  
• Another way to hold people to account is by setting numerical targets.  I've written about the problems with targets in a previous post.  They change the focus from doing the right thing to making the numbers look good, even if that means doing the wrong thing.  
• The undesirable effects of targets can be made even worse by payment by results.  They are a way to financially reward providers for producing data about targets, and not for helping the people they exist to help.  

Imagine what the place I visited might look like if it were commissioned in the traditional way?  What would it be like for the women who go there?  What would it be like for the staff and volunteers?  Would it be any more efficient?

Why do we fund and commission in this way?

As business writer Aaron Dignan puts it, "The way we work is broken.  It was invented 100 years ago on a factory floor for a world that no longer exists".  Commissioning is a symptom of these outdated ways of working, grounded in mass-production and 'Taylorism', which results in treating people as though they are parts in a production line.

In the 1980s, public services started to embrace what was subsequently called New Public Management.  This meant running public services as though they were private sector organisations, being more 'business-like', treating citizens as customers, and attempting to use competitive markets to reduce costs.   This led to policies like Compulsory Competitive Tendering (CCT), later replaced by Best Value, which are is still with us today.  

What are the alternatives?

There are many folks who know much more than me about how to improve funding and commissioning practices.

My go-to person for this is usually Toby Lowe.  He's an academic, who's previously been a provider of commissioned services, and has done loads of research in to this area with voluntary and public sector organisations. With his colleague Dawn Plimmer, he's put all of this into a brilliant report called Exploring the new world: Practical insights for funding, commissioning, and managing in complexity.  You can watch him speaking about it in this 13 minute video.

Andy Brogan, co-founder of Easier Inc, has recently written an accessible 'how' to report.  It gives lots of insight and helpful advice on how to put what he calls 'Commissioning 2.0' in to practice.

Jo Gibson from Vanguard has been doing some great work in this area too.  You can watch one of her students speaking about how they changed the way they commissioned homecare services in this 20 minute talk.  Jo is co-hosting a one-day commissioning event in London on 5 May 2020 which is worth checking out.

Over to you...

Do you work for a an organisation that provides commissioned or funded services?  How accurately  does what I've written here reflect your world?

Likewise, if you're at an organisation that commissions or funds services, are you still doing it in a traditional way, or have you started to look at some of the alternatives?

I'd love to read your thoughts in a comment below.  And please do feel free to share this with anyone who might be interested.  

9 reasons why targets make performance worse

"When management sets targets and makes people's jobs dependant on meeting them, they will likely meet the targets  – even if they have to destroy the enterprise to do it" 

– W Edwards Deming

If you're in the UK, you'll be aware of the Windrush Scandal. The Home Office threatened the children of Commonwealth immigrants (mainly from the Caribbean) who arrived before 1973 with possible deportation if they couldn't prove their immigration status.

Something that contributed to the scandal was the Home Office setting "a target of achieving 12,800 enforced returns in 2017-18".  Much has been written about whether the targets existed, and if certain people in charge know about them. 

This post isn't about that.  Today I'm writing about the problems with targets themselves.  When organisations set arbitrary numerical 'performance' targets, which people or teams are judged by. 

Here are 9 reasons why targets make performance worse:

1. They narrow focus, so people concentrate on doing only what achieves the target.  This isn't the same as doing the right thing for the customer or citizen. 

For example, schools would give disproportionate attention to pupils expected to get a C or a D grade, as their target is pupils getting C or above. 

In hospitals, doctors were diverted from treating seriously ill patients to ones with minor problems in order to meet 4-hour waiting time targets.  As a result "people were left for hours covered in blood and without pain relief".   

Or Police didn't act upon warnings about child sex grooming because they were told by management to prioritise robbery and car theft, as that's what achieves the targets. 

2. People cheat so they meet their targets.  Studies have shown this.

Staff at an outsourced Police control room were making 999 calls at quiet times in order to meet their target of answering 92% of calls within 10 seconds. 

Confession time – in my formative years I did something similar.  I was working on a call centre, and we had an average call handling target.  Me and a couple of colleagues worked out that calling each other and quickly hanging up was an easy way to meet our targets.  We were using our ingenuity to meet arbitrary numbers, instead of helping the customer.

3. Cherry picking. I was working with a housing repairs service.  Tradespeople were set targets for how many jobs they get through in a day.  This created a behaviour called 'sponge knocking'.  If a job looked like it would take a long time – and risk not achieving the daily target – they'd silently push a 'sorry we missed you' card through the letterbox, and scarper.

The UK government's troubled families programme was reported to have a 99% success rate of turning lives around.  However, investigations showed some councils were picking the families most likely to meet the success criteria, and not working with the ones that needed the most support. 

4. People lie.  For example, traffic wardens were fabricating evidence in order to issue parking tickets, for fear of losing their jobs if they didn't meet their target.   

5. Statistics are manipulated.  In the brilliant US crime drama The Wire they use the term 'juking the stats'.  This is brought to life in the 1.5 minute clip below (contains swearing).

This isn't just the stuff of TV drama.  For example, juking the stats has happened in the UK Police force, and at hospitals.  

6. They cause student syndrome (when a student only starts writing an essay at the last possible moment before it's deadline).  When you apply for planning permission at your local council, they'll have a government target to meet of 8 weeks to decide your application.  The chart below – from one council I worked at – shows the large proportion of applications were decided in week 7 or 8. 

It might be possible to decide the application earlier, but as far as performance measures are concerned, it doesn't matter as long as it was done in under 8 weeks. 

As a different council found: "to meet these targets, applications would get refused if they were unacceptable and the deadline was approaching. [This] meant that the applicant suffered delay, additional costs and frustration.... The Council in turn incurred additional costs either defending planning appeals or processing a second planning application”.

I once did similar analysis looking at complaints, with a 15 day response target.  No prizes for guessing which day most of the complaints were responded to on.   

7. Staff get sick.  Targets put people under pressure to meet arbitrary numbers, which causes stress. Police Officers felt "almost continually under threat of being blamed and subsequently punished for failing to hit targets".  This does not create an environment that's good for people's health. 

I've worked with call centre staff who had average call handling targets to meet.  They hated not being able to help the customer because their manager wanted them to end the call. 

At a target-driven DWP call centre, mental health-related absences tripled.  At the same government department, staff went on strike because "We are being prevented from providing good quality service because of unnecessary and unrealistic targets."

8. People do unethical stuff.  Targets are an extrinsic motivator (coming from outside the individual).  Studies have shown that extrinsic motivators undermine intrinsic motivation. 

Sometimes people do the wrong thing in order to avoid punitive consequences.  Like in this DWP example, where the employee is clearly upset.  They want to do the right thing, but at the same time they need to survive in a bad system.  

There are other examples, such as PPI mis-selling, where people are doing the wrong thing because the target is attached to a bonus (financial incentives act like a turbo-boost to targets). 

Then there was the Wells Fargo fraud in the US, where staff at the bank sold customers things they didn't ask for, in order to meet targets.  This also shows how arbitrary numerical targets are.  When John Stumpf, the CEO, was questioned about why staff had a sales target of eight financial products per customer, he said he chose the number because "eight rhymes with great". 

9. Targets can kill people.  A study looking at targets in the NHS found patients were required "to wait in queues of ambulances outside A&E Departments until the hospital in question was confident that that patient could be seen within four hours [the waiting time target]".  In one tragic instance, this practice led to the death of a 16 year old boy. 

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I'm not blaming the people who are working to the targets.  When a manager, government, or someone in authority sets a target, people will tend to presume it's right.  The Milgram experiment showed us that.

People focus on meeting targets to avoid getting grief from their boss, to make sure they don't get sacked, or to secure a bonus.  We all have bills to pay, and can't afford to risk losing our income. 

To quote again from Deming: "A bad system will beat a good person every time".  Or to quote from John Little: "Targets turn good people in to liars and cheats". 

My question to anyone reading this is – given all the points above – why do people continue to think it's a good idea to set targets?

What are your thoughts?  Please feel free to comment below, or share this post with someone who could be interested.