All too human: the need for coalitions across different motivations and organisations

mirror mazeHere’s a post I’ve written on the need for coalition building across a range of motivations and organisations if successful change is to happen in social care. This is part of the #socialcarefuture series that @mroutled has been bringing together, designed to create a space to get past just thinking about stabilising the current social care system which isn’t fit for the future. Here is the rest of the #socialcarefuture blog series.

Much debate in public policy focuses on the “why” and the “what”. Why is this issue important? Why should it be prioritised over something else? What should be in place that isn’t? What needs to change for this to happen?

Comparatively little focus is placed on “how” – the practicalities of putting the why and what into action. The “how” follows once the “why” and the “what” have been largely agreed, and is important because it’s in this space that all of people’s experiences are generated. It’s also where good ideas can turn into bad delivery.

But below the “how” is a question even less attention is given to: “who?” Rarely is it considered: who is asking for this change? Who is the change being asked of? What are the motivations of these respective groups?

It is too easy to lament how poor commissioning and commissioners are; or how it would be so much better if only senior leaders recognised the radical difference that x or y would make. But this is to fall into the trap of “what’s the matter with these people?” rather than thinking, familiarly enough, “what matters to these people?”

This thought came home to me when, for around three years, I was simultaneously on both “sides” of a policy argument. For around half of my time I was working in a disabled people’s user-led organisation (DPULO), advocating for disabled people’s equality and rights, delivering user-led services and promoting choice and control through personalisation in social care. The other half of my time was in, of all places, the Office for Disability issues within the Department for Work and Pensions (DWP_.

What was fascinating about this was, even though I would say exactly the same things when wearing my DPULO or DWP hat, people would receive a message considerably differently depending on how they perceived me in that moment. Disability rights campaigners would broadly be ok with my thoughts when shared from a DPULO perspective. But the exact same thoughts wouldn’t be acceptable if I expressed them from a DWP platform.

In neither situation was the idea that disabled people’s equality and rights mattered to me. Nor was it recognised I was consciously choosing different means to others by which to achieve what was, in fact, a common goal.

This leads to two connected conclusions relevant for #socialcarefuture.

The first is to understand that what matters to people, matters. Motivations for engaging in an issue will differ. There will be a junior minister who wants to be promoted; there will be lifelong advocates who have dedicated themselves for 25 years to a certain change; there will be civil servants who want a pragmatic solution to a pressing problem they are facing. But all of these different motivations are as present as each other, and can be skilfully aligned to achieve a common change that works for all.

The second is to recognise that such a broad coalition of people with different motivations will be located across a wide range of organisations. Indeed, the coalition has to be widely distributed if it has any chance of succeeding: each participant will have access to something others don’t, and that is needed for the overall change. As a result, some coalition members will be “inside” the system. Some will be outside (possibly literally, chained to railings or waving placards). Some will be in the grey area that is neither inside nor outside (the voluntary sector is most often found in this space). Some may not even know they’re in the coalition.

What leads to change is consciously acknowledging and valuing the existence of such a broad coalition across motivations and organisations. Each participant – each “who”, with their all too human motivations and positions – makes a needed contribution, and it is only through this coalition that successful change will come about.

(For those interested in the public policy theory that underpins such coalitions, this primer on Advocacy Coalition Frameworks is excellent.)


The Tory answer to the question “who pays for social care?”: You!

Image via WikiHow

Two excellent responses to the Conservatives’ social care manifesto proposal: Torsten Bell at the Resolution Foundation and, of course, The King’s Fund.

It took me quite a long time to figure out the main implications of the proposals (I’m not sure I understand them even now).

We can summarise them as:

  • If you have assets under £100,000, you’re a winner
  • If you have assets over £100,000, you’re not a winner

In essence, the Tory answer to the question “who pays for social care?” is “you, not us”.

Coupled with the proposal to scrap the universall Winter Fuel Allowance, one argument is that the Conseratives’ proposals are progressive, redistributive mechanisms that will benefit people from lower incomes, or working-age people who have been reliant on social care for their adult lives (and are less likely to have built up assets).

The counter argument – including when comparing the proposals against the Dilnot Commission’s proposals – is that these proposals create a further breakdown in the inherent universalism and sharing of risk that only government can provide (see also: the NHS).

These proposals may provide a financial solution to the social care crisis*, but they certainly don’t shore up the idea that “we’re all in this together”.

*Though deferred payments from housing still requires large short- and medium-term injections of cash, and we don’t know how inheritance law and behaviour will respond to these announcements.

We can’t all be change agents

Around 16% of people in an organisation are change agents. About 50% of people are late adopters or laggards.

change agents
Image via Helen Bevan on Twitter

Similarly, around 13% of employees are engaged contributers in the workplace:

Image via School for Change Agents

All the rest are compliant – disconnected from the purpose of their organisation, controlled by performance management and procedures, largely resistant to change.

An idle thought: though we’d all dearly love to be change agents and contributors, by definition, we can’t all be change agents; we can’t all be contributors.

Half the battle – actually, over 80% of the battle – may be recognising our place in the organisational picture.


The opportunity for public services of truly engaged expert citizens

The World Wide Web was invented in 1989 and Google was incorporated as a company nearly a decade later, in 1998. AirBnB started in 2007 and Uber in 2009.

I wonder why there was such a big delay between the web and Google, and then Google and AirBnB, Uber etc., and then a subsequent delay in their reaching a tipping point in terms of awareness and use by the general public?

I ask this because there have been a very wide number of approaches and initiatives for improving public services, not least health and social care, through technology and particularly the web. For example, there have been care comparison sites a-plenty, much talk of open data and suggestions of location-based services to replace off- and online directories. And yet we see relatively little evidence of these approaching a tipping point, let alone being used regularly by local authorities, providers and the general public when it comes to health and social care.

The prompt for these thoughts is this excellent, detailed post at Policy Exchange about the rise of the citizen expert.

In it Beth Simone Noveck (former United States deputy chief technology officer and director of the White House Open Government Initiative) takes as a starting point another area of public policy – citizen engagement – and notes how the obvious opportunity to improve public services and local communities hasn’t been taken in the way it could have been.

Citizen engagement isn’t just the equivalent of technology: it’s clearly bigger than that. Beth makes clear this point by showing how better harnessing the interests and expertise of citizens can help both bridge the democratic divide and make the most of people in contributing to their local communities and society.

The internet is radically decreasing the costs of identifying diverse forms of expertise so that the person who has taken courses on an online learning platform can showcase those credentials with a searchable digital badge. The person who has answered thousands of questions on a question-and-answer website can demonstrate their practical ability and willingness to help. Ratings by other users further attest to the usefulness of their contributions. In short, it is becoming possible to discover what people know and can do in ever more finely tuned ways and match people to opportunities to participate that speak to their talents.

But she also notes the most significant barrier to this: the continued dominance / monopoly of policy- and service-elites in the work that they do:

[There is a] long-held belief, even among reformers, that only professional public servants or credentialed elites possess the requisite abilities to govern in a complex society.

Why? Because it is believed

Citizens are spectators who can express opinions but cognitive incapacity, laziness or simply the complexity of modern society limit participation to asking people what they feel by means of elections, opinion polls, or social media.

The shifting of the cause of the problem of a lack of engagement onto citizens themselves rather than the professionals asking the questions is a familiar refrain. We regularly hear laments about “the usual suspects”, limited response rates or adversarial consultation processes that create more problems than they solve.

But this characterisation of this situation only makes sense for one set of players: it suits both the technocratic elites who dominate public policy and services, and the other well-embedded elites with (vested) interests who can mobilise quickly to respond to consultation/engagement that affect their organisations.

It is, of course, a characterisation that doesn’t really stand up to scrutiny. For example, we know that (proper) co-production in health and social care has a solid evidence base in the difference it makes. But we also know it continues to be at best a nice-to-have rather than a must-have.

Thus we come back to the questions kicking about in my mind at the start of this post: if the ability to do this sort of thing exists (be it citizen engagement or technology), why hasn’t social care and the like made the most of this opportunity?

It’s largely because elites aren’t yet comfortable with distributing leadership and expertise.

One of the ways to overcome this discomfort, then, is to make it valuable and rational for the existing elites to engage in effective citizen engagement by ensuring a ‘good’ group of people are engaged and involved in public service reform in the first place.

Noveck rightly says:

To make all forms of engagement more effective, we need to increase the likelihood that the opportunity to participate will be known to those who need to participate. If a city really wants to improve the chances of crafting a workable plan for bike lanes, it should be able to reach out to urban planners, transportation engineers, cyclists, and cab drivers and offer them ways to participate meaningfully. When a public organisation needs hands on help from techies to build better websites or data crunching from data scientists, it needs to be able to connect.

To do this:

[I]nstitutions [must] begin to leverage such platforms to match the need for expertise to the demand for it and, in the process, increase engagement becoming more effective and more legitimate.

This is appealing. Citizen engagement may not be valued by elites because there hasn’t been adequate effort or ability to engage sufficient citizens to make it worthwhile enough.

As Noveck concludes:

This is about chances for civic participation; to be a member of a local community and to make a contribution based on this… It has everything to do with what it means to be a citizen in a contemporary democracy.

This is why I particularly like this: this isn’t just about technical changes around the edges of public service economies, but the broad meaningful difference it could make.



Culture change is change if we understand culture properly

Change cartoon

I enjoyed Alex’s post on why “culture change is no change”, though this is a rare occasion on which I don’t wholeheartedly agree with him.

He notes:

Most [of] the profound and important changes we need to see in public services, we describe as ‘culture changes’… What do we mean by ‘culture change’? Generally, it’s code for a change we don’t think will happen and that we don’t think is our fault when it doesn’t.

Though I can see the point, I don’t think it is right.

Before looking at Alex’s central points and so exploring why I don’t think the above is  right, let’s briefly try to answer the following: “What is culture?”

There are many ways or frameworks for defining or understanding culture. McKinsey & Co famously defined it as

How we do things around here.

Schein expands (summarised in The Art of Change Making (pdf), p.131):

Culture is the way that an organisation survives. It is a way of being, believing and feeling that gives consistency and stability. It gives a way of surviving internal and external threat and disruption. It is how a place makes sense of the world. It is how it does things and how it chooses to be seen.

What this gives rise to are three levels of culture: tacit (what is assumed), espoused (what is spoken of) and observable (what is done in practice):

Culture-3 types
Schein’s three types of culture

How then, does culture – the way an organisation or system does things, survives and makes sense of the world – manifest itself? One of the more common ways of seeing this is through the Cultural Web (see pp.134-137 of The Art of Change Making). This sees culture as the result of the wonderfully Kafkaesque


The paradigm is

the core beliefs of [an] organisation about themselves. The paradigm and the organisation’s behaviours, actions and thoughts are interlinked, they are a complex web and are inseparable. Every thought, behaviour and action feeds into the paradigm and the paradigm in turn influences every thought and action.

There are then thought to be six cultural influences that inform this paradigm and which are themselves informed by the paradigm (all of which exist at each of the three levels noted by Schein: tacit, espoused, observable).

The Cultural Web

With these common definitions of culture (and so culture change) in place, we can therefore explore the two central points of Alex’s post.

Just so you can see where I’m going with this, I’ll say now: we’ll see that culture change is precisely the sort of change Alex is rightly looking for.

The first main point in Alex’s post is this:

[I]n reality culture is always, always trumped by the hard levers and incentives in any system.

I think there is a grain of truth in this, but I think it underplays two issues.

The first is that hard levers and incentives themselves are part of the culture. In the Cultural Web they are examples of “Control Systems”, which

are the ways that an organisation controls how things are done, from things such as quality control and financial control, through to reward and punishment… People will behave in ways that they think will please the control system.

That is, what the organisation or system values is what leads to the creation of hard levers or incentives in the first place.

The second issue is that in any complex system the “hard” and the “soft” interact with each other in complex and possibly unknowable ways. (This is true even if you don’t think hard levers and incentives are part of the culture.) What this means is that for successful change to happen we should have both changes to the law, policy and financial flows that govern how systems are structured (the “hard”) and to the culture that governs how/why they work (“soft”).

The second main point in Alex’s post is about power:

Power on the other hand, is not elusive, and rarely dispersed… So next time someone in power suggests a culture change is needed, perhaps the appropriate question is, “[H]ow are you going to give your power to someone else, to start that happening?”

This point and related question about power are exactly right. From the definition of culture, though, we can see that power and power structures are part of the culture of an organisation or system. Or put another way: for power to be moved from one person to another is exactly to require a culture change.

It’s rare for me to disagree with Alex but I hope this post has explained why, on this occasion, I do. To summarise: if people use the phrase “culture change” as code for things they don’t think will happen, I’d suggest they probably don’t understand definitions of culture (at either a system or organisation level), how it manifests itself, and so what culture change might actually entail.


Scooby Doo and the human reasons reform doesn’t happen


Image via

Francis Fukuyuma noted 4 reasons why political reform happens:

  1. Reform is a profoundly political process, not a technical one
  2. The political coalition favouring reform has to be based on groups that do not have a strong stake in the existing system
  3. While government reform reflects the material interests of the parties involved, ideas are critical in shaping how individuals see their interests
  4. Reform takes a great deal of time.

Humans are a significant (actually, the only) reason these reforms don’t happen – we can see this in, for example, the lack of speed with which any public service reform happens.

Why are we like this? Fukuyama notes:

Human nature has provided us with a suite of emotions that encourage rule or norm following that is independent of the norm’s rationality. Sometimes… we follow rules simply because they are old and traditional. We are instinctively conformist and look around at our fellows for guidelines to our own behaviour.

Instead of reason, human behaviour is grounded in emotion and resulting biases (pace Kahnemann) like pride or shame.

Such human behaviour aggregates to institutions, and there are two main reasons institutions don’t adapt either.

The first is because they’re made up of humans, who follow rules for reasons that aren’t rational – see above!

The second is that institutions contain groups who have a vested interest in keeping things as they are:

Political institutions develop as new social groups emerge and challenge the existing equilibrium. If successful institutional development occurs, the rules of the system change and the former outsiders become insiders.

This is encouraging for those who seek and are successful in change.

As the institutions update themselves, though, so we have to be wary about the new elites within them:

But then the insiders acquire a stake in the new system and henceforth act to defend the new status quo. Because they are insiders, they can use their superior access to information and resources to manipulate the rules in their favour.

As each baddie in Scooby Doo notes they’d have gotten away with it if it weren’t for those pesky kids, so we’d achieve every public policy aim we could ever wish for if it weren’t for those pesky humans.


Four lessons for political reform


  1. Reform is a profoundly political process, not a technical one
  2. The political coalition favouring reform has to be based on groups that do not have a strong stake in the existing system
  3. While government reform reflects the material interests of the parties involved, ideas are critical in shaping how individuals see their interests
  4. Reform takes a great deal of time.

These lessons are from Francis Fukushima and how to reform patronage-based political systems to modern, merit-based ones, but I’d say they’re equally applicable to most public service change processes – including, of course, personalisation across health and social care.

If we were to apply the four lessons to how things have gone with personalisation so far, I’d suggest the following:

  1. Personalisation has focused too much on technical changes (e.g. Resource Allocation Systems, online directories of support), and not enough on political ones (including attitudinal and cultural)
  2. There has been a coalition of people wishing to change the social care and health systems through personalisation. This coalition, however, hasn’t been sufficient, and certainly hasn’t yet engaged enough with groups that have a strong stake in how things currently are (particularly social workers, who broadly remain wary of personalisation)
  3. The idea of personalisation is a strong one. Indeed, it’s probably driven reform in other areas of public services
  4. Even if we took 1996 as the starting point for personalisation, we’re still only 20 years into this journey. 2007 is a more realistic starting point (with the advent of Putting People First), and for the scale of political, cultural and attitudinal change we know personalisation requires, a decade is nowhere near enough. If this is in doubt, ask any race, gender or sexuality equality campaigners in the UK, US or beyond.

If we looked at the topic of social care funding, I suspect we’d find even less evidence on each of the four lessons for political change.