The make-believe space

I have just finished reading the most amazing book by Yael-Navaro-Yashin which was suggested to me by my fantastic colleague Michael Fischer.  This book presents a rich and detailed account of long term ethnographic research in Northern Cyprus.

In 1974 Turkey invaded Northern Cyprus and there was a separation of Turkish-Cypriots and Greek-Cypriots through the imposition of a boundary.  This book explores a number of the implications of this partition and the displacement of individuals and communities and expropriation of property that went along with this process.

This is not only a detailed and nuanced ethnographic study of a community that has often lacked visibility, but in the process, Navaro-Yashin also develops a rang of theoretical insights into the dynamic interactions of materiality, subjectivity, affect and the phantasmic.

In this fascinating account Navaro-Yashin explores what she calls ‘make-believe’ space.  She is talking about this idea of being make-believe not just in the sense of the space and territory being inhabited but also the modes of governance and administration that emerge in response to this and their associate material practices.

The mainstream public administration literature, as Christopher Pollitt reminds us, has typically struggled to accommodate notions of time and space in its analysis.  Navaro-Yashin illustrates just why this is so important and the relationships between these aspects and the material practices of governance and administration.

The book deals with issues of the phantasmic in a truly fascinating way.  I imagine many of us have worked in organisations which feel like they are inhabited by ghosts and that the specter of individuals or values can be felt through practices or objects long after they have left the building.

The chapter on administration and affect is fascinating and terrifying in equal amounts.  There a whole series of issues relating to the status of public servants and expectations of their contribution to work that in many places we would imagine have been confined to the past.  Yet, the description of processes that lack any rational or instrumental value but are still carried out because of their symbolic value will be incredibly familiar to many.

There is a vast amount of theoretical depth and richness that could very helpfully be applied in a public administration setting and could further develop our thinking in this space about why individuals and groups behave the ways that they do and the impact that waves of reform have over organisations.  Well worth a read for something a little different and similar at the same time.

make believe

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The best and worst health systems

This morning I came across a link in my Twitter feed about the best and worst health systems in the world.  On closer inspection it was referring to the Commonwealth Fund’s study from last year comparing the performance of the US’s health system to ten other developed country health systems.  If you missed the reporting at the time the summary is copied below and you can read the full report here.

For those who hear little but how bad the UK National Health Service is, the results might be surprising given that this health system comes out on top.  The UK scores particularly well on access, quality of care, efficiency and equity for an average health expenditure per capita of $3,405 (US$).  The only area that the UK does not do well is in terms of the score for ‘Health Lives’ which is a score based on mortality amenable to medical care, infant mortality and healthy life expectancy at age 60.

France’s ranking was a bit of a surprise for me in this study.  From comparative research I’ve read before I expected that France would do pretty well but it comes 9th out of 11 countries .  Sure the health expenditure per capita is a bit more than some other countries ($4,118) and we know that the French system isn’t the most efficient but I was surprised to see it come bottom in terms of access and close to bottom on quality care and equity.  France does top the chart in one area though – healthy lives.

I always think these rankings of health systems are fascinating, particularly because they are a very visible trade off between a range of different factors.  This sort of analysis typically tends to show that unless you live in Sweden and enjoy paying high taxes, you can’t have it all.  Typically it is argued that the UK NHS trades off the kinds of access you get in other systems (being able to get an appointment with your GP within a week, for example, or going directly to a specialist) for efficiency gains.  Any economist will tell you that having a queue and a gatekeeper for specialist services are helpful in driving efficiency.  In this study the UK does well on access, which I assume is because access is considered to be a measure of both timeliness of care and also cost associated with accessing health care.  As a universal system free at the point of use the UK was always going to do well on those sorts of metrics.

What these figures don’t seem to reflect though is the fact that the UK is four quite different health systems now with political devolution to Scotland and Wales in the late 1990s and Northern Ireland has always operated slightly different due to political factors (for those interested in this natural experiment see some of Scott Greer’s work).  We are starting to see interesting trends in the data that come from these devolved nations in comparison with England and questions being asked about the degree to which these are linked to organisation and management reforms.

The US comes dead last in the list, low down on pretty much all of the metrics at an average health cost per capita of $8,508 – and yet internationally is often known as being at the forefront of medical research.  Some of the best care may be available, but it is not necessarily widely shared as the US does very badly on equity.  It will be interesting to see the impact that the Affordable Care Act makes on these figures over time.

The only saving grace for the US might be Canada’s poor showing in these rankings.  They came overall second to bottom at a health expenditure per capita of $4,522 and poor on quality care, access, efficiency, equity and a low placing on healthy lives.

For the Aussies out there you will be pleased to hear you score 4th, doing particularly well on quality of care and for a cost per capita of about $3,800.  Interestingly Australia doesn’t do too well in terms of access, which was a shock to me given that on moving to Australia for the first time ever in my life I got an appointment with a GP on the same day that I wanted one and it was on a weekend.  The report cites cost-related problems with the Australian system which presumably is the result of the dual public and private systems.

The thing that really stands out in these figures is the relationship between healthy lives and health systems.  If the UK systems ranks first on all things but healthy lives and the French system ranks low on most things but first on healthy lives then what is going on here?  Are we saying that health systems have no bearing on health outcomes?  The more right wing amongst you might be thinking this is an example of how a ‘Socialist nanny state’ like the UK doesn’t encourage people to look after their health (although I would of course point out that the US comes rock bottom on healthy lives and Sweden comes 2nd in this category and first in terms of equity).  Or is the issue that indicators like ‘healthy lives’ are more long term and we might expect the recent improvements made in the NHS will filter through to improve these aspects in ten or twenty years time?

Of course there are no easy answers to these sorts of questions but comparing systems in this way is a fascinating way to get into discussions about both the relative merits of different approaches to organising and delivering services and also what we want from our health systems.  In the mean time this is a nice change from just reading bad things about the UK NHS.

commonwealth fund

What is commissioning?

This week I’ll be chairing a workshop on commissioning public services featuring myself and Helen Sullivan from the Melbourne School of Government and Robin Miller and Catherine Mangan from the University of Birmingham in the UK.  Whilst commissioning is a newer concept to Australia, the UK has been experimenting with various different aspects of a commissioning approach for about 20 years.

In this week’s workshop we will be exploring what commissioning is and what the evidence base says about the effectiveness of this concept and how best to go about commissioning public services.  I am also just finishing up a working paper for the Melbourne School of Government which should be published soon on this topic.

Working on the report and getting ready for this week’s workshop I was reminded of this video clip that I was involved in last year.  In this clip Dr Mark Booth from the Australian Department of Health, Dr Judith Smith from the Nuffield Trust and myself discuss commissioning with PHCRIS Director Professor Ellen McIntyre.

 

 

Walled states, waning sovereignty

Recently I have been thinking about boundaries in public administration and how we might theorise these in a different and more dynamic way.  In doing so I have been reading a number of books from disciplines such as geography and international relations.

One of the latest books I’ve read in this project is Walled states, waning sovereignty by Wendy Brown.  This book critically analyses the practice of wall building in a context where nation-state sovereignty is seemingly on the decline in an ever more mobile and interconnected world.

This is a wonderfully written book that draws on a range of different political theories to consider why it is that states still engage in wall building when all of the evidence suggests that they rarely fulfill their aims.

Brown argues that the main functions of these walls are not material but symbolic.  Walls generate what Heidegger calls a reassuring world picture in terms of the need for security and social and psychic integration for political membership (pg. 26).  Brown argues that walls have theatrical, theological and material effects.

From the analysis of a number of walls, such as those dividing Texas from Mexico, Israel from Palestine, South Africa from Zimbabwe, Brown concludes that ‘ walls are consummately functional and walls are potent organizers of human psychic landscapes generative of cultural and political identities.  The emerge from and figure in discourses, they can become discursive statements themselves and they are crucial to the organization of power in and through space.  The meaning is not in the referent, walls do not narrative and do not even speak’ (pg. 74).

The study of boundaries in public administration is yet to include consideration of these types of symbolic and psychic entities and yet we know from attempts to engage in organisational restructuring, for example, that boundaries have more than just physical implications.  Marianna Fotaki  has started to explore some of these issues in the context of organisational theory drawing on psychoanalytical literatures, although these kinds of insights are yet to make their way into mainstream public administration literatures.  Brown similarly speaks about the psychic fantasies and anxieties that walls are able to deal with by creating a visual effect (even if they do not actually manage what is promised of them).

For anyone trying to think about boundaries from a different perspective this book offers plenty of inspiration.

brown

The rise of experimental government

I just came across this blog from David Halpern (National Adviser on What Works and CEO of Behavioural Insights Team, UK) which is concerned with the lack of empirical evidence used to guide decision making in many areas of public services.  In the UK a series of ‘What Works’ centres have been established to generate ‘good empirical studies’ in a range of different welfare service areas.

Now I am all for using more evidence to inform policy and practice (working in a university how could I be against this?).  Although I suspect that in some of the areas that the What Works teams are talking about it is not necessarily a lack of evidence that is the problem but weighing up a series of complex value judgements.  These are typically not easily resolved by more evidence about effectiveness.

Anyway, I have written about this blog not to get into a debate about evidence and decision making and if you have been in one of my policy design and implementation classes you will have heard all about my stance on this.  I raise it instead because of the last section of Halpern’s piece which talks about the idea of radical incrementalism.  Halpern explains:

‘Radical incrementalism is the idea that dramatic improvements can be achieved, and are more likely to be achieved, by systematically testing small variations in everything we do, rather than through dramatic leaps into the dark. For example, the dramatic wins of the British cycling team at the last Olympics are widely attributed to the systematic testing by the team of many variations of the bike design and training schedules. Many of these led to small improvements, but when combined created a winning team. Similarly, many of the dramatic advances in survival rates for cancer over the last 30 years are due more to constant refinements in treatment dosage and combination than to new ‘breakthrough’ drugs. Applying similar ‘radical incrementalism’ to public sector policy and practice, from how we design our websites, to the endless details in jobcentres to business support schemes, we can be pretty confident that each of these incremental improvements can lead to an overall performance that is utterly transformed in its cost-effectiveness and overall impact.

 

Helen Sullivan talked about this very same idea in the Imagining the 21st century public servant workforce report which we published last year. What we argued in this report was that if the approach of radical incrementalism is to be effective then the first task must be to ensure that we all have a sense of what we are working towards.  We both use the example of British cycling and there I guess the aim is to go faster for longer.  The aims in areas of local economic development or early education might be slightly more complex.  Without a sense of strategic aim then evidence cannot play the role in the process that it might.  In our research into the Australian public service one of the things we heard frequently was the lack of strategic oversight and horizon scanning – and I don’t think Australia is alone in this.  Having established where we want to go, having good evidence to back up this process and to help us track progress is, of course, absolutely crucial.

I would like to hear from any individuals or teams who have experimented with this notion of radical incrementalism in recent practice and hear about your experience with this.  Did it turn out to be as radical as you had hoped?  Did you reach the end point?  What helped and hindered this process?

 

 

 

 

 

No website is complete without cute pictures

So to balance out the nerd content and to appeal to all the animal lovers out there here are a few pictures of the pets that cause chaos around our family home.  They are all pretty young as we have got them all since arriving in Australia.

First up we got our lovely wolf grey husky Polly.

Polly

Because one husky is never enough we got Dexter about 8 months later.  This is him as a baby.  He is an Isabella White husky which confuses a lot of people as they don’t expect huskies to be this colour.  We’ve often been asked if he is anything from a lab cross to a dingo!

dexter

He’s lots bigger and stronger now.  Here is a picture of Polly and Dexter together

doggies

We also have a cat called Elvis.  He is a little cat and won’t grow much after he nearly died at about 6 months of age.  He had to have a very serious operation and it was touch and go for a while.  He pulled through and now does whatever he wants (he nearly died after all).  Here is a picture of Polly nursing him back to health when he was sick.

elvispolly

More gratuitous animal shots to follow no doubt as the family have more animal plans in the pipeline!

POETQ

For my PhD research I invented an online evaluation tool to use within health and social care partnerships.  This was called the Partnership Online Evaluation Toolkit – or POET as it became known.  Whilst POET served the purpose for the PhD there was quite a bit I wanted to do to improve it before using it again in broader studies.  My fantastic colleague Stephen Jeffares had also been working on the evaluation of collaborative working and had used a Q-methodology based approach in his PhD research.  POETQ (the addition of a Q methodology approach to the POET tool) came about as an integration of the work that Stephen and I had done.

Stephen and I were part of a team that received funding from the UK National Institute of Health Research to investigate the topic of joint commissioning and we proposed to use POETQ as one of the major tools of data collection.  We hired a web designer, Greg Hughes (who at that time was a University of Birmingham undergrad student and now is based in San Francisco working for Apple) to help us develop a better application to deliver POETQ through.  You can find out more about POETQ and see screen shots and a video of it in action here.  If you are interested in using this as a research method then please get in touch – we can make it freely available to people with certain affiliations.  You can read more about how we used POETQ in the joint commissioning research report which you can access here.  It is also mentioned in Stephen’s great book Interpreting hashtag politics which is pictured below and which I thoroughly recommend to anyone interested in the rise and fall of policy ideas.

hashtag politics

Some recent and not so recent pieces

In this post I summarise some of the various pieces I have authored or co-authored in this research programme over the last few years.

In 2012 Catherine Needham and I chaired a roundtable on the idea of the 21st century public servant under the auspices of the Public Service Academy at the University of Birmingham.  You can find the summary of the discussion here

21c-ps-cover-resize

Shortly before moving to Melbourne Catherine Needham and I won some funds from the ESRC to form a knowledge partnership with Birmingham City Council.  When I left the UK I handed over my part of the project to Catherine Mangan but did stay involve in a less formal capacity.  You can find the review of the literature that the three of us did here and which sets out 8 lessons about the future public service workforce.

21c lessons from the lit

Helen Sullivan and I conducted a research project interviewing about 30 individuals in total to try and get a better handle on what the future Australian public servant workforce might look like and the steps needed to achieve this.  This followed up from a discussion paper that Helen did with Maria Katsonis of the Victorian Department of Premier and Cabinet (you can access this here).  The final report of the research by Helen and I can be found here.  Below there is a picture of Helen, myself, Maria and Sir Gus O’Donnell at the launch of this work.

21cps launch

The report from the Birmingham research can be found here.    Below is one of the great illustrations that the Birmingham team commissioned to illustrate their research.

21cps illustration

In addition to these reports a number of pieces have also appeared in public service magazines like The Mandarin or newspapers.  I have put links to these below. 

21st century public service: changing education and recruitmentThe Mandarin, 13thJanuary 2015.

21st century public service: shared vision needed for ‘softer’ skillsThe Mandarin, 17thDecember, 2014.

The 21st century public service: are we ready for the change needed?  The Mandarin, 8thDecember, 2014

Creating the 21st century public servant: emerging from identity crisisThe Mandarin14th July,2014

The 21st-century public servant needs new skillsGuardian Society, 1st May 2013

The making of the 21st century public servantGuardian Professional, 22nd November 2012.

21st Century Public Servant

Although lots has been written about the need for public services to reform, less has been discussed about how this will impact on the workforce.  If we are to plan effectively for the future then it is crucial that we have a sense of what the public service workforce of the future might look like, what roles public servants might play, the skills and capabilities they will need to achieve this and how development and education will need to change.  The workforce issue is important not only because of the sorts of changes that are taking place in the public service context, but also as we are starting to see shifts in terms of the nature of work more broadly.  Whilst some of the suggested changes to work may be more postulated than real at the moment; what is clear is that we are all going to work for longer, we will likely have several careers over this period and portfolio careers will be become more popular.

Over the last few years I have been doing work on this topic in the UK (in conjunction with colleagues at the University of Birmingham) and in Australia.  In this category I will bring together some of the publications that have come out of this work, interesting articles that I come across and ideas of where to take the work programme next.  If you are interested in this topic you might also want to read the blog that I run with colleagues at the University of Birmingham – https://21stcenturypublicservant.wordpress.com/  We’re always keen to hear about new and interesting ideas, articles or events that might also cover these issues.