PRINCIPLES ARE BETTER THAN TARGETS

Our Better Way proposition:

All too often universal targets, standard setting and inspection regimes fail to encourage the best behaviours or prevent the worst. Quality is a continual process, emerging from principles of human dignity, best reinforced by citizen engagement, challenge and accountability. 

Insights about our proposition...

Over the last 20 years governments across the UK and beyond have sought to improve public service performance by introducing an array of targets, league tables and performance information. Read more… 

Whilst the introduction of performance targets has certainly improved performance in specific areas (e.g. NHS waiting times in England) experts have also pointed to a number of problems with this type of approach including ‘gaming’. Read more…

Alternative approaches: moves towards outcomes measurement and the use of wellbeing frameworks

Partly in response to some of the challenges associated with targets based ‘New Public Management’ there has, in the last few decades been a growing international interest in outcomes based performance management that more closely align measures of public service performance with the experience of users. Read more…

Wellbeing is a multi-dimensional concept that encompasses social, environmental and economic outcomes. A number of governments are using wellbeing frameworks to measure progress against these outcomes and to guide the development of policy and practice. Read more…

Benefits of outcomes based wellbeing frameworks

Wellbeing frameworks and outcomes based approaches can offer a number of benefits including more joined up approaches to government and citizen engagement but outcomes are not immune to gaming and there are challenges regarding attribution, impact and measurement. Read more …

Alternatives: Service design, delivery and assessment based on human rights principles

In their paper Being Human: A Human Rights Based Approach to Health and Social Care in Scotland the Alliance argue that a Human Rights based approach to health and Social Care that supports people to be independent, active citizens as well as have good health could offer the basis for high quality social care. Read more…

Alternatives: a move away from targets, regulation and compliance altogether and a focus on purpose, demand and learning

John Seddon, in his book ‘The Whitehall Effect’ argues that a whole system change is required moving away from targets, regulation and compliance altogether. Read more…

The secret of a good service Seddon argues, is to focus on giving customers what they need. Read more…

There is however significant evidence against Seddon’s approach. There is for example, good evidence to suggest targets can also improve outcomes particularly when it comes to raising minimum standards and that politicians may find it difficult to limit themselves to defining purpose only. Read more…

Practice examples

A good example of the use of an outcomes based wellbeing framework to improve public services is Scotland National Performance Framework and the development of a shared assessment process for the care of older people in Dundee provides a practice based example of service design based around purpose and customer focus rather than top down targets. Read more…

We want to generate more insights and examples about our propositions. Do get in touch with any thoughts or additions. 

SHAKING THINGS UP A BIT: SOME DISCUSSION POINTS FOR A BETTER WAY

How do we retain the improvements to public services we have seen as a result of targets and outcomes based performance management whilst also shifting towards a more open and honest learning environment?

How do we create a culture of continuous improvement underpinned by transparency, understanding and trust?

Is some kind of national framework required to address widespread dissatisfaction with a ‘postcode lottery’ or with service discrimination against particular groups of people?  And if so, what might that look like?

Do you have views on these questions – or are there other questions we should be asking?