The two paradigms of People Centred Systems
Inspired by Davis 2016 p53, Seddon 2003 p11
|Command and Control||Beyond Command and Control
|‘Meet the KPIs, miss the point.’||Purpose||‘Help me to live my life the way I want to.’/
‘Help us to live our lives the way we want to.’
|Control. Paternalistic. Deficit-based.||Ethos||Learn and improve. Enabling. Understand citizen and community strengths and assets.|
|Top-down, hierarchical view of service provision from organisation’s point of view.||Perspective||Outside-in, from the citizen’s point of view.|
|Owned (controlled) by professionals.||Control of what matters||Owned (controlled) by citizens.|
|Service users. Passive, homogenous, rationally-acting ‘consumers’ of services.||Identity||Citizens have unique social identities.|
|Identify and respond to problems/crises. Centralised control. Functional specialisms. Multiple front doors. Deficit-based view creates labels, pulls funding and leads to commissioning of services. Purchaser (commissioner) / provider split leads to adversarial relationships, with focus on reduction of unit costs / maximising revenue.||Method||What matters / what does a good life look like to you?’ The ‘good life’ determines the assets to be explored and strengths to be developed. Boundaries and timescales are set by the citizen. Collaborative approach to commissioning around shared purpose. Citizens are supported to help themselves to live their good lives within their communities.|
|Reactive. Presenting, episodic demand viewed in transactional snapshots as new, separate cases, with no understanding of ‘failure demand’. Demand perceived to be increasing, threatening to overwhelm system.||View
|Proactive. Demand is contextual and relational, requiring an understanding of a citizen’s dynamic ‘good life’, as it changes over time. Relationships allow for flexible support on a ‘pull’ basis as required.|
|Bureaucratic, professionalised. ‘Assess-refer-do’ loops. Gatekeeping. Standardised, specified services are ‘pushed’ from a menu of responses, which may give way to punitive sanctions and labelling people. Information resides within agency silos.
Efficiency sought via lower transaction costs (eg ‘digital by default’).
Provision of services to treat symptoms.
|Response to demand||Bespoke to situation. Citizen-led. Build relationships to understand and achieve what matters. Demonstrate requisite variety. Expertise and services are ‘pulled’ in as necessary. Relationships allow for thermostatic responses to changes in a citizen’s circumstances. (Re)build strengths, support and networks. Let solutions emerge. Knowledge and expertise located where required.
Economies flow from creating value.
Systems strengthened to prevent symptoms.
|Behave and comply.||Role of citizens||Create fulfilling identities / relationships.|
|Be safe, be efficient, be compliant. Extrinsically motivated, require incentivising.||Role of workers||Autonomy to do what is right to enable citizens and communities. Build relationships. Listen and understand. Help people to help themselves. Intrinsically motivated.|
|Act on the people. Manage the achievement of activity measures and control costs against budget.||Role of managers||Act on the system to achieve purpose and what matters.|
|Separated from the work, via the hierarchy.||Decision-making||Integrated with the work, via the workers, citizens and communities.|
|Workers and their managers must be held to account for errors. Working to policies and procedures mitigates and protects workers and citizens against risk. Regulation and retrospective inspection ensure compliance.||Attitude to risk||The best route to countering risk is to support responsible, adaptable workers to spend sufficient time alongside people, understanding their unique context and building relationships. Systems exist to enable workers to do a good job and to support citizens to make and implement informed choices.|
|Activity and budget management measures. Measure delivery against specifications. Obscures ability to see cases which present repeatedly.||Measures||Achievement of purpose: measure impact on citizen’s good life, the wider system and community. Measure to learn and improve.|
|Economies of scale: lowest unit cost. Optimising efficiency of parts believed to maximise efficiency overall.||Costs||Economies of flow: costs are in flow, end-to-end. Efficiency gained as a consequence of increasing the effectiveness of the whole system.|
|Projects. Reactive. Planned. Silos remain.||Approach to change||Adaptive. Integral. Emergent. Boundaries dissolved.|
|Citizens: Deterioration. Service dependency. Lack of control.
Costs/capacity: Inflated failure demand, waste and end-to-end costs.
Staff: Demoralised, frustrated.
|Outcomes||Citizens: Have agency. Enabled to live their good lives. Stronger individuals and communities.
Costs/capacity: Reduced failure demand, waste and costs.
Staff: Motivated, engaged.