Outcomes and Measurements Project: Interview with Prof John Seddon
This is an interview with Colin MacLean exploring a series of questions about outcomes and measurements aiming to get nuanced views from people as what started as a part of an action research project.
Below is a transcript of the above recording. Special thanks go to Prof John Seddon giving the time to share his considerable experience in reflecting on these questions. I am grateful to his participation and giving of time to share his thoughts through this project.
John Seddon: probably know if you’ve been reading our work that we would regard ourselves as already in stage three in as much as we help people go and study so they realize that we’re not a civilized society; we don’t turn up and listen and help and we turn up with our preoccupations of our specialist lens, our thresholds, our budgets. These provide an incapacity to listen so we do a lot of administrative work and passing on. I mean if we eventually provide a service it’s standardized because it’s market tested and market driven the standardized services don’t meet the needs some people represent.
So we’ve got all of that going on; it’s just adding costs so we take; we get to study all that which is really easy to study because all you’ve got to do is take cases and ask some sensible questions and you can see that when you state the cases that someone might have had 107 different transactions with 17 different bodies nobody really helped them. At no point in all of this did anybody understand what actually mattered to them; no one looked at the world from their point of view…because we didn’t do that you can see why the things that we provided didn’t help them – you can see the cost of doing all this
So then we help them employ straightforward principles that when someone puts their hand up, you turn up – all of them – although some don’t qualify in any way, you turn up; you establish what matters to them; you establish what’s happened; you establish their context; you help them define what good looks like and it might be a good life or it might be a good death but you help them define what good looks like
You then help them take responsibility, to achieve that, and then you draw from the community or the voluntary sector or the state only the services that are required to help them on the journey that they have defined. The consequence of that is that many lives are quickly back on the rails and the costs are trivial compared to the cost of not doing it
So easy to study, easy to design and then you hit the big problem of actually what you’ve got to do is redesign the way we provide services through 17 different organizations. We don’t need 17 and that’s where you hit the wall because you’ve got all of these people with vested interests and agendas and politics and shit; but when that’s the space we’re currently in…
…that we could do the study, we could do the redesign and then we, you know, we’re doing this in manchester, for example. We’re rather hoping that when they appoint the mayor that this becomes the mayor’s baby because you need someone with the political clout to say we’re having one organization called ‘an organization that’s designed to help people whose lives fallen off the rails’ – we’re not going to have 17 of them doing their own specialist things.
These specialists are important but they’ve got to be located on what we call a ‘pull basis’ so specialism number seven is relevant only to this demand and that demand but it’s the person who’s interfacing with the demand who provides continuity in the relationship and pulls number seven if seven is required as opposed to all of 17 looking at you. Does that makes sense ?
Alex Dunedin: yes
John Seddon: It’s very simple isn’t it
Alex Dunedin: rather than me introduce anecdotes I think I will let you speak. So could you talk a little bit about the structures you work in and under
John Seddon: meaning ?
Alex Dunedin: meaning, so you you’re obviously working for clients or which are organizations
John Seddon: yeah
Alex Dunedin: and within regulatory frameworks
John Seddon: yeah uh
Alex Dunedin: so maybe local councils, I’m interested to know an account of what that’s like and because i’m not very aware of some of the places you’re working with or the way, the means in which you’re meant to communicate and coordinate with other people in approaching collective problems
John Seddon: I’m not sure this will answer your question but the regulatory frameworks are a problem because the thing I talked about earlier that, you know, regulation works on the basis of specification and inspection and so we have regulators who want to see all of the things that are dysfunctional in the current current design…
…you know whether you’ve done your assessments in certain times or passed people on; so you can you can look good in a regulatory framework but be doing nothing of value. The health service is the worst of them; the people who now manage the health service are the ones who are left; the good people went and the ones who are left have been conditioned by 15 years of managerialism and are really like puppets of the center.
Even when even when you take them through the study phase and they see what they’re doing is actually dysfunctional for people; they kind of don’t want to know because to know would threaten their very existence in a regime that judges them on different parameters from above.
Having said that the way we intervene is the issues with regulation audit and any other control functions are the responsibilities of leaders not us and we’re not there to intervene on those matters we’re there to help the leaders create a dialogue with the regulators.
We’ve done that in a series of occasions where – this is quite extraordinary – where the leaders have taken the results of the study phase to a regulator or involved the regulator or local auditor in the study phase; but where their allowed to take them to a government regulator, which is by law, the regulations are enshrined in law, what we find is that the regulator will give them dispensation to move to a redesign which i find an absurd idea because effectively what you’re showing the regulator is that your study phase has taught you that adherence to the regulations is not having a positive impact on the service that you’re… it’s dysfunctional
So you’d kind of think the regulator would go oh my god if this is true for you it’s true for the whole of what we’re doing in England or Scotland therefore we’ve got to rethink regulation. No they don’t think that they think ‘well we’ll let you go ahead with your redesign but we’re going to make you responsible so you have to sign a series of documents that allow you to operate outside of the law. Improvement is banned by law, do you understand ? it’s fucking bonkers ! That’s why I write about regulation in The Whitehall Effect and in other places.
Alex Dunedin: Can you talk about some successes that you’ve had ?
John Seddon: Yeah many have you read have you read our last periodical on people centered services
Alex Dunedin: I don’t believe so
John Seddon: Emmawill give you a copy to read on the train and there’s a lot of stuff in there; there’s a lot of stuff on the website where we publish results and successes – that we’ve got quite a lot of evidence and if you want more than we’ve got there on in the periodical, on the website I can supply you with more evidence but it goes back to the thing I talked about earlier that Whitehall doesn’t do evidence – also I don’t want Whitehall to do evidence…
…you see if Whitehall understood the evidence and understood therefore what’s required is a different design then Whitehall would promulgate that as an answer whereas it’s the root that teaches you how to think so, you know, if we just promulgated it as an answer people wouldn’t get the thinking and so it wouldn’t be successful
You’ve got to, it’s through the study phase that you unlearn management because if you’re a manager in a care service you’re preoccupied with caseloads, assessment targets and all the legal protections that you’ve got to cover yourself with and, you know, that’s what your life is – and if someone comes along and says ‘well look this is complete…it’s just it doesn’t work, do this instead’ well you wouldn’t.
You’d look at the ‘do this instead’ and go ‘no that wouldn’t work, that would offend all the things I’m taught is good management’ so you have to take them through the study phase and to see that all the things that they actually think is good management is not good management. So it’s normative learning.
Alex Dunedin: So your successes you, am I right in hearing, are to do with getting people to unlearn…
John Seddon: Correct
Alex Dunedin: …what they have been operationalizing
John Seddon: Correct, so far as another example is if you stand in a room and tell managers that targets make performance worse some will think you’re nuts; some will think ‘no it’s okay if you reset the right target’ or have the right people set the target. You see you are telling them something that offends their worldview so it creates dissonance so they can only accommodate this dissonance by rationalizing it into their worldview – that’s human.
If you take them out to study their organization, and we know what to get them to do, they’ll come back and say to you – targets are making performance worse; correct; now you’ve opened their mind to the general idea that arbitrary measures distort a system. So now you’re in a place where you can start teaching them that if you use measures that aren’t arbitrary, that are actual, and they’re derived from the purpose of this service from a customer’s point of view and you improve on those thing then not only will service improve but the costs will fall
Now you see they they’d find that counterintuitive. If you started with a proposition – you stand in the room and you say to them if you provide a better service your costs will be lower they go ‘no, no’, because their heads are conditioned by the idea that better service is always more expensive because it’s about more resource or doing more for people.
They can’t understand that their current focus on efficiency damages effectiveness and if you make a service effective the costs fall out of it. So you know, in a typical, if you go back to care services in a typical situation so you can see from the mapping that someone’s life fell off the rails and you can see from the mapping they’ve had 117 interactions and we’ve done this, this and this and this and they’re no better in fact they’re usually worse and so you can you can cost that up.
Well we currently spend 400 000 pounds on this person and they’re no better off or they’re worse. Well just conceptualize this in the redesign phase for the moment, suppose we actually found out what really mattered to them and then we have to go and do that and we find out if we understood what mattered to them what they would have tried to achieve and we’d actually just help them do that would it cost 400 000 pounds ? The answer is no.
Alex Dunedin: do the current systems of administration help you achieve these successes
John Seddon: No
Alex Dunedin: …very clear from your work. Can you talk about the difficulties of measuring outcomes
John Seddon: well you know outcome measures are a tricky area because very often when whitehall people talk about outcome measures they actually mean activity measures. You know, so the number of people on parenting courses or the number of drug rehabilitation programs; these are not outcomes. The outcomes that you need to understand and measure are those that the individual sets for themselves in terms of a good life or a good death – that’s what the statement of purpose is for that person, from which the measures need to be derived for that person, to which then the methods are employed only that is that’s required to achieve the purpose. So you have a simple relationship between the purpose and the measures and the method; so outcome measures framed that way are idiosyncratic
Alex Dunedin: they cannot readily be standardized
John Seddon: no, never standardize, because if you standardize then you’ve just ignored variety. Of the 16 people whose lives have fallen off the rails in Buckingham today there’ll be 16 different contexts, needs, people, desires, statements of purpose; so, idiosyncratic – what’s the word… would be individualized measures.
Alex Dunedin: can you think of helpful and unhelpful examples of bureaucracies in relation to your work
John Seddon: Well a legion of unhelpful bureaucracies built all around the idea of cost, efficiency, scale, you know; so the whole of the DWP, HMRC, the regulatory frameworks, these are all built around the same basic ideas about industrializing services, going after cheaper services but they actually drive the costs up
I mean bureaucracies don’t have to be like that…you know i don’t think bureaucracy is necessarily a bad word but if you think about Max Weber’s idea, that the important thing about bureaucracy is it’s the same for all citizens and it’s your position in the hierarchy dictates what you’re allowed to do and not do.
And I think that was okay in a world where he was developing that. Particularly in his culture, of germanic culture where services to the populace were relatively limited. Today we live in quite a different world and standardization in the Max Weber world had its virtue but standardization in today’s world has no virtue at all, it drives costs up; but i do believe that you could build a bureaucracy or a management structure and a regulatory framework over better effective designs and i argue this in ‘The Whitehall Effect’, you know that I say that…if i use the Purpose-Measures Method frameworks – one of my frameworks – the fundamental error in regulation is that ministers and regulators take a view on measures and methods.
I think their view should be limited to purpose so if you take a view on measures of method then you create a specification and when you come and inspect for regulatory purposes, you’re inspecting for adherence to your measures that you’ve imposed and your methods that you’ve imposed; so you create a compliance culture.
I think if you limit the regulator and politician’s involvement to purpose then you make it a responsibility for the service provider to make their choices not about purpose but about measures and methods and then when the inspector comes up as part of the regulatory process the first question is ‘well what what measures and methods have you chosen in terms of achieving the purpose and let’s see how you’re doing ?’.
So it would increase transparency. You see in the current regime you can be a bad bastard and get away with it; you can have a lousy service but get ticks from the regulator. In the environment I’m describing it’s very hard to get away with bad things because you’ve had to demonstrate the choices you’ve made and then the inspector looks at what you’re doing
So it increases transparency but more importantly it puts the locus of control in the right place because it will drive innovation
Alex Dunedin: how often do funding and administration systems change and do they have continuity
John Seddon: Now, yes – a lot, and no; no, a lot of no because these things they’re not based on any knowledge so they’re always sources of interference and they get people preoccupied with compliance
Alex Dunedin: so you have been looking at this for some time and that’s that’s over so what over 30 years, 40 years ?
John Seddon: In the public sector probably 17 years, probably around that sort of time
Alex Dunedin: So do the the funding and administration structures allow long-term planning
John Seddon: No
Alex Dunedin: do they allow the latitude to implement policies and actions which are relevant and important
John Seddon: Well the Whitehall would say yes and I would say no, well because Whitehall tends to determine importance. So for example, you know, they would tell the police to go after certain types of crime so funnily enough police find them. You know, so if they’re going after violent crime they’ll criminalize our children for having a fight in a playground or they’ll count a domestic dispute as two assaults
It might might not have been important to either criminalize the children or the husband and wife but it makes your numbers. You could turn shoplifting into theft and so on; you know, people use their ingenuity to feed what’s required in my argument
I’d prefer them to use their ingenuity to understand and improve what they’re doing, so it’s very important, if you stay with policing for a moment or the health system or many of these systems – what’s really the first and most important thing to understand, if you can design an effective service is the nature of demand and demand is different in Bournemouth from Edinburgh and Fife and wherever, you know, it’s different. So the design should be different, it should accommodate what demand is in public services
Alex Dunedin: do you think there’s the ability through existing structures to forge connections with outside organizations; so inter-sector working, multi-agency working.
John Seddon: Do you mean public and private or public and voluntary or both
Alex Dunedin: Both I suppose when people and organizations identify a need or expertise from whether it’s community private or public… do you think people have the the agency to have those conversations and strike up functional relationships
John Seddon: well if you’re asking that question, as it were, from the citizens point of view into those agencies I really can’t answer that because that’s not my domain but I can talk about the relationship between the public sector and the voluntary sector, and the public sector and the private sector
So the public sector in the voluntary sector that’s been made hugely more difficult by the advent of commissioning because effectively what that does is it puts enormous bureaucratic structures, specification and inspection structures over the voluntary sector in order to win contracts
So there’s an enormous amount of work to do in winning contracts and then you’ve got to subscribe to all of those things that they’ve specified in the delivery of the contracts regardless of whether those things are important in terms of the service that you’re delivering – they’re thought to be important by the commissioner but what you actually find is they’re encumbrance and they’re a distraction and they’re consuming resource and they can often take the focus away from what’s important in the delivery of that service and I’m not the only person to observe this.
If you look at the work of the Locality organization which is like a trade association for the voluntary sector they’re saying the same thing. If you look at the National Coalition for Independent Action which is an organization from within the voluntary sector they used to have a slogan which I really loved which is “we’re not on arm of the state we have our own arms”; okay – so they fought this phenomenon.
When we look at the ratio between the public sector and the private sector, well this has largely been driven by all governments since Thatcher on the basis that…’the private sector is better isn’t it – at the delivery’; that’s not true; better is a matter of method and I happen to take the view that if better is a matter of method then if we can get the public sector to employ better methods, where better services lower costs and pay less tax.
The way typically in which outsourced contracts are arranged from the public sector and the private sector advantages the private sector insofar as if the service is bad and demand rises it costs more money and we’ve seen this in so many contracts you know.
Equally if you hear the kind of thing that Capita are doing and there are many examples of this – the DWP programs that they’ve outsourced on work capability that kind of thing, they’re driving targets to disadvantage people or punish really the people who are the bottom end of life you know. I think that’s all bad. I can’t see any theoretical merit for the private sector being better I can only see great examples of wasted money that’s public money
Alex Dunedin: So when you talk about commissioning are you talking about what would be referred to as procurement ?
John Seddon: yeah, well procurement’s a wider issue but commissioning is a new phenomenon, so it’s recent – the last, five years and it’s the way in which public sector organizations like local authorities in the health service go and buy services from the private sector and from the voluntary agencies based on no understanding of demand.
It’s really interesting you know, so if you’re a commissioner and you want some drug treatment programs the best they get at understanding demand is counting up the number of drug treatment programs they had in this geography last year. They never asked the question how effective were these, and if they studied and they learned that these were largely ineffective, the first question they should be addressing is well how can we help these people with these drug problems in a manner that’s effective
That’s what we’re looking for first you know and so this goes back to well actually the best thing to do is to commission on the basis of attitude, not price, that what we want is a drug treatment partner who will not just deal with the drug problem but will deal with the person, context, what matters and do the thing I described earlier in terms of what a good service looks like
So together between the commissioner and the provider we can learn about what effectiveness means. Currently all they’re concerned about is buying someone who can do 400 programs next year or whatever it is and paying them for it and if they can buy that cheaper than somebody else they think they’ve done god’s work…
Alex Dunedin: [laughs]
John Seddon: It’s not funny [laughs]
Alex Dunedin: I’m laughing in the strictly Monty Python sense
John Seddon: It’s fucking absurd isn’t it
Alex Dunedin: It is absurd and laughter is, you know, an important medicine otherwise my head would just explode
John Seddon: yeah but I’ll tell you what else; you know I’ve been talking to some of my people who work in this space and we’re seriously considering whether we should build counselling support because they see some terrible things and they witness the failure to help people who could be helped it’s hard to sleep at night when you know this
Alex Dunedin: there must be incredible emotional double binds
John Seddon: yeah
Alex Dunedin: at work and high stress. Can you talk about the language used in administration outcomes and measurements and whether this language is adequate to represent the realities
John Seddon: oh well I mean I suppose, you know, I mean, I’m not sure this answers your question but you know, what I’ve seen in the administration and measurement, the broad specifications world is that it’s based largely – regardless of which which party you vote for – based largely on the ideas of economy of scale, industrialization, cost focus, activity focus, arbitrary measures like targets and standards and service levels and all of that is dysfunctional; it’s man-made, we can change it; it’s dysfunctional but they’re not aware of the dysfunction and if you make them aware of the dysfunction they tend not to like you very much
Alex Dunedin: Which is, yeah, an issue. Do you feel the that the sector’s or your work is adequately funded or resourced ?
John Seddon: My work is adequately funded or resourced ?
Alex Dunedin: Right
John Seddon: The Vanguard’s work ?
Alex Dunedin: Yes
John Seddon: or the service work ?
Alex Dunedin: I suppose both, i’m wondering how…
John Seddon: At Vanguard cash is not an issue because we’re, you know, in the world, in the scheme of things we’re a cash-rich company so it’s not an issue. We have a lot of money in the private sector, we do things at cheaper rates in the public sector; we do a lot of pro bono work in the voluntary sector.
So ours is not an issue, if you ask the question about ‘is the public sector adequately funded ?’ I would argue that it would be if we can design effective public services current budgets could be slashed; we don’t need all this money, we pay all this money for ineffective services
You know Witehall will tell you that people are getting older and demand is rising; only one of those statements is true people – are getting older; when you study demand you find it stable, what is rising is failure demand because the services don’t work. When you design a service that works the failure demand disappears equally – and we didn’t expect this, the original value demands also fall – because better families, better communities etcetera, as things are getting better
And from just the first step in terms of going from an ineffective cost focused service design industrial type to going actually an effective design – designing its demand – you see a dramatic fall in the costs as well as an improvement in service so just based on that jump we could be running the public sector at much lower costs
Alex Dunedin: what role should broader society play in facilitating your work ?
John Seddon: very difficult question, okay. It’s a very difficult question you see because it’d be nice to be able to say, you know, ‘they should champion good things’. The trouble is that broader society is educated by the media and the media shares the narrative with the politicians, so a broader society believes in a lot of things that are dysfunctional, you know, like ‘the private sector does it better’ or ‘we’re paying too much money’ or ‘demand is rising’ and ‘it’s the problem is bloody old people’ – which is actually not a problem, it’s not the greatest consumer resource actually – so it’s kind of….
…I mean I do my best to help by communicating things that I know in the simplest language possible to make people curious but I don’t think we could ever expect society to argue the things that need to be argued. For me it’s the same, you know, you hear Whitehall talk about co-production and I get that if I’m a social worker working with a paraplegic and I’m trying to work on ‘well you know what do you want to get out of life’; I get that co-production, I get that level but Whitehall generalizes…
…and I don’t think the public would want to or could take a view on the design of the planning service or the design of the bin service or the design of the homelessness service or how to design a fucking service; why would they know ? And so I think it’s very dangerous. I mean I wrote The Whitehall Effect hoping it would sell to the average intelligentsia to get them angry about the amount of public money that’s actually wasted but unfortunately, you know, the book didn’t sell so the effect didn’t come through but I wrote The Whitehall Effect in short chapters to make it very simple to get people angry about things they should be angry about
Alex Dunedin: how might the clients or service users best support in delivering support ?
John Seddon: Well I think, I mean, the service user in effective service design and if it’s ‘life has fallen off the rails’ type service their definition of where where they want to get to is integral to the design of the service but not in the bins
Alex Dunedin: And my final question would be what questions do you think are important in working towards greater understandings ?
John Seddon: Amongst whom ?
Alex Dunedin: everybody’s interested in in trying to work out what’s going wrong
John Seddon: oh well those will be questions….
Alex Dunedin: and how to make things right – they’re working – how do we make working services ?
John Seddon: Oh well those those would be questions that drive you towards knowledge as opposed to opinion, you know, so they’ll be questions like ‘what do you know about current performance ?’ and I mean know as opposed to have a view about; have you studied ?
So in Vanguard language ‘what do you actually know about demand ?’. When I when I was on the radio with Peter Day I said to him the managers of the public sector don’t know anything about demand coming into their organizations he couldn’t believe that. How could you run a service organization without understanding demand ?
Well they do; they treat demand as volume. So if you treat demand just as volume and 80 of that demand is failure demand you’ve missed a kind of big trick haven’t you. So you’ve got to understand what the original demands are – the value demands – and if you’ve understood that; a second thing you need knowledge about is how well the service responds in terms of what matters to the customer or the citizen. You’ve got to measure that.
Then you get a shock because that tells you something different to your reports on targets and activity, the things that you’re used to as a manager… what you’ve got to look, if you’re looking at, you know, ‘people’s lives have fallen off the rails’, you’ve got a look at the question I talked about earlier – did at any point in time did we understand this person, their need and their context and the answer is ‘no, no we didn’t’.
So here, there’s three bits of knowledge that ought to be prerequisites to doing anything about it because if you don’t make those things prerequisites you’re not in a good place to start thinking about how to design a service that works
Alex Dunedin: Brilliant, thank you very much
John Seddon: It’s a pleasure
Alex Dunedin: Very stimulating it’s really really valuable to be able to get your thoughts
Permission was obtained to publish on 28th October 2020 and when asked if anything had changed or if there was anything which he wanted to add he said the following brief statement.
The landscape re Whitehall is same and worse.
Covid is a study in why central control fails.
Wikipedia profile: John Seddon is a British occupational psychologist and author, specialising in change in the service industry. He is the managing director of Vanguard, a consultancy company he formed in 1985 and the inventor of ‘The Vanguard Method’. Vanguard currently operates in eleven countries. Seddon is a visiting professor at Buckingham University Business School.
Seddon’s prominence grew following attacks on current British management thinking including the belief in economies of scale, quality standards such as ISO 9000 and much of public sector reform including “deliverology”, the use of targets, inspection and centralised control of local services. The Daily Telegraph described him as a “reluctant management guru”, with a background in occupational psychology….
John Seddon and his colleagues have produced a wide range of informational and educational videos on Youtube available to access without cost:
The Vanguard Method is a form of systems thinking developed by John Seddon and his colleagues which enables managers to study the way work flows through their service organisation.
The understanding gained from these studies allows managers to redesign their service as a system, concentrating on doing what matters to the customer. By focussing on delivering value to the end user, many counter intuitive truths are discovered: for example, the costs of the service fall.
He is the author of a range of books examining aspects of systems thinking and design. You can see some of these on the Good Reads website
To find out more about his books you can visit Triarchy Press, a small, independent publisher, founded in 2005 who’s focus is on systems thinking, publishing books and ideas that challenge the way we think about and view the world, broadly as follows:
- Improving the way that we run certain kinds of organisations (schools, local government, public services – including police and health services)
- Improving the way that leadership, innovation and teamwork happen in all organisations
- Improving the way that we think about the future (whether it’s scenario planning in a company, saving the planet from genocide, ecological disaster or societal collapse, or preparing for crisis)
- Improving the way that we structure economies, banking and financial systems
You can find out more information on his website which he introduces as follows: “We, humankind, invented management and we can change it. And there is a lot that needs changing in mainstream management practice. Inspired by Deming’s declaration that organisations should be managed as systems, and intervention theory – that changing thinking is the key – John Seddon developed the Vanguard Method.
Those who have employed the Vanguard Method testify to profound results in terms of revenue, cost, customer service, employee morale and capacity to innovate.
Here is an interview with him available on Youtube