Unhappy customers: are inhuman public services destroying trust?

By David Donaldson

Friday May 31, 2019

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Can government rekindle trust with constituents through better, more human services? A Mandarin Live event recently looked at some successful cases.

Western countries are suffering from a deficiency of public trust.

A survey of Australians has shown a large drop in satisfaction with our democratic system in the past decade, though the Edelman Trust Barometer recently reported an uptick.

Overseas, the situation is even less stable, with angry voters embracing populist politics in the form of Trump and Brexit.

Could impersonal government be contributing to the problem?

Conceptualising citizens as customers, for example, is “great when we’re thinking efficiency, when we’re thinking service improvement and service delivery”, notes Centre for Public Impact Executive Director Adrian Brown.

But by reducing the relationship to a transaction, such framing does not treat people as “a fully fledged citizen”.

“When we start talking to citizens that way, they start thinking of government as just a provider like a bank, so it takes away something quite important, I think,” he told Mandarin Live’s first event, ‘Rebuilding legitimacy and trust’. Mandarin Live is a new series of events that will feature public sector thinkers and leaders giving practical insights for public servants.

“So, perhaps we need to rethink government and challenge the philosophy that developed through new public management of managerialism, measurement, standards.”

While such approaches “have a place”, they cannot be the whole story, Brown thinks.

“We need to rebalance the way we think about government away from some of those more managerial and technocratic ways of thinking about government, and towards something more human.”

He points to efforts to make human services more human-centred. In the Netherlands, aged care used to be run “like an efficient machine”, which meant it became “transactional” — one patient would have several different staff coming through their room each day. It’s a model that will sound familiar to Australians, and one many would agree doesn’t lead to great outcomes.

“Can you run people as an efficient machine?” Brown asks.

Instead, aged care organisation Buurtzorg gave teams of highly qualified nurses the ability to self-manage, and the nurses have moved towards a model in which each patient sees a maximum of two or three staff.

The Centre for Public Impact’s case study on it found patient-satisfaction rates are the highest of any healthcare organisation, substantial financial savings have been made, and Buurtzorg continues to be a great place for employees. The approach has won plaudits and imitators elsewhere in Europe, with the UK minister of health and social care stating “the Dutch model delivers higher-quality care at a lower cost. I want to see it grow.”

Such models require trust from those at the top, but show that decentralising some power to the frontline can allow for more adaptable and fit for purpose services.

“If you want to create trust, you have to show trust,” says Brown.

He also argued that with governments increasingly working with citizens and private organisations, it is important to think of policy and service capacity not only in terms of the public service’s own abilities but the capacity of the whole system. Improving on this count will require better flows of information across organisations — a challenge for many public servants, whose systems tend to be designed to allow information to flow up and down, but not across.

Brown also highlighted the case of Wigan local government in northern England, which used the huge austerity cuts placed on them — around 40% of the budget, at a time when demand was still rising — to rethink how they work with constituents.

Led by CEO Donna Hall, the council reformed its culture, focusing on prevention and working with citizens to identify where the community could substitute for more expensive public services. Staff were trained in ethnographic techniques like how to listen actively to residents’ concerns.

One example was a daycare patient whose care costs fell from almost GBP2000 to less than GBP20. He was “a man with dementia — who had previously spent every day being collected by a minibus and taken to a day centre he hated – [and] was found to enjoy running and watching rugby league. His new support package involved being set up with a running buddy from a local club and being given a season ticket for Wigan Warriors rugby league club.”

The council has not just adapted to the massive budget cuts, but improved some of its services. Staff satisfaction, even after a significant proportion of their colleagues were laid off, is among the highest in the country. And this is against a background of worsening life outcomes across many parts of the country.

Brown wonders how much of this comes down to having the right combination of a burning platform and a visionary leader in place.

“Do you have to crash the car to fix it? Or has someone else already crashed it?”

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