David Albury’s lessons in better outcomes for lower costs

By Harley Dennett

October 3, 2014

Innovation and the public service were not terms that often went together before Geoff Mulgan and David Albury (pictured) wrote their pioneering report for the British government in 2003. The sector has changed remarkably over the last decade, however, and Albury has found a significant following, eager to change their organisations, their culture and themselves in pursuit of better deliverance of public service.

Not just better outcomes, but also cheaper. Albury believes innovation has become critical as agencies reconcile their budgets with several inescapable trends: changing demands, technology, globalisation, building an environmentally-sustainable way of living and adjusting to the pressures on post-global financial crisis budgets. He told The Mandarin:

“In their experience of other sectors, they expect higher levels of service, more ready access to service. The nature of the demand has also changed. Perhaps it is most experienced in health, where we have a health system designed for acute, infectious disease, even injury, but the major challenges are now those in the elderly population and chronic diseases.”

A public health service that has been finely tuned to efficiently cater to the previous era won’t adapt quite so easily to 21st century needs. Each sector is facing its own challenges in this respect, but also new technology and social media have opened up possibilities for service delivery. When there’s all sorts of ways we can provide health care and enable people to fill in their tax returns — where a decade ago it would have been impossible — there’s pressure to change, Albury says, albeit in positive ways.

“We live in a more globalised society, and so the competitive nature of public services becomes more transparent. There are countries that have better health systems, better education systems, better transport systems, that perform better economically and so are able to increase their outcomes.

“Rather than trying to just tweak public services in some way, how can we engender radical changes in public services that could deliver better outcomes, particularly with lower costs?”

No stranger to Australian shores, Albury, a consultant and co-chair of The Innovation Unit, is bringing his workshop back to Melbourne to assist agencies leaders to innovate the public sector in delivering good outcomes.

The innovative leader

Albury advocates for an innovation culture and leadership, as a necessity to foster and stimulate innovation. That leadership, while relentlessly focused on outcomes, must also allow significant space for experimentation with the means of achieving those outcomes. It comes down to the ability to look externally at other sectors and organisations, and bringing those broad views and experiences in-house.

“One of the problems is, in the public sector, leaders are often more obsessed with process and controls than they are with articulating, passionately putting forward the outcomes, the aspirations, and the overall goals of our system … [Innovative leaders] always tend to be searching out for examples elsewhere where they can learn from, not in transferring in a literal fashion, but learn from, that will help back in our client area.

“We know innovative cultures can flourish where people from the organisations come from diverse backgrounds. Diverse views are something essential to creating a more innovative culture. Often public services tend to recruit in our own village, rather than trying to pick people from different backgrounds, different cultures.”

Innovative cultures also value managing risk and learning from failure, Albury told The Mandarin: “How do we move from the situation which, when faced with a difficulty, or a failure, or underperformance, we assign blame which will have limiting culture on people, to instead use those as learning experiences?”

One strategy is to think small. Don’t necessarily try to change everything at once. Diagnose where their organisation is at, and ask: “I’ve got this specific issue, how can we begin to develop a culture around that issue that we can really tap into radically, and it would work?” Build out from that base, Albury says.

“We know innovative cultures can flourish where people from the organisations come from diverse backgrounds.”

There are clusters of common issues raised with Albury. Health systems have found innovation has assisted in creating efficiencies by providing more out-of-hospital care to those people with chronic conditions, as often hospital care is by no means the best place to care and treat people with asthma or diabetes. Experimentation can mean offering patients ways to self-manage, improving quality of life as well as driving down costs.

Policing and community safety organisations, meanwhile, have been looking at reducing reactive approaches to dealing with crime after they have been committed. Albury says his experience in working in policing innovation has been about working upstream, in communities, rather than away, thus preventing crimes rather than the more costly and challenging task of solving them.

In education, public services have been concerned with dropout rates and the level of teaching engagement when dealing with many students. The challenge there is now to create teaching and learning processes that fully engage the students, like project-based learning, and more personalised learning.

Albury asks that public sector leaders must “be prepared to think really radically” and question what their passions are compared to the needs of the organisation. Before you can reach a pilot stage, Albury says you first need to consider the landscape you’re working with, in terms of political frameworks, sources of funding and accountability, as well as the sort of leadership and the culture which is necessary to foster and stimulate innovation in public services. Then you can look at it from the other direction and ask what practical methods could stimulate innovation and incubate, test, refine and develop those innovations into ideas capable of being implemented.

Efficiency in co-production, contestability

Efficiency doesn’t have to just mean working the existing system harder, Albury says. Rather, it’s about finding different models that deliver significantly better outcomes and at significantly lower costs. “One of the tricks of that is the way citizens, users, patients, member of the public, have been more active participants in this process — co-production, co-delivery,” he said.

Innovation is other ways which we can work with not-for-profits and the private sector to create different models for service provision that enable us to have greater choice for the public, Albury says, as well as greater choice for public servants when trying to decide what’s the best way to deliver any service.

“That notion of contestability — a major feature of how they’ve been thinking about this — is also good. How do you get a bit more competition, not competition in a sense of money necessarily, but competition in the sense of can we have some different models that we can begin to check out, on how we can channel some of our motives?”

While the government is looking for efficiencies and more devolution to the states and territories, Australia has a can-do attitude, Albury says, “a mentality of openness”, including some parts of the public sector. So while other countries hit harder by the GFC were more desperate in trying to find a solution to problems when faced with really significant budget cuts, Australia can learn from those examples.

Albury says equality is too rarely found in public sectors, but Australia has an optimistic focus on what is possible.

“Often we have Aboriginal communities, or Mauri and Pacific Island communities, we see that the outcomes of those remote communities is far worse than the outcome for the majority of the population. Often people will come with issues or challenges, relating to: how do we really construct, deliver, design, develop services that can really meet the need and the possibilities for these remote communities? That’s a slightly sharper debate, in Australia or New Zealand.”

But Albury warns innovation in a federalist system like Australia should be about prototyping and adaptation rather than transfer and replication. Just because a health service in Sydney can support people with long-term conditions to care for themselves doesn’t means it will work in Western Australia.

“It’s rare that innovation would transfer across any sort of boundaries unmodified. They tend to be adapted to a particular area. What will you look at is the way in which you can construct prototypes.”

ANZSOG is hosting a workshop with David Albury on “Delivering Better Outcomes for Lower Costs: Leading public sector innovation” in Melbourne on October 21-23.

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