Rethinking the ideas behind service delivery

In this guest blog, Joy MacKeith, Co-founder of Triangle and co-author of the Outcomes Star suite of tools, details how we must rethink the ideas driving service delivery and how the right mental models can enable the right kind of help to reach those who need it. For more on the themes raised in this blog, take a look at our Rethink, Rebuild programme of work.

Many of you will be familiar with the Outcomes Star—a suite of tools which both support and measure change when working with people. Triangle, the organisation behind the Outcomes Star, is a social enterprise with a mission to help service providers—whether that’s a local addiction charity, a local authority family support worker, or an NHS Trust—to transform lives, both by creating engaging tools and promoting ‘enabling approaches’.

Having created 44 Outcomes Stars over a period of 18 years, we believe that what’s needed is a fundamental rethink of the ideas that shape the way services are delivered in both the public and the third sector. These ideas are not always explicit, but they powerfully shape what is possible in social provision.

In our new report, Enabling Help, we aim to bring these ideas into the light, so that we can make a real choice about whether they are suitable. We also propose a new set of ideas whose time, we believe, has now come.

Our experience is that it is through (what we call) enabling approaches to service delivery that organisations and those that fund them can best serve the people they exist to help.

What works when meeting human needs and supporting change

Each version of the Outcomes Star that we create is made in collaboration with one or more organisations providing a service in that sector. We hold workshops, focus groups and interviews with people with lived experience of the issue at hand and with people in front-line helping roles. We review the academic literature and policy documents. We draft, get feedback, re-draft, pilot, get more feedback and re-draft again.

Out of that intensive process comes not only a new version of the Outcomes Star, but also a lot of learning about what works when supporting people with those needs. Pulling that learning together, we have identified six key principles for effective service delivery. It is help that is:

• Relational—based on a trusting, caring human relationship.
• Motivational—building hope and belief that change is possible.
• Developmental—valuing the skills and abilities of the person being helped and supporting them to build new capabilities.
• Holistic—taking in their situation in the round.
• Flexible—tailored to what this particular person needs.
• Contextual—recognising wider issues and factors in the person’s past and present.

We call help that follows these six principles ‘Enabling Help’.

These ideas are unlikely to be controversial. They are very much in tune with person-centred, trauma-informed and strengths-based approaches. But our experience of training and supporting over 1,000 organisations to put these principles into practice is that organisations find it very hard to translate their aspiration for this way of working into a reality on the ground. Why is that?

The service delivery system gets in the way

We have found that all too often it is the service delivery system itself that gets in the way. Front-line workers often do not have the time, training or support to work in an enabling way. Managers are held accountable for the completion of paperwork rather than the quality of front-line engagement. Commissioners are not sure what the most relevant data is or how to make use of the data that is reported to them. Tendering for service contracts builds competition rather than cooperation between providers.

All in all, current practices make it more difficult for people at the front line to build trusting relationships, develop people’s confidence and skills, and work in a holistic, flexible way.

Unlocking the potential of people and services

We believe that the underlying problem is the paradigm or the mental models and theories that frame service commissioning and delivery. We have identified four different paradigms which have in the past or are currently shaping different levels of service delivery. Each one is borrowed from another sphere of study (medicine, bureaucracy, economics and the natural sciences) and they are based on assumptions that don’t fit in with the complex world of people meeting challenges and working to improve their lives.

The paradigms are:

1. Medical: In this traditional service delivery paradigm, the focus is on the deliverer as a ‘helper’, the person receiving the service is conceived of as a ‘patient’, the service is the ‘treatment’ and the assumptions are that the person is sick or flawed and the helper has the answer. This paradigm has largely been rejected now at least in theory but some of its legacy lives on in practice.
2. Bureaucratic: This is an organisation-centric paradigm in which the ‘patient’ becomes the ‘recipient’ of a ‘process’ rather than a ‘treatment’. The core assumption is that fairness and risk management are best addressed through standardisation.
3. Market / Economic: This paradigm switches the focus onto the commissioner, services become products and the core assumption is that performance is maximised through competition and financial incentives.
4. Natural science: This paradigm shifts the focus onto the intervention itself. The person is a subject, and the service is a formula that can be codified into ‘what works’ and replicated independently of context. 

The human sciences paradigm

We are making the case for a new paradigm—one based on what we know about human beings and what we all need to thrive. In this new paradigm, the focus is on the person being helped, who is a collaborator or a partner, and enabling relationships are key to creating change for individuals, organisations and systems.

Our Enabling Help report argues that service delivery should be based on the human sciences and particularly the discoveries of human neuroscience. This field of study reinforces what Triangle has learnt again and again from services and people with lived experience—that caring, committed, empathic human relationships and a flexible, learning, problem-solving approach, alongside the necessary resources, are the key to effective help.

Without this fundamental shift of ideas, attempts to implement enabling approaches to service delivery will always meet impossible barriers. It’s a bit like an iceberg with just the service someone receives being visible above the waterline. Below the waterline, the management, commissioning and policy framework also profoundly shape what happens at the front line. The illustration below shows how the right mental models can enable the right kind of help to reach those who need it.

A PDF version of this diagram can be accessed on page 49 of this report.

NPC is making the case for charities and funders to work together to create ambitious strategies for systems change. This is exactly what we are calling for in our report. Triangle is adding its voice to a growing movement which is making the case for a paradigm shift in service delivery. If you would like to find out more, I hope you will join us on 3 November at our free Enabling Help webinar.

Enabling Help was launched on 29 September and can be downloaded from www.outcomesstar.org.uk/enablinghelp

The right mental models can enable the right kind of help to reach those who need it. We must rethink service delivery. Guest blog by Joy MacKeith, Co-founder of Triangle: Click To Tweet