The fallacy of the unmeasurable ‘soft’ intervention

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December 5th, 2013

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When the clamour for change reaches fever pitch, as it is around the NHS at present, evidence based decision-making can fall by the wayside. For example, threatening Foundation Trusts and hospitals with the loss or reduction of their indemnity cover hits all the right notes if your approach to performance management is ‘carrot and stick’. The difficulty is that the literature as it relates to motivation, and which Dan Pink has summarized in pithy form, suggests such an approach is flawed. Stick works fine as punishment, but poorly in terms of improving performance. In this instance, the British Government’s aim is to increase standards of patient care and reduce clinical negligence complaints and, in turn, insurance costs and the size of payouts.

How do you change an organisation to create more compassion?...

How do you change an organisation to create more compassion?…

All of which raises some interesting questions if you want to change the behaviour of people in an organisation, and figure out how to measure impact. There is the fallacy that interventions can be categorized as ‘soft’ or ‘hard’, and that change can also be neatly labeled as one or other. And yet that is a regular topic of conversation amongst change and organisational development practitioners, and the press. Let’s not dive too deep here.

Initiatives that cannot be measured have no value – True or False?

I mentioned in my last post I wanted to discuss impact measurement of development programmes. At one extreme, the criteria for success is more about numbers of people in the room and completing a programme, and less about hard business outcomes. Just because something cannot be measured does not mean it has no value, although an interesting debate might ensue based on our differing opinions – but that is not the point. Rather, I suggest that ‘either’/’or’ thinking (i.e. ‘soft’ or ‘hard’ but never both) is not particularly helpful – or grounded in reality – when measuring impact in human systems. The following case study illustrates my point, and I welcome suggestions of others.

‘Hard’ outcomes, ‘soft’ intervention?

I met Pip Hardy of Patient Voices at an event for those working in and around the health and care sectors. Patient Voices exists “to facilitate the telling and the hearing of some of the unwritten and unspoken stories of ordinary people so that those who devise and implement strategy in health and social care, as well as the professionals and clinicians directly involved in care, may carry out their duties in a more informed and compassionate manner”.

Both/And, not Either/Or

Patient Voices worked with Manchester Mental Health & Social Care NHS Trust on a project aimed at addressing poor patient and staff satisfaction survey scores in relation to dignity, respect and communication. Over two years, they ran six workshops, worked with 39 participants and created 43 digital stories. The stories are shown at the start of every board meeting, used in recruitment and selection interviews, induction and training and at public events. Digital stories created as part of the project can be accessed here, and a radio interview about the impact here.

So what changed?

‘Soft’ outcomes are impressive e.g.:

  • More confident patients and staff, able to tell their stories
  • Increased involvement of patients and carers in creation of care plans
  • Greater recognition of patients and carers as ‘experts by experience’
  • More engagement with family members

‘Hard’ outcomes equally so e.g.:

  • Reduction in complaints related to care (45%)
  • Reduction in complaints related to staff issues (9%)
  • Reduction in complaints related to communication (22%)
  • Reduction in CNST (clinical negligence scheme for trust) claims (50%)

I asked Pip if she could give me an idea of the Return on Investment for the above project.

It is a hard to be precise about the cost… but the total figure lies somewhere between £80,000 and £90,000. As well as the efficiency and cost savings, there are tangible benefits for workshop participants – staff as well as patients – in terms of increased confidence, improved communication skills and greater understanding and empathy – not to mention the goodwill that has been built up between staff in the Trust and the people they serve.

Change at all cost?

When the pressure for change is at its most intense, often when things are going particularly badly, the clamour for certainty and action becomes overwhelming. And that says more about our fear of getting things wrong (again) than it does about what might actually make a difference. Complex problems require thinking to match, that sees solutions about more than one end of a polarity or another. More compassion in a system requires compassionate leadership and interventions to match.

NHS-Cover-ThumbnailRoffey Park recently published a research report which is available as a free download, that outlines the main lessons from a review of 15 change programmes that took place over recent years across NHS South of England (previously NHS South West, NHS South Central and NHS South East Coast).

If you want to find out more about our approach, get in touch.