Self-Efficacy & Services
In 2017 we are exploring the potential for public services to become engines of self-efficacy to drive significant improvements in service impact and help more people feel able to take control of their lives. So what is self-efficacy and why does it matter? Self-efficacy refers to the confidence someone has to succeed in specific situations. It is well established that self-efficacy is a pre-requisite for action on anything. This means that if we want to help people change their diet, get fit, find work or enter rehabilitation they need at least some self-efficacy just to get started. We think of self-efficacy as the oil in the machine of society, it makes everything work better. And without it, as we are seeing currently, things start to seize up. For more details on self-efficacy see our explanatory blog and our Guardian article.
Public service crisis. Funding cuts, increased costs and persistent complex challenges are putting unprecedented pressures on public services. Recent walkouts by teachers, doctors and prison staff have been motivated in large part by falling service standards and squeezed working conditions. A recent report found that a sense of exclusion due to falling quality in public services was a primary reason people voted for Brexit.
Increasing demand for people powered services (PPS): Many current public service challenges – e.g. obesity, youth unemployment and addiction – are tackled most effectively by people taking action themselves. This has long been recognised in health where the costs of patient inaction are especially obvious. Other sectors are now waking up to the potential of genuine user empowerment to enable the delivery of services at reduced costs.
Divided Britain, the haves and have nots: As the dust settles on Brexit, it has become clear that many people in the UK feel left behind, with 56% identifying as ‘have nots’. Reasons include frustration at being ignored by distant bureaucracies, missing out on the fruits of the recovery and losing control of their lives. As the evidence of inequality and low social mobility continues to mount the political imperative for a practical response grows.
New People Powered Services Pioneers
A new movement of PPS pioneers has been developing in the UK that we think marks a departure from much of the co-production work seen previously. The new PPS pioneers are characterised by the following qualities:
Supporting people to take control: there is growing evidence that when services that require individual action have been redesigned to build the self-efficacy of users, the outcomes can be significantly improved.
Service quality improvement: there is growing evidence that supporting people to take control improves service quality when the locus of control must rest with them. These pioneers work to create demonstrable improvements in service quality.
Cost saving: there is growing evidence that self-efficacy based public services can be highly cost effective in many ways such as reducing wasted prescriptions, removing bureaucracy and reducing user service dependence.
Evidence based: the pioneers know that evidence matters, and are committed to generating it.
Supporting social mobility: self-efficacy is a pre-requisite of social mobility. The more control you experience in one area of your life, the more likely you are to feel able to control other areas of life.
Self-efficacy practices: today’s PPS are directly informed by what we call the self-efficacy practices (see here). These make them quite distinct from the vast majority of existing ‘co-production’ and ‘user involvement’ practice.
From Efficiency to People Power – Changing the Narrative
Public service transformation since 2010 has been dominated by seeking efficiency savings through ever tighter micro-management (‘LEAN management’). This has resulted in cost savings but has also severely compromised service quality and staff motivation. It has also undermined the very staff and user efficacy we think is needed. We think PPS offers a practical and inspiring alternative to the currently dispiriting narrative of efficiency over all else.
Examples of Self-Efficacy Based PPS (For more examples see here.)
|Service User Empowerment||Brightside Trust||Young people are nearly three times more likely to be unemployed than the rest of the population (14.4% as opposed to 5.7%). The largest gap in more than 20 years.||Help young people find work by building their confidence, networks and knowledge of how different job markets work. A lot of their support is provided online: mentoring and network building.||Support over 15,000 young people/year. Working with 60 partner organisations.|
|Delivery Staff Empowerment||Buurtzorg||An aging population, increased demand for social care and severe funding constraints are resulting in falling service quality and increased staff pressure.||Give nurses extraordinarily high levels of control in day-to-day work. Virtually eliminating the need for middle management and associated bureaucratic costs.||6,500 nurses working across 580 teams caring for over 70,000 patients. Higher levels of patient satisfaction and lower care provision costs.|
Supporting the Movement
There is now a substantial movement of self-efficacy based PPS across the UK and the world (see here). There is growing evidence that the core goals of service improvement and cost savings are being achieved. However the movement is fragile. It is poorly networked, largely undefined, needs a stronger impact evidence base and is highly vulnerable to poorly informed commissioners and continuing budget cuts.
Learning from Health
Self-efficacy has been recognised as critical in health for many years. For example the UK expert patient programme was created under license from the Stanford Patient Education Centre which was explicitly applying Bandura’s self-efficacy work in health. Self-efficacy thinking is now foundational to much of NHS England’s Five Year Forward View strategy and can be seen through various activities such as the creation of patient activation measures and the roll out of health coaching. This work would be seeking to apply the experience of health to other sectors.
Longer Term Focus
The reconfiguring of public services is often a slow and painstaking process. The resistance to more user led ways of working is coming at all levels. From professionals who feel their role is threatened to members of charities who fear it may create greater inequalities. For this reason we imagine any PPS will need to have a long term focus.
A Post Brexit Strategy
We believe this is a practical response to the divisions that are dominating the political and social landscape in Britain: focused on supporting people to be active agents in improving their local services and in so doing reducing alienation.
In 2017 we intend to do four things: (1) map current activity and need in this area and identify good practice; (2) create a community of practice for self-efficacy based PPS; (3) advocate the need for change through publications, videos and blogs; (4) identify the areas where there is greatest potential and start prototyping, with partners, new approaches to PPS. We will launch an initial report with partners in June 2017. We will undertake this R&D process in an open, distributed and interactive way. An important goal is to create new opportunities for self-efficacy pioneers (e.g. Groundswell and Brightside) to amplify their impact. We are currently undertaking key interviews, mapping the ‘sector’ and seeking steering group members/core partners. We will launch a provisional findings paper in March.
Project initiated by Osca directors Nick Nielsen and Rich Wilson who previously founded the charities Envision and Involve. It will involve multiple partners transparently, many of whom have already committed to its support. It is assumed that the PPS Lab will be independent from Osca and have a non-profit, potentially becoming a charity.
Photo credit: Jim Wolff