System design choices: The building blocks of health and human services
System design choices: The building blocks of health and human services
In this edition of NousCast Shorts we speak to Nous Principal Tim Marney about how designers of government services in health and human services can make system design choices that deliver enduring benefits.
You can also read his article, “How system design choices can make – or break – a mental health system”.
About NousCast Shorts
The NousCast Shorts podcast series brings you fresh thinking on some of the biggest challenges facing organisations today. Each episode of NousCast Shorts will feature a rapid-fire interview with a Nous consultant about an emerging issue in their area of expertise – in about the time it takes to have a cup of coffee.
There is a need for a system design approach to get the right balance of services in place and for those services to be effectively integrated, and at the right cost.
Ari Sharp: Hello, and welcome to NousCast Shorts, a podcast that brings you short and sharp insights from the team at Nous Group, an International Management Consultancy. I’m your host, Ari Sharp, and today on NousCast Shorts, we’re talking to Tim Marney, a Nous Principal who specialises in public policy. Tim previously served as Western Australia’s Under Treasurer, then later, as its Mental Health Commissioner; and now works with Nous’ public sector clients across Australia on some of their biggest challenges.
Recently, Tim wrote an article for Nous Insights explaining how system design choices can make or break a mental health system. But as Tim’s article explains, system design thinking can have implications for policy areas far beyond mental health. Tim Marney, welcome to NousCast Shorts.
Tim Marney: Ari Sharp, great to be here and looking forward to having a quick chat.
Ari Sharp: Tim, you’ve written for Nous about system design. Can you explain what it is and why it’s so important?
Tim Marney: I think that the key element of system design is elevating your thinking and line-of-sight from individual services and service expansion. And, often organisations are looking in the space where they’re trying to plug holes in service gaps without looking at the system as a whole and the system of services and what that looks like, and really looking from the client or the consumer’s perspective as to how they move through a system of services – as opposed to how do they use an individual service. And I think the reality in some of our service systems is – because there hasn’t been that overall system design and architecture thinking – what we have is not actually a system, but a collection of services. And then that means navigating those services as a system in accordance with client consumer needs is very ad hoc, and you end up with significant gaps and overlaps.
So that’s kind of the main point around systems thinking: what is the journey for the individual? How do all the services marry together? And really putting an evidence-base to that, as well as to what the services are that people need across the continuum from prevention, early intervention and support right through to treatment and acute care – no matter what that setting is, whether it’s a mental health system or a child or family support or housing system. You can take that same systems thinking and really reimagine what service delivery and strategy should look like.
Ari Sharp: Tim you’ve had plenty of experience working on mental health policy. What was the evidence and experience that guided your thinking?
Tim Marney: I guess there was a couple of elements: one, not surprisingly and incredibly importantly, was the views of consumers, carers and families in articulating their experience with the mental health system and the shortcomings of particularly integration of services, individual services and how they dovetail together. And also related to that, the difficulty in navigating services: the difficulty for people in finding the right service for them, at the right time, in the right place. And that again goes back to that systems issue: what do individuals need and really looking at it from the lens of the consumer, the carer or the family member. I think the other key evidence piece – and it’s a little bit unique in the mental health and alcohol-and-other-drugs base – is the national planning framework.
The national mental health services planning framework – and there’s an equivalent planning framework for alcohol and other drugs services as well – is a really, really robust methodology for identifying what the community’s need is for mental health services, right from community support (with non-government organisations providing social support right through to acute clinical treatment and everything in between), and what is the optimal mix of those services? So bringing together the views of consumers, carers and families with an evidence-base that’s driven by epidemiology was what led to the need for – and the focus on – a system thinking, system design, system architecture.
Ari Sharp: Given what you’ve told us about system thinking, what do you think organisations should be doing in response?
Tim Marney: Organisations have a responsibility for (I don’t like this word) stewardship of systems. Stewardship, I think is, the word people use – but to me it’s far too passive. Systems don’t just evolve by themselves unless you have a conscious design intent. So I think organisations need to be engaging the experts and experience of consumers, carers, families and service clients to understand what the system design should look like and what direction they need to move to from where they are at the moment to progress towards that design.
And that’s a long term piece of work. You know, it’s taken us decades for the service systems to get to where they are now. It’s going to take a significant amount of time to get them to where we want them to be. But unless we have the strategic intent, we’ll never get there. So organisations that have that responsibility for system and market design need to establish their strategic intent, and they need to establish it with the input of the people who are using the systems and benefiting from them. And they need to clearly communicate that and then develop strategies to actually get them there.
Ari Sharp: Now, Tim you’ve really walked the talk on this because for five years you were the Mental Health Commissioner in Western Australia. What were some of the features of the system that you had in place there that you think can be replicated elsewhere?
Tim Marney: Probably the strongest feature in the WA system – and it stands today even almost three years after I’ve left – was that clear articulation of the strategic intent; the direction for the design of the system. And we did that through the 10-year plan, and most jurisdictions have some sort of long-term planning framework for their mental health and alcohol-and-other-drug systems. We were unique in that we took the epidemiologically-based modeling; put it together with input from consumers, carers, and families; and published everything completely transparently. So even where the modeling showed that we had an 80% shortfall of supply of community support relative to the optimal supply, we were open and upfront about that. And because the evidence was so strong, the plan itself achieved bi-partisan support and survived the change of government halfway through.
So that’s been an instrumental piece in guiding service development and service enhancement and growth in the Western Australia mental health and alcohol-and-other-drug services. Everything gets referenced back to that strategic intent. It doesn’t mean there’s not trade-offs in implementation of which services were next, but there’s certainly a robust framework and everyone can understand what the evidence says – what consumers, carers, and families say – and they can put government decisions in that context as well. It is the universally-accepted guidance for design and progression of this system, as a system – as opposed to ‘here’s another service, here’s another service, here’s expansion of existing service’.
Ari Sharp: And what were the biggest barriers that you faced, and how did you overcome them?
Tim Marney: Probably the biggest barrier – and with no disrespect to my former colleagues at Treasury – was being so transparent about the shortfalls in particular areas of service delivery. But that was important as well in terms of them understanding that: if all you ever do is invest in the acute end, then you’re never going to have enough money to be able to cope with demand. So, seven years down the track, in some respects, they actually understand the narrative better than some of the guys that are in the system itself.
Ari Sharp: So Tim, how do you know if you’re getting there?
Tim Marney: Well, I guess the steward, the designer of the system also has a role in terms of checking where you’re at fairly regularly. Are we progressing towards that strategic intent in terms of what we want the system to look like, or are we deviating away from that? And if so, why? And there may be good reason why, but regular performance monitoring and regular transparent reporting on where that system development is up to is incredibly important. And those are areas where, particularly in WA, since I left the commission, they’ve actually done really well at in enhancing that framework to give regular updates on what progress towards that overall system design is looking like: are we on track, and what are the priorities coming up in the near term?
So everyone knows what to expect. Basically, they know where we’ve come to. Well, they know where we want to hit. They know where we’re at in that journey. And they know what the next bit of the journey looks like. And I think that’s kind of basic line-of-sight stuff that people – agents within the system, but also consumers, carers and families – need to understand: what progress looks like, what progress has been achieved and what progress is up next.
Ari Sharp: Tim, it sounds like it’s got huge potential to make an impact in public policy. Thank you for talking to NousCast Shorts.
Tim Marney: Thank you Ari.
Ari Sharp: That was Tim Marney, a principal at Nous Group. You can find Tim’s article “How system design choices can make or break a mental health system” on the Nous website. You can also contact him directly via email on LinkedIn. We’ll provide links in the episode notes.
Before we go, some information on us at Nous Group: for more than 20 years Nous has offered a broad consulting capability that allows us to solve our clients’ most complex strategic challenges and partner with them through transformational change. We’ve contributed to significant agendas in Australia, the United Kingdom and Canada; including shaping the future of higher education, advancing indigenous reconciliation, digitally transforming service delivery, and developing models of regulation for the future economy. You can find out more about Nous, meet our people and read our insights at our website www.nousgroup.com.
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