Commissioning Series: #6 There is no incentive to admit mistakes

We will all make mistakes! The joy of learning and development is in learning from mistakes and making gradual improvements. The legalistic and political world of public health commissioning, as well as the financial constraints, does not leave a huge amount of room for admitting mistakes. This is a shame because that is where all the rich learning is! There are a number of key drivers that ex-colleagues and friends in commissioning have expressed to me and that I have experienced directly as a commissioner and provider.

If your newly commissioned provider doesn’t deliver what they said they would, it can be a tricky decision to de-commission them. Commissioners and local politicians are not incentivised to admit they may have made a mistake. It is possible that you may disregard this statement, but Local Authorities are naturally risk averse organisations (rightly so in most circumstances) and are already heavily criticised for many things. The fear that the public will react negatively to money spent on a process and provider that was a mistake is difficult to overcome – whether you are brave enough to admit it or not. If you are a commissioner, think about the number of times you have heard about poor provision from providers and then how many times you have heard of contract termination and re-tendering, rather than waiting out a contract. This may be controversial – but it is true.

If you do decommission a service, it feels like the procurement was a waste of time. It also means more time needs to be spent procuring a new service and there will likely be a period of no provision of the service that will not bode well. However, none of this was a waste of time. Learning what does and doesn’t work is absolutely critical for improvement in the future.

To admit to a mistake and then have to reverse a decision, can cost money and time, get legally complex and potentially politically dangerous. But what matters most is, that the public get the best possible service. Is the true cost of keeping a poor performing provider worth it?

It is tempting to lean towards the argument that even if you did go out to tender again, what is to suggest that you wouldn’t end up worse off, or that another provider might fare even worse than the current one. The tendency is towards ‘better the devil you know’, and to work to make the best out of a bad situation. This is totally understandable, but flawed. You now know so much more than you did before. In any other instance we would be telling people to use their learnings to improve next time. It was unreasonable to expect you to get everything right first time. You are human like everyone else. Progressive work cultures embrace ‘failure’ as a great opportunity to learn and improve.

We have definitely had to adapt almost all of our contracts to suit the needs of the population and the political environment. E.g. when referral pathways are not clear, there is greater need is certain groups than anticipated or when politics between certain organisations makes linking with both difficult. However, your provider should be providing you with this information and asking to make key decisions together. If this happens in all contracts, always, then this provider is not learning effectively from their mistakes. My blog on getting references describes the need to contact other commissioners to see if they are having a common experience. Anomalies happen, but if it is in all contracts, they should adjust the story they are telling in their tenders.