Utopia is temporary: why public services always need fixing

I began my day by dismantling the u-bend under our kitchen sink, because I needed to unblock it. It wasn’t pretty (or fragrant) but it had to be done.

In theory, it never should have come to this. A few years ago, a plumber told us we could keep our drain clear forever as long as we poured a bottle of vinegar down it every couple of months. ‘Well,’ we figured. ‘That’s pretty easy – we can definitely manage that for the rest of our lives.’

Now, I don’t know what the evidence base for the vinegar remedy is, but we did it consistently for a while, and our drains stayed clear. And I know that we haven’t done it for a loooong time. I don’t feel particularly guilty about this, because in my experience, this is what most people do when presented with a new strategy – implement it assiduously for a while, and then stop doing it. It’s not that we forget a strategy, we just forget to do it, or just get sick of doing it.

You’ll be familiar with this phenomenon if you’ve ever joined a gym, attended three times a week, and then, after a while, suddenly realised you literally haven’t been for months.

This has implications for public service innovation, and it’s the reason that utopian visions never work out as they’re supposed to: the utopian view of social change assumes that after one big transformation, everything will be different, and we will be incapable of regressing back to our old habits. In other words, ‘Come the revolution, we’ll all regularly pour vinegar down the drain.’

The surgeon Atul Gawande addressed this in an article for the New Yorker that compared American health care reform to the agricultural reform of the 1930s. You should read the whole article (available here), but here’s the most relevant paragraph to what I’m talking about:

There are, in human affairs, two kinds of problems: those which are amenable to a technical solution and those which are not. Universal health-care coverage belongs to the first category: you can pick one of several possible solutions, pass a bill, and (allowing for some tinkering around the edges) it will happen. Problems of the second kind, by contrast, are never solved, exactly; they are managed. Reforming the agricultural system so that it serves the country’s needs has been a process, involving millions of farmers pursuing their individual interests. This could not happen by fiat. There was no one-time fix. The same goes for reforming the health-care system so that it serves the country’s needs. No nation has escaped the cost problem: the expenditure curves have outpaced inflation around the world. Nobody has found a master switch that you can flip to make the problem go away. If we want to start solving it, we first need to recognize that there is no technical solution. […] With problems that don’t have technical solutions, the struggle never ends.

This article, and my own experience, have led me to two maxims (neither of these are particularly original, but I find them useful):

1. If you can’t maintain a reform with 75% effort, it won’t stick
You see lots of negative examples of this with IT-based reforms that make assumptions like ‘As long as doctors/teachers fill in these fifteen boxes on the screen every time they meet with a patient/student, we’ll collect all the data we need.’ The problem is, that even the most conscientious doctor/teacher will stop filling in the boxes carefully after a few weeks. Whatever change you make to behavior, you need to allow people to get lax about it without breaking the system.

2. You need to keep trying new things
As Franklin Delano Roosevelt said in 1932, ‘Above all, try something.’ This is important not only because it’s good to find new solutions, but because when you are thinking about, and reflecting on, new approaches to your work, you remain more engaged in what you’re doing, and avoid falling into a rut. Reflective practitioners are always experimenting, and this keeps them focused on their work. Headteacher Andy Raymer has grown and maintained a culture of experimentation and reflection at Matthew Moss High School for over 12 years by encouraging everyone to keep learning about education, and to share what they learn with their colleagues (and their students!). You can hear more about how he did it here.

In public services (and in your own life), remember that all solutions are temporary. Come the revolution, the pipes will run clear. Two years after the revolution, we’ll all stop pouring vinegar down the drain.