Can commissioning help encourage PIEs?

Would smarter commissioning help?

The biggest mistake that commissioners can make is to stipulate that the services they will commission should 'be' a PIE. This is not merely a misunderstanding; it is positively damaging.

Firstly, a PIE is simply not an 'either/or' thing. A PIE is always a matter of degree, and it is a continuous process of being informed.  To demand services must 'be' a PIE is at best to ignore the importance of the process of discussion and learning; and as worst, to invite mere lip service. 

Secondly, being a PIE is a multi-faceted thing. In PIEs 2, we identify five main themes; and these are then composed of a number of other more specific practice elements. Any working services is going to be further advanced in some areas than in others. Not all may be relevant. Again, it's not an 'either/or' thing.

Thirdly, insisting a services should 'be' a PIE might just work, if there was somewhere a list of the things you supposedly 'must do, in order to 'be' a PIE; except that that would inevitably tend to encourage tick box adherence.  Which is another reasons why there isn't such a list. Even the many examples we can give here should be seen as just a menu from which services can choose what suits them best.

But more seriously still: development as a PIE always come from the ground up, not 'from above'.  Just as tightly specified 'outcomes' simply tie the hands of services for those with complex needs, overly prescriptive contracting can often end up dis-empowering staff for creativity and responsiveness.

But there is a better way. It's for all these reasons that we have developed the Pizazz, the self assessment tool that sets out to measure 'distance travelled', and works with staff's own views of what they can improve.

Not for nothing, then, do we say that being a PIE is best seen as a journey, not a destination; and It is clear that funding and contracted service specification can hugely assist or can seriously restrict the development of PIEs within services. We need the commissioning process itself to be psychologically informed. 

 

A PIE of pathways - whole system PIEs

For commissioners and other funders keen to see a whole systems approach, and deeper system change, the PIE Abacus offers a tool for obtaining that local overview of gaps and hindrances to be addressed; and using the PIE Abacus, the views of services' staff can now also be complemented and strengthened with service user input in these assessments.

This more systemic approach to assessment may help to operationalise the recommendations of the duo of papers published by Collaborate with first Newcastle and now Northumberland universities, on commissioning for complexity. Toby's papers - the PIE approach, and the Pizazz, doing at system level - operationalising

The stress on relationships, central to any kind of working as a PIE, suggests that it is not simply the proponents of Housing First that question the constant 'staircase' (or 'pass-the-parcel') approach that has characterised much thinking on service provision in the past. New thinking on early trauma suggest the importance of attachment, and valuing continuity of support, and tackling barriers. ( see Gaps and Barriers)

But this is not to say that short term services cannot be psychologically astute; on the contrary, short term and initial engagement services play a crucial role in initial engagement, paving the way for others to build on a constructive first encounter.

Likewise measures of success and 'value for money' that might be quite workable for simple interventions can ignore the real nature of work with the more marginalised and disengaged. Complex and entrenched needs require both longer timescales and subtler and more multi-dimensions outcomes.

Systems and sector engagement

Until recently, much of the focus on development of PIEs identifying the key features and encouraging development of PIEs has been focussed on the work being done within services 'at the coalface'. Wider government and local funders' efforts have been in the background.

With the publication of the expanded PIEs 2.0 framework, this is changing.  Increasingly we see recognition of those services that are actively engaged with identifying and tackling gaps and barriers to their service users' progress and prospects, and addressing such issues not solely in individual casework, but in wider forums where the coherence or fragmentation of the systems and pathways can be addressed.

The self assessment framework, the Pizazz, therefore explicitly makes a place for such 'sector engagement'. In addition to the keyworker's brokerage of gaps and barriers with individual users, as part of the general organisational ethos of Learning and Enquiry, both here and in the on-line version (the PIE Abacus), services are encouraged to assess how far they are able to do that, and what helps and hinders.

 

 

Further background reading/listening/viewing

PIElink pages

PIEs 2.0 : (HERE)

The Inner Game of PIE : (HERE)

A single framework : (HERE)

Evaluation by outcomes : (HERE)

PIEs accreditation? : (HERE)

Service users' PIE assessments (page): HERE

 

Library items.

Please note that you must be registered and logged in to access Library materials. 

Johnson R: Do 'complex needs' need 'complex needs services'? Part One (HERE)

Johnson R: Do 'complex needs' need 'complex needs services'? Part Two  (HERE)

Lankelly Chase: Behaving like a system: HERE

Zack Ahmed on Participatory appraisal in Tower Hamlets: HERE

Paul Hoggett:  Conflict and ambivalence in public services: HERE

Lipsky (Wikipedia age) on street level bureaucrats: HERE