A framework for public health problem solving in the new world

 

A  Framework for Public Health “Consultancy” and Problem-Solving Skills: Using Mike Cope’s Seven C’s of Consulting in a Public Health Context

 

I have been using Mike Cope’s book “The Seven Cs of Consulting” for more years than I care to remember, at least since around 2001 when a first edition was published.

This short guide is intended to be used as a “quick guide” to applying Mike Cope’s book and learning from it in a public health context.  This book is well worth using and reading with a public health eye.

The Book: Mike Cope, The Seven C’s of Consulting

  • Paperback: 400 pages
  • Publisher: Financial Times/ Prentice Hall; 3 edition (22 April 2010)
  • Language: English
  • ISBN-10: 0273731084
  • ISBN-13: 978-0273731085

Why use a Consulting approach?

Public Health in the new system post April 2013 needs to work with a range of partners, applying their expertise and skills, to improve and protect the health of the population. We should treat our partners as “customers” – people who want or need something from us and have asked us to help, and for whom we should seek to provide a high-quality process and product or service.

This means we  could and should work almost like problem-solving consultant, working with CCGs, Joint Commissioning Team, other HCC Departments, partners and others, where we seek:

  • to identify the problem or challenge and agree with the ““customer”” (our partner/CCG etc)
  • identify what public health skills, support, advice and engagement will be needed
  • deliver this
  • close the piece of work

Anyone who has done consulting or indeed public health – short term or long term – would have at some stage experienced that they are expected to do nothing less than magic. There are many schools of thought on problem solving success – ranging from following of rigid methodologies and templates to the other extreme of letting the consultant on the job doing it in their own individual style.

What this book offers is a model – “customer”, clarify, create, change, confirm, continue, close” – that serves as a framework for handling problem solving and support work and this can be applied to situations where “experts” in a technical field use their skills to apply to a specific challenge. In addition to providing a professional touch to the consultant, it also includes “customer” in its approach aimed at bringing out the real problems (and not just perceptions) and the long term solutions.

I have used this approach since the first edition of this book in 2001. What it does is offer an effective process to understand the person you are working with, clarify what needs to be done, deliver it and close off.

Each of these 7C’s in-turn has seven steps – so this is really about “49 steps to effective problem solving” – making it really comprehensive. You may not need to use all 49; as long as you get the seven steps clear and the key outcome for each, you can get a good process.

Each of the seven Cs are shown below. You might find this helpful when working through the book, and the book is well worth getting.

The Five “Es” of Public Health

Public Health is about achieving the 5 E’s as part of achieving the improvement and protection of the health of our population:

  • Evidence – application of evidence across the commissioning and provision of services to ensure
  • Equity across populations
  • Effectiveness of interventions
  • Economy for the public purse
  • Efficiency in commissioning and provision

This means we need to use technical public health skills with a range of stakeholders, across a range of problems. We seek to problem solve and improve. Treating people as customers can work for us. Finding an approach to problem solving and embedding solutions also can work for us.  There are real similarities between this process and the business consulting process.

The Seven Cs Process has a number of assets about it which can help us work effectively in delivering public health solutions.

 

Now onto each C in turn:

1.“Customer” – Getting it Right from the Start

The key insights here are that applying public health skills is a social/interpersonal act. You need to build a relationship where the person you are seeking to support is clear what they want, need and are getting out of you

Cope says there are 7 sub-steps to doing this well:

  • Orientation – Viewing the problem as the “customer” sees it (including their perception)
  • Desired Outcome – Bringing clarity of the desired outcome (the real value and not just an end-state) and getting this agreed in writing
  • Change Ladder – Removing the fog from the problem by focusing on where change may be required using public health skills
  • Situation Viability – Studying if the issue can be successfully resolved and see if the timing is right for change
  • Decision Makers – Having a clear picture of the decision makers who can influence the initial stages of contract development
  • Ethos – Considering if the changes will be coercive or participative in Nature.
  • Contract – Establishing a contract or work plan or Memorandum of Understanding that sets out a framework for action and measurement
    • In Public Health terms you could also consider the Public Health 5 Es here : Evidence, Effectiveness, Economy, Equity, Efficiency

Your key output is a statement of what the challenge is, and how you will work together to address the 5 public Health E’s

 

2.  Clarify – Understanding the Real Issues

The key insights here are, now you have an understanding of the “customer”, real clarity on what the issues are. Public Health is as much about asking the right questions (what need, what issue, what population, what outcome wanted, what evidence for interventions, what process to apply and what scale) as giving the right answers.

  • Diagnosis – Gathering information that will determine the real sources of the issue and not just the symptoms
  • Shadow – Getting a clear appreciation of the unspoken activities affecting the situation by speaking to and working with people
  • Culture – Understanding the deep cultural factors that might affect the change
  • System Construction – Understanding the structural make-up of the system
  • Stakeholders – Getting a clear map that indicates who can influence the outcome of the change
  • Life-cycle risk – Determining the extent to which known and unknown factors will have an impact
  • Feedback – Establishing clarity on how the “customer” and the organization wishes to be informed of the progress

 

The key output here is an understanding of the political, cultural, organizational and technical challenges and the process milestones which you can share confidently with the “customer” and enables you to practice both the science and the art (persuasion, leadership) of public health


 
3.  Create – Developing a Deliverable Solution

The key insights here are to develop a solution which is

1) either based on evidence or, where evidence is silent has a clear logic and theory model with evaluation framework which enables us to tell whether it has worked, and

 2) implementable and achievable within the context of the organization, finance, problem etc

  • Managed Creativity – Ensuring that any creative solutions can actually be delivered.
  • Creative Blockage – Understanding the potential creative blockages for the “customer”.
  • Scanning – Finding solutions in the evidence and in the work others have done or doing (not trying to re-invent the wheel) and using and assessing evidence for these solutions
  • Storyboard – Underlining a clear process for deciding on the final solution and how public health skills apply.
  • Resources – Mapping the resources needed and available to the potential solutions to ensure that the options are viable
  • Stream Owners – Identifying clear owners for the solution and verifying that they have the capability and desire to own them and identify who will do what and how
  • Positics – “Positive application of Politics!”. Considering if it is possible to redirect some of the selfish energy of internal politics and turn the negative aspects into worthy ones.

The key output here is a plan (some written, some perhaps best left to agreed unwritten tactics) of how to get to the desired outcome for the “customer”

 

4.  Change – Working to Make Things Happen

The key insight here is how to make the change you and the “customer” want to happen. Much of this will be down to them but you need to apply public health skills to guide them through the process and do the right thing consistent with steps 1-3.

  • Methodology -Understanding the ethos and approach of how the change will be managed
  • Energy – Appreciating where the change energy will come from, and how it could be neutralized or enhanced across the different stake holders and problems
  • Engage – Engaging the people to be involved in the transformation process at a personal and emotional level.
  • Entry – Identifying the best level of entry to make the long-lasting transformation on the change ladder
  • System Dynamics – Anticipating how the system would react to the proposed change
  • Uncertainty – Make the plan flexible enough to operate in a dynamic and complex world (predictability and stability are false idols!)
  • Resistance – Accepting resistance to change as expected and working towards minimizing the resistance to the proposed changes

The key outcome here is you and the “customer” working with your guidance and support, to deliver the change agreed in the steps above with your ongoing support and advice. This may mean:

  • Advising, sitting on project teams, delivering training, showing people how to apply the solution, advising on implementation, working through specifications for commissioning and commenting in detail etc

 

5.  Confirm – Measuring the Change

The key insight here is to confirm that the change is occurring or has occurred (e.g. the new pathway is getting in place and being embedded.)

  • Responsible – Agreeing upon who will own and manage the measurement process
  • Timing – Deciding when the measurement will take place (without which early results – which may not be true indicators – are taken to measure success)
  • Design – Identifying the qualitative and quantitative measures and establishing the relationship between these measures.
  • Depth – Determining if extrinsic measurement be used or to deal with intrinsic issues such as motivation, attitude and beliefs
  • Data map – Controlling measurement activities to ensure that an integrated approach is taken in the clarification stage (and not a deluge of data)
  • Consulting Performance – Gathering quick specific and detailed feedback of consultant (self) performance from the “customer”
  • Costs – Having a clear view of the impact cost will have on the different measurement processes

The key outcomes of this C are:

1)   A clear way of measuring and determining that the change desired to solve the problem has been achieved , and is agreed between “customer” and consultant AND

2)   Clarity on what has been achieved

 

6.  Continue – Make Sure that the Solution Sticks

The key insight here is to make sure that the new solution is embedded into practice/commissioning by the “customer”.

  • Sustainability – Planning to ensure that the change is sustained and ensure slippage doesn’t occur after the transformation project has been closed
  • Language – Determining the extent of the change by observing the shift in the “customer” or consumer language
  • Gravity – Ensuring that the weight and structure and bureaucracy of the organization doesn’t take away from the transformation
  • Flow – Gaining from change projects by way of learning and reflecting (equally important as the end delivery)
  • Knowledge TransferTransferring the knowledge and competencies so that they remain in the business
  • Knowledge ManagementWorking towards making knowledge created as part of the change be embodied as a tangible asset to the business
  • Diffusion Channels – Analyzing the “customer”’s capability to physically diffuse new ideas through various channels

The key outcome here is to ensure that your solution works for the client and works for the 5 Es of Public Health


 
7.  Close – Signing Off with Style

The key insight here is to ensure that you and the “customer” agree the piece of work has been achieved, and you can move onto the next piece of work/challenge

  • “customer”s view – Listening and taking time to understand the “customer” perception over the total life cycle of change
  • Outcome Review – Pulling together data and gauging the the success of the programme
  • Learning – Help the “customer” to consider what has been learned over and above the planned outcomes
  • Added Value – Checking if there is clear indication of a tangible improvement to the operational or commercial viability of the organization
  • Build – Investigate what opportunities exist for future work
  • Reengage – In this closing stage, there are multiple options to re-engage with the “customer” on what further needs exist for public health input. Key ones are re-engage and modify (if parts of the process has failed), re-engage and extend, close and exit (with a feel-good factor), close and start a new engagement (an ideal outcome).
  • Exit – Ensuring that unnecessary levels of dependence have gone from all sides of the relationship

The key outcome of this stage is a “customer” who is clear what has been achieved, what they will do now, and what, if any, our role is for them .

Mike Cope’s books have helped me greatly in my professional and volunteering life. I am currently working with colleagues on applying these insights at work. If you want to use this, buy the book and let me know how you go.

 

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