Sunday 16 February 2020

How might we go about enacting a no #tickbox policy?

This post first appeared on the Radix blog...

Here are the three most egregious versions of tickbox that I have run across in the last few days…

First, the government’s proposals to reform the early years foundation stage, which the Early Years Alliance warns is risking turning it into “a series of bullet points … a narrow tickbox approach.”

Second, the unmissable NHS blogger Roy Lilley used a similar word to attack the CQC, the doyennes of tickbox in the health sector:

“The Confed, Providers, NAPC, the Shalfords, the Mulberries, unions, the think-tanks should find the guts to say what the dogs in the streets know…

…it is time for a narrative that says; when we started to look for quality improvements all we had was a clip-board and a box to tick. Now, we have data, algorithms and machine learning. We are able to spot problems in the making, warn leaders and support them to sidestep disaster. Keep us safe...

When there are viable, sensible alternatives, to carry on with clapped-out inspection wins no applause from the people failed by quality…”

Third, the so-called uberization of mental health in an important article by Dr Elizabeth Cotton who writes the blog Surviving Work. The article followed the conference last year called the ‘industrialistion of care’.

This refers to the way the government’s favoured IAPT approach to mental health is “based on a series of patient assessments that use tightly-scripted questionnaires allowing only minimal freedom of discussion between therapist and patient.”

This is the model that is increasingly being delivered online, often by staff unqualified as psychologists.

Complaining about people’s lack of qualifications is the layman’s version of tickbox, but there is no doubt that people’s special mental health needs requires this excessive simplification. More on the mental health aspects of tickbox in my book.

I suppose I would probably add the government’s consultation on green regulations for new homes, now closed. Stupidly in my view, they want to prevent local authorities from experimenting with setting their own higher environmental standards for new build – on the grounds that you can save money if everyone has the same regulations.

Thus is a classic tickbox mistake, because economists tend to measure economies of scale but ignore the diseconomies of scale.

So whether it is bowlderisation, stupidiification or uberization – or McDonaldisation (the title of a 1993 book by Georg Ritzer) – we know tickbox now for what it is, an insidious and creeping problem that is suffocating our ability to act on the world.

I proposed in my last blog a self-denying ordinance, a pledge signed by professionals, promising to ignore the tickboxes imposed on them and do what is necessary for who ever stands before them.

That seems to me to be one approach, appealing to the humanity and pride of the professions and challenging them to show they have not been completely hollowed out.

Could we also legislate for large organisations so that, when they use a tickbox system, they must also provide an obvious and easy access to a human being if people want one? But then, what such legislation would actually be trying to tackle would be the way that some organisations, public and private have such overwheening confidence in their own systems (the Immigration Service and myHermes spring to mind) that there is no way to register a complaint which has any chance of reaching a human being.

What else do we need for a fully-fledged No Tickbox policy that might be enacted? Please let me know…

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Monday 10 February 2020

Towards a heroic No #Tickbox pledge

This blog first appeared on the Radix UK site...

It has only been a fortnight since the publication of my Tickbox book, but the trickle of background information that was beginning to emerge when the book was first out has now become a flood.

That is clearly also my mood to some extent, even more than when I was writing the book: I now see symptoms of tickbox everywhere I look.

Teachers tell me that this is the reason they are leaving the profession. I’ve heard from NHS psychologists, prison officials, health workers - though not yet the marketing or HR people responsible for the ubiquitous five-point surveys every time we have any kind of interaction with businesses…

I suppose my top tickbox this week will have to include the news, uncovered by the BBC’s Moneybox programme (no relation!), that serious complaints about the Department for Work and Pensions can take around four years to resolve.

This example reeks of tickbox because the DWP makes the absolutely classic mistake of measuring their performance only from the moment their senior experts open the file, which is usually at least 18 months from the time the complaint is made.

There should be a word for that kind of dodge, because it happens so often - and always has done (a symptom of Goodhart’s Law in action). As far as I know, there isn’t.

I’m also glad to be cited in the British Medical Journal, no less, by Miles Sibley in his plea for more person-centred feedback being required if the NHS is really going to provide person-centred care.

I was fascinated to see a link there to a blog by Andrea Siodmok in the open policy blog of the Cabinet Office, looking for what she called 'thick data' alongside more conventional but doubtful big data - most of it seriously compromised by Goodhart's Law.  She means data with depth, about human beings - not instead, but so that big data and thick data is required to test each other.

Then there was the news that, unsurprisingly, the roll-out of universal credit - a good idea undermined and stupidified by tickbox - has been delayed again.

I came away from my Steyning Bookshop event (see picture) with a greater understanding of the meaning of tickbox. It means that people take less responsibility for the inevitable way in which the people they serve fail to fit the preferred process.

There is both the meaning and a potential antidote to tickbox. It amounts to a plea to people serving the public to take a little more responsibility. I don't mean flinging caution to the winds, but enough to make the system work. Perhaps we need some kind of public pledge - at least an I WILL NOT TICKBOX bumper sticker?

You can buy the Tickbox book from Hive or Amazon.