Creating value in ecosystems: the place of the well-bounded organisation

Creating value in ecosystems: the place
of the well-bounded organisation
Philip Boxer BSc MBA PhD
Copenhagen, July 9th 2017
1Commons Copyright © Philip Boxer 2017 – Attribution-ShareAlike

Competing within an ecosystem
The impact of tempo when Demand tempo exceeds Alignment tempo
clients’ chronic
conditions
Service suppliers Mental Health Care Systems
Mental Health Care ecosystem
Demand tempo:
The rate at which new forms of
situated demand need to be
responded to in a timely way
Product or
Service Supplier 1
Product or
Service Supplier n
source
source
Acquisition tempo:
The rate at which new
requirements for component
products or services can be met
users’
capabilities
dynamic
orchestration
dynamic
synchronization
Alignment tempo:
The rate at which users’
capabilities can be combined to
form new treatments
users’
capabilities
clients’ chronic conditions give
rise to demands within the
context of their ongoing lives
The mental health care system
aligns its episodes of care to the
demands of its clients’ conditions
The supplier responds to demands
from the Mental Health Care System
for new products or services
Demand
Tempo
Alignment
Tempo
Acquisition
Tempo
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Relation to DemandGovernance
Cross-boundary relation to
client situation increasingly
at demand tempo
Increasingly customised
alignment of differentiated
system-of-system behaviours
Increasingly
accountable for
performance within
client’s context-of-use
Responsibility through
increasingly horizontal
span of complexity
across an ecosystem
Client-driven forms of
behavior become
necessary
The challenge: in turbulent environments
the organization is doubly subjected
Congruence of
http://www.asymmetricleadership.com/2013/10/requisite-authority-when-is-triple-loop-learning-necessary/

The obstacle: the foreclosure wrought by
scientific discourse aka ‘management’
• Extracted from ‘Action of the Structure’ (J-A- Miller 1968)
(my emphasis):
So how, then, is a scientific discourse possible that only takes orders
from itself, a flat discourse, without unconscious, adequate to its
object?
This closing of discourse actually expels lack. Thought from within the field it
circumscribes, this closing will be given the name: closure.
This closure operates a redistribution between a closed field, on the one hand, of
which one perceives no limit if one considers it from the inside, and a foreclosed
space on the other.
Foreclosure is the other side of closure.
This term will suffice to indicate that every scientific discourse is structured like a
psychosis: the foreclosed returns under the form of the impossible.
• Foreclosure means no possibility of a relation between the
place of the organisation and this foreclosed space.

The case of ‘Winterbourne View’ –
the foreclosed returns as the impossible
• A 26 bed hospital opened in 2006, which by 2010 had a
turnover of £3.7m and an average weekly fee for a client
£3,500.
• Its clients were people with a learning disability and/or
autism who displayed behaviour that challenged, and
included those with a mental health condition.
• Following a whistleblowing Panorama Program in May 2011,
6 care workers were jailed and 5 others received suspended
sentences for either neglect or ill-treatment of clients.
• In December 2012 The ‘Transforming Care’ report came out.
• Its central commitment was to move out from hospitals all
people better supported in the community by 2014.

The impossible: inpatient care facilities as
oubliettes*
* oubliette: a place to put people where they can be forgotten
VODG – Voluntary Organisations Disability Group
ACEVO – Association of Chief Executives of
Voluntary Organisations
The provision of care, instead of
being structured around centres,
needed to be structured around the
lives of the people being cared for.

A well-bounded
organisation
This is a client of mine with whom I have been working since
2012. Its services included clients drawn from the same
population as Winterbourne View.

2012 Organisation Chart
Ceased trading
Central functions
Operating Units

2012 staff:client ratios

the ‘WHO-
for-WHOM’
the ‘HOW’
the ‘WHY’
the ‘WHAT’
Well-bounded organisation
Interactions with
the person-in-care
1: service unit
2: Team leader
3: Service Manager
4: Director of Operations
5: CEO of Operating Unit
6: Group CEO
7: Trust Board
Complexity of the
actual service is being
managed at this level
1: prescribed output
2: Situational response
3: Systematic Provision
4: Comprehensive Provision
5: Field Coverage
6: Multi-Field Coverage
7: Total Coverage
Jaques levels:
span-of-complexity
aka
timespan-of-discretion
Interactions with
the person-in-care

What changed?

My client was learning to align more and more
services dynamically to the needs of its clients
Services involve
collaborating with
other parts of the
ecosystem

It was learning to balance ‘wedges’ and
‘rings’…
• Each wedge had to be well-bounded, orchestrating and
synchronising services from across the ecosystem in a way that
was aligned to its client
• Operating in this way as a part of an ecosystem provided a much
better service aligned to the developing needs of the client…
• … and the total costs of care to the state are between 30%-50% less
than inpatient care
Rings = ServicesRings = ServicesRings = Services
‘rings’ = Services
delivering
economies of scale
and scope
Wedges = peopleWedges = peopleWedges = people
‘wedges’ delivering
economies of
alignment to clients

… leading to the Current situation
• Now about 2,000 staff covering 1,000 clients
• Slowly migrating away from block contracts towards one-at-a-time,
adding one individual every two months
But…
• For local authorities:
• Valued as a dependable and innovative support provider.
… while also…
• A place to dump risk at relatively little cost.
• Acceptable costing restricts skilled support staff to being paid just
above the minimum wage
numbers Type of Service Contribution
500 Aggregated within block contract <10%
400 Individual plans ~10% break even
100 One-at-a-time >10%

Meanwhile,
4 years after the 2011
whistleblowing
The CEO had been involved in a consortium of service
suppliers proposing to adopt these approaches for moving
people out of the Treatment and Assessment Centres into
community settings.

Progress on the ‘Winterbourne View’
client population
• The 2015 report from the National Audit Office:
• In December 2012, when the commitments were made,
• the scope and the quality of data on clients with learning disabilities was
poor.
• The government underestimated the complexity and level of challenge
involved in meeting its commitments.
• Funding did not follow the client, so there was no financial incentive for
local areas to bring inpatients home.
• By mid-2015, 500 people had been discharged, but 450 re-
admitted.
• A national plan was announced in 2015 for 48 Transforming
Care Partnerships to develop community services and to
close inpatient facilities. The plan was to reduce inpatients
by 50% over three years.
• Plans put forward by a consortium of service providers (including
my client) in 2015 were rejected.

Scale/Scope meets Alignment
• My client’s engagement with ‘Winterbourne View’ client
population:
• Coordinating 150 individual assessments in London Region
• impact on individuals is unique to them and changes over time.
• Social care providers are bothered about individuals and there is no
sense of measuring one-at-a-time impact at the national level.
• Providing care as part of an ecosystem costs 30%-50% less than
providing inpatient care.
• Meanwhile, with NHS England’s national plan,
• KPI’s created by NHS England were largely meaningless as they hid a
wide variety of variations, both good and bad.
• No timetable or ambition to reduce the inflow of inpatients with
learning disabilities or to close hospitals.
• Significant delays in decision-making on funding for bespoke
community based care packages.
• Little appreciation of the time involved in developing sustainable
community services for people with a learning disability and
challenging behaviour.

What was getting
foreclosed?
Spaces for well-boundedness within an ecosystem

Competitive Advantage
• A different form of competitive advantage flows from each
form of asymmetric advantage:
1. Superior know-how about uses-of-technology generates
economies of scale:
• we can produce things more economically than our competitors
2. Superior know-how about customisation-of-business-processes
generates economies of scope:
• we can deliver our products and services to markets more economically than our
competitors
3. Superior know-how about embedding-in-client-context-of-use
generates economies of alignment:
• we can orchestrate and synchronize products and services dynamically in ways that
change with the way your particular needs are changing better than our competitors.

First
Asymmetry:
the technology is
not the product
1.Technology
2.Product/
Service
replication
of supply
possible
behaviors
See http://www.asymmetricdesign.com/2006/01/3-asymmetries/
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The third asymmetry was being
foreclosed
20
Second
Asymmetry:
the business is
not the solution
3.Business
4.Solution
Value
Chains
customisation
to market
niches
Third
Asymmetry:
the client demand is
not the experience
5.Client
Demand
6.Client
Experience
clients’
Value
Deficits
Orchestration
Know-how
dynamically aligning
to situation

Horizontal linkages to particular
clients’ contexts-of-use
Vertical
accountabilities for
use of capabilities
the ‘WHO-
for-WHOM’
the ‘HOW’ the ‘WHY’
the ‘WHAT’
http://www.asymmetricdesign.com/2006/12/finding-the-edge/
Each asymmetry creates a
‘surface’
21
primary
task
1st asymmetry: Relation
to all the possible
behaviours of capabilities
domain of
relevance
2nd asymmetry: Relation to all
the direct and indirect traces
arising from behaviours
primary
risk
3rd asymmetry: Relation to all
the relations to the value
deficits of the clients

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1
5: Synchronisation
events
4: Orchestrations of
Composite Services
Horizontal
linkages
The organisation is the way governance
holds these surfaces in relation to each other
3: Suppliers of
Services
Vertical
accountabilities
1: Constituent
parts of a service
2: Parts of a service put
together as a supply chain

The ‘WHAT’
The ‘WHO-
FOR-WHOM’
The ‘WHY’
The ‘HOW’
operational professional positional relational
Integration of
differentiated
behaviors
Differentiation
of behaviors
The relation to
the domain of
relevance
supplier’s
good
client’s
good
relational
‘above’ the strategy
ceiling is ‘none of your
business’
the strategy ceiling
http://www.asymmetricleadership.com/2011/07/the-strategy-ceiling/
A strategy ceiling forecloses
23

Horizontal
linkages
Vertical
accountabilities
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1
It is the relation to clients’ value deficits
that is getting foreclosed
Supply-side Regulation at
different levels of
aggregation: NHS England,
CCGs, Local Authorities.
This is also the focus of NHS
Monitor, Charity Commission
and CQC across different
populations of actor
Royal Colleges,
Nursing/Psychiatry etc are
ultimately concerned with the
practice of the underlying
technologies and how they
may be used
NHS/Foundation Trusts
are ultimately suppliers
of services that are
economically viable
Demand-side Regulation:
NAO and Public Accounts
Committee ultimately
examine how things have
actually been done…
Advocates,
Individuals and
Families
VODG, H&SA and
ACEVO all have a
concern with the way
this is done in practice
Ministers and the Department of Health should be concerned with
the dynamics of this whole system. In practice they act more like a
supply-side regulator subject to intense lobbying…

The place of the well-bounded organisation
has to become an organisation of well-
bounded spaces
1. Globalization and digitalization drives organizations to have to
compete through the dynamic alignment of services.
2. That which has no place to be thought by managers and staff
arises in the environment of the organisation as a symptom of
its unconscious foreclosure.
3. The multi-sidedness of value for the client-citizen in these
dynamic contexts involves collaboration between services
within an ecosystem that must be made to cohere around the
client-citizen’s situation.
4. This need for cohesion involves placing routine emphasis on
the contexts in which citizen-clients’ needs arise and on how
these contexts unfold over time.
5. The organization under these conditions can no longer sustain
support for the unconscious valencies of its managers and staff
based on a foreclosure of the relation to clients’ value deficits.

Creating value in ecosystems: the place of the well-bounded organisation

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Creating value in ecosystems: the place of the well-bounded organisation