ABSTRACT
Services should be rooted in an approach of trial-and-error learning, and of accepting surprises. This view also accords with what Nobel prize-winning economist Professor Ronald Coase called ‘the problem of social cost’, which is concerned with assessing and facilitating necessary trade-offs and improved costs and benefits. Sir Douglas Hague outlined the four ways in which any system can be changed: by coercion; by contagion; by coaching; or by the evolution of a learning organization. As Sir Douglas said, the most desirable way of changing a culture is when the people in the organisation set out to do so for themselves. The National Health Service and social care reforms have engaged management in all four approaches. Three of the four ‘effectors’ – contagion, coaching, and the learning organisation – are regarded as relatively innocent even if time-consuming activities by many public sector managers and by medical professionals.
