A complexity view of contracting public health services

Public health and social services are often hard to specify, complex to deliver and challenging to measure. This research uses a complexity theory-informed lens to explore the challenges and opportunities of contracting out for public health and social services in Aotearoa New Zealand. This qualitative study considers the implications of complexity concepts with ten public sector managers experienced in contracting out for public health and social services.

Our newly published findings show that public sector managers are experimenting with different ways of contracting out.

There are four key themes from the interviews: (i) use broad boundaries to frame contracting out; (ii) consider the role of adjacent systems as enablers or constrainers to contracting out; (iii) develop trusting relationships to create value with providers, and (iv) sponsor a learning environment” (Oakden et al., 2020, p. 185).

An alternative, complexity theory-informed, framing highlights where changes to contracting out organisation and practices may support more effective service provision.

Exploring contracting out using a complexity theory lens helps surface adaptive practices that funders already use to navigate uncertain and unpredictable contracting” (Oakden et al. 2020, p. 189).

Yet the underlying New Public Management ethos, which is being applied in many administrative arms of government, can hamper initiatives.

Several interacting adjacent systems can create enablers or barriers to funders and providers contracting out to achieve their intended goals. …Contracting out [requires] navigating legal, procurement and accounting processes set up for NPM. These processes can help, but also at times hinder, contracting out for complex service delivery” (Oakden et al., 2020, p. 189).

This research also provides insights into why achieving change is hard.

While there are few examples of successful contracting out done explicitly from a complexity-informed approach, there appears to be alignment with many of the practices described here, despite rather than because of, the broader contracting or legal or accounting systems” (Oakden et al., 2020, p. 192).

However, there is a growing impetus to find alternative approaches to contract out more effectively.

When the funder acts as a system steward or facilitator to support mutual learning, large-scale change is possible” (Oakden et al, 2020, p. 189).

In summary, this research suggests “change is possible when funders: build trusted rather than transactional relationships; support innovation and greater flexibility rather than focusing on counting deliverables; and embed learning as an alternative form of accountability in the contracting process. By using a complexity-informed framing, funders and providers may be better placed to develop services that are fit for purpose for all the contexts where they are needed” (Oakden et al., 2020, p. 192).