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Ann Glover, as reported on Euractiv (here):

But it appears she also found it difficult to disentangle the Commission’s evidence gathering processes from what she calls the “political imperative” that’s behind them. …

To back its policy proposals, the Commission often outsources the evidence-gathering part of the job to external consulting firms, which provide ‘impact assessment studies’ or ‘research’ that are often branded as ‘independent’. However, Glover says such consultancies have little incentive to produce evidence that contradicts the Commission’s political agenda. “If they want repeat business, [they] are not going to go out and find the evidence to show that this is a crazy idea,” she says.

Disturbing stuff. In my role as an advisor and having taught policy development to civil servants, I have emphasised their responsibility to “speak truth to power”. If, as Glover says, this isn’t happening within the European policy-making machinery, then that may explain much policy creep at the Commission level.

Giant Squid, Glover's Harbour

The policy process: Not what Ann Glover has in mind? Source: Giant Squid, Glover's Harbour (Photo credit: Product of Newfoundland)

Her characterisation of European civil servants wind-up toys, that just run off and do what they are told suggests there could be some danger to good governance from hyperactive civil servants who unthinkingly do what they’re told with dossiers that should be binned. This suggest two things problems: the first is the quality of guidance on developing policy options itself, how to work with external advisors (carefully by the way) and the second is that the interface between the most senior level and Commissioners lacks candour and the failure of the most senior to truth to power. This is evidence of cowardice. at least, and incompetence at most.

Her remarks suggest that perhaps Glover hasn’t also been particularly effective elevating the evidence base of policy-making itself.  Her solution, though, is seriously flawed. She seems to believe that it is possible to create a definitive evidence base around which all can agree and that it is indeed possible in policy processes to factor out the political dimension. The ‘symmetry of ignorance’ [see NOTES below] explains why a room full of experts don’t usually agree and why it is relatively easy for ‘my’ experts to challenge ‘your’ experts. Policy problems are complex, sometimes called wicked, problems, and that means that one single course of action is unlikely, that interventions may create new problems, and unlike (scientific) problems, you may not know when you’ve solved the problem (called ‘the stopping’ problem).

What science dislikes is absence of agreement (e.g. science is about proof, not consensus), whereas policy is about consensus and disagreement: the result is one of the following: do nothing, act from the precautionary principle (i.e. do something just in case, but knowing there isn’t really any good evidence), guess, compromise or satisficing [see NOTES below].  Scientists often believe that evidence leads unequivocally to specific policy actions, but this is just one view of the world. While Glover has claimed to provide independent advice, she has actualy provided ‘her’ advice, reflecting how she weighs the balance of evidence against her understanding and framing of the problems and choices on offer from what she has read, and the people she has spoken to. One could legitimately ask whether her academic roots and scientific preferences as a biologist have preconditioned her towards thinking about policy problems and evidence in a particular way.That does not detract from her alarm at the policy machinery, but does inform our assessment of her proposed solution.

Hasn’t anyone read Feyerabend?

Therefore, purely technocratic policy governance, as I think Glover is advocating, is flawed and likely dangerous as it replaces the messiness of the real world of policy problems and choice-making with tidy authoritarianism.

Equally worrying is her comment on the quality of advice from paid consultants. I once put a dossier to a DG to be be an advisor, but haven’t been called (we’re up to almost 3 years, so I guess I shouldn’t expect the phone to ring!)  It is the job of advisors to advise, and that means also saying when something is not a good idea. That the European Commission has constructed a giant out-sourced advisory industry is not surprising as it is actually a tactic to cement the European project by creating an advisory system that works in harmony with the Commission’s objectives. That so many consultancies have fallen for this trick and taken the bait is disappointing but not surprising.

Many of the Commission-funded consultancy reports I have read have started and ended with the merits of the proposed Commission actions. I can’t recall a report that said something shouldn’t be done. It is also a tactic in assessing policy options (what Glover refers to as risk assessment) to write the most about the favoured option and less about the least favoured option.I blogged here on a Commission consultancy meeting, the cost of which was no doubt staggering; the Commissioner spoke on what she wanted, everyone agreed, the presentations showed how Europe would be a better place if this were done and everyone agreed with everyone, had a nice lunch and the many unpaid interns took notes for their CVs to PR firms or consultancies so they could get more work. And so the system feeds itself by indoctrinating people into the world of uncritical agreement.

Now, for disclosure, I have been ticked off by Commission civil servants for things I’ve said that were not European Commission

doctrine. Perhaps that explains why my dossier is in a box on the bottom shelf.

NOTE:

Symmetry of Ignorance: The expertise and ignorance is distributed over all participants in a wicked problem. There is a symmetry of ignorance among those who participate because nobody knows better by virtue of his degrees or his status. There are no experts (which is irritating for experts), and if experts there are, they are only experts in guiding the process of dealing with a wicked problem, but not for the subject matter of the problem. Source: Horst Rittel, 1972 “On the planning crisis”.

Satisficing is a decision-making strategy that attempts to meet criteria for adequacy, rather than to identify an optimal solution.

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Just about every country has identified life sciences in some form or other as a priority for academic and commercial development. But what will characterise the countries that may in the end prevail?

  1. The research community needs a high degree of autonomy. The European University Association released an interesting study, University Autonomy in Europe II: the Scorecard, in 2011, assessing the degree of institutional autonomy universities in the various EU member states enjoyed. The countries with the greatest university autonomy were from northern Europe: Denmark, Ireland, UK, Finland, Sweden Latvia, Lithuania. Those with highly regulated and state controlled systems were from southern Europe, or had systems where the state just likes to intrude: France, Luxembourg, Greece, Italy and others. To be fair, some countries were more or less autnomous on different indicators, but the rough distinction can be drawn. Surprisingly, at least to me, was the middling performance of countries like the Netherlands, Austria and Germany. No doubt various higher control states will endeavour to justify why the state needs to be so intrusive, but as evidence that this is perhaps an unhealthy state of affairs, we see the highly instrusive French state over the past year moving to create greater diversity and differentiation in funding for its universities with greater autonomy (see this news item for instance). Clearly, greater autonomy necessitates greater diversity and differentiation and in the end some will need to become better than others. While we would like to think that all universities are essentially the same, reality suggests that the only real equality lies in the extent to which they all meet minimum standards, rather than all trying to meet some arbitrary ‘gold standard’.
  2. The second point is that the bulk of significant research results in life sciences arise from centres known as academic health science centres (AHSC). This is a theme I warm too, as it provides an organisational model that drives innovation from the clinical user end, rather than from the research end. Yes, more research funds are always needed, but we also need solutions. Efforts to operationalise translational medicine are doomed to fail if the driving forces are not coupled to the clinical user and innovation policies in general need to start with problems needing solutions, and hence a factor more likely to be evidenced. Only a few countries have AHSCs — such as US (over 50), Canada (about 14), Sweden (1), Belgium (1), Netherlands (8) and the UK (5). Germany arguably has at least one as does Italy. France has none, and one will need to see whether changes in their higher education system are likely to lead to formal establishment of this approach. The challenge (and this was the subject of a paper I presented, see the previous entry below), is that while universities are more likely to enjoy degrees of autonomy, hospitals are less likely to. The UK was only able to move toward establishment of AHSCs when the state control of the hospitals was relaxed through successive periods of NHS reform. The Netherlands model built on existing relationships. Countries without AHSCs, though, will confront the twin challenge of institutional autonomy of both universities and hospitals.
  3. The third point is that not all countries will be able to do everything in life sciences and therefore will need to set some priorities. National priorities are hard to conceive, because countries usually think of themselves as being able to do everything and so efforts for instance, get diluted and underperform. Cash is tight these days (think debt) and governments just cannot afford everything, so the most difficult challenge is establishing priorities.

The Academic Health Science Centre undertakes three important missions:

  • they treat patients

  • they conduct research

  • they teach the next generation of clinicians

The AHSC model, as a structured and integrated organisational form, is most developed in the US, Canada, Netherlands, UK, Sweden and a few others, and emergent in other countries.

They are a distinct and probably unique type of organisation, quite expensive to run (annual revenue streams on the order of €2 billion or more), very complex and home to a diversity of stakeholders. Often, AHSCs are thought of simply as teaching hospitals in a loose affiliation with universities but this underpowers their role.

The AHSC represents the most robust model of an institution that could be seen as sitting at the nexus of innovation and entrepreneurialism in health sciences. They essentially own the challenges facing us in the biomedical and treatment arenas, and have access to, or indeed may own, their own research capacity to solve those problems – they can be seen as both producer of new knowledge and consumer of it. And through their role in the intergenerational transfer of knowledge (i.e. teaching), they can influence future priorities, and clinical treatment practices within healthcare systems. As large and potentially well connected organisations, they have the potential to access considerable sums of start up capital, and spin-out a variety of new companies.

Not all teaching hospitals have the capacity to be an AHSC. Not all universities become an AHSC simply by linking their medical schools to a hospital, anymore than simply bolting on some labs to a hospital creates productive research capacity.

Virtually all countries, and regional economies, prioritise biomedical research probably within at least their top 5 areas of investment – despite frequently have significant deficiencies. While thinking that an AHSCs may be seen as the best local solution, local capacity can be lacking or weak. A critical worry is that AHSCs will be created from small, dysfunctional, and poorly performing institutions into large dysfunctional and poorly performing institutions, wasting public money, frustrating researchers and would-be entrepreneurs, weakening treatment capacity, and failing to deliver the innovations.

Internationally, AHSCs should be seen as sitting at the top of the healthcare pyramid, providing care from the simplest up to the most complex, and with unique expertise. While challenging to national/regional innovation strategies (which are often parochial in perspective), AHSCs should be at the forefront of international collaborations and integral to globalisation of knowledge transfer and evidence-based care.

Therefore, creating an AHSC as a driver of innovation and home to entrepreneur is not to be undertaken lightly.

One aspect of the AHSC that is particularly important to conceptualise and operationalise effectively is how they commercialise their intellectual property as a result of being both owners of problems, and creators of solutions to these problems. Risks here include inappropriate de-risking of research, premature efforts at commercialisation, confusion over ownership of the work itself, and conflict between institutional components on the methods to choose. These all track back into the AHSC itself, and how it is governed and how the executive suite and board, decide what can and cannot be done, or done well.

The paper draws on the author’s professional experience of working in an AHSC, working with an AHSC in thinking through their commercialisation strategy, and comparative policy research on commercialisation of research and strategies.

What is an Academic Health Science Centre?

AHSCs come in many forms. Understanding why particular arrangements are needed is important to ensuring that AHSCs are not created out of poorly performing component institutions. They are not simply an aggregation logic for pooling knowledge and capabilities. AHSCs can be vertically integrated providers through to a confederation of autonomous institutions. In some countries, the structure of AHSCs is accredited, mandated or otherwise designated, while in others, they emerge as a logical and rational solution to various research/ treatment/ teaching challenges. In addition, AHSCs also form networks for further collaboration.

Depending on national funding systems in higher education and in healthcare, AHSCs may have to deal with a large number of government ministries or agencies (in addition to health and higher education: social/community care, research councils, labour, industry/commerce ) which may be at differing levels in government (national/federal, state, local) as well as charitable and international sources. With this comes a diversity of public supervisory and oversight arrangements, which unsurprisingly may conflict on a number of levels: research priorities, service delivery objectives, degrees of institutional autonomy, and not to ignore the diversity of political interest which may complicate this further.

And within this mix, the challenge of coordination looms very large, to accommodate the autonomy of constituent parts, public accountability and institutional mission.

How should AHSCs organise themselves to conduct research and development for commercialisation?

AHSCs should be understood as accelerators of innovation. In virtue of owning the problems, they can disseminate new practices, enhance the evidence base for treatment options, and alter the very structure of service delivery itself.

Therefore, a critical issue for an AHSC is how they go about commercialisation, that is, operationalising the acceleration and dissemination of innovation and how they enable the entrepreneurial nature of researchers.

Particular challenges arise when higher educational institutions and healthcare organisations are state owned and run, with the result that staff (academics and researchers) are public employees or civil servants. This has the potential to create difficulties for individuals who may wish to be entrepreneurial yet retain their relationship to those issues which sparked the innovation in the first place.

Problems in this area have been raised by the French government with respect to the visibility and commercialisation of national research from state-owned laboratories and from the universities themselves. Institutional restrictions on commercialisation can create conflicts as in the UK where the universities pursue one approach while NHS hospitals use NHS/Department of Health commercialisation strategies.

External sources of seed capital are faced with constructing sensible funding arrangements in this environment. This has led institutions such as Karolinska in Sweden or Imperial Innovations in the UK to create an entrepreneurial subsidiary to deal with the commercialisation process. We are a long way from simple technology transfer here.

What are implications for policy: on research, on commercialisation and on higher education?

At some level, AHSCs are ill-defined in the European context, what their characteristics are, how they are organised and perform. Sensible investigation is needed to identify the performance, role and function of AHSCs in Europe, and to understand whether they are in fact a nexus of innovation or a quagmire of bureaucratic interference.

We need lessons and cases to draw on to understand how to structure appropriate innovation policies that may require the formation of high performing AHSCs that can be breeders of entrepreneurs. We also need to think beyond biomedical research as the potential scope of AHSCs includes innovations in systems and ways of working, health information technology and software, medical devices and not just medicines and so on. This nexus of innovation is very broad.

As someone who sees the challenge of AHSCs through both the institutional as well as policy lens, some key areas of priority are implicated and which are presented as conclusions:

  • Funding of AHSCs is not quite the same as funding the constituent parts, so national policies need to be harmonised if AHSCs are to become effective accelerators of innovation and enablers of entrepreneurs. This will raise coordination challenges for governments as the incentives they deploy may come from different pots of money with differing purposes.

  • Institutional design is important and only suitably high performing institutions should comprise an AHSC; this has implications for whether a national accreditation system should be used (England), or policies and initiatives to advance the role of AHSCs (Canada).

  • Commercialisation design is important and plays to national policies on public ownership of publicly funded research, whether state-owned research infrastructure should be disposed off to non-state ownership, with corresponding implications for the employment status of entrepreneurs. National taxation and entrepreneurial policies can be remarkably short-sighted and counter-productive; we really need to understand how bad some national legal frameworks are, and how good others are. AHSCs will be embedded in these legal frameworks, so how productive they can be is linked.

  • We really need to understand how national policies can encourage the introduction of high performing AHSCs where none exist, or prune the numbers of AHSCs if they have proliferated without also achieving high levels of (international) recognition and performance, or enable existing AHSCs to be real drivers of innovation.

NOTE:

Presented at the 2012 Entrepreneuriship conference in Maastricht in March 2012: see here for more details.

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Euractiv is reporting some concerns that there will be a decrease in research spending in the EU. The article is here.

According to the survey that triggered the anxiety, some 93% of those surveyed said that “investing in innovation is one of the best ways

Innovation

Innovation can also be quite mundane, it all depends on what problem you're trying to solve (Photo credit: Stephanie Booth)

to create jobs in Europe.” This is absolutely right! However, investing in innovation is not the same thing as spending more on research.

There are two, broad schools of thought here. The first sees spending money on research, translating into innovation. The other is that innovation occurs when real-world problems are solved. The EU and most EU member states have pursued the first approach; the problem of job creation is pursued through the second approach. The evidence on job creation might suggest that the first approach is not working.

Spending more on research is not, in itself a bad thing. However, the quality of the research has to be good, results disseminated and academic researchers held to account for their work. I am not a big fan of state-run or controlled higher education, and less a fan of protected job status for academics. According to this model, more research literally pushes innovations into the market where hungry investors snap these great ideas up and go off start companies and hire people. And so it goes. This approach does not generally work. It is called the ‘research push’ model, and is faced with the tremendously difficult challenge of research translation, that is, of linking the research through various arrangements to people who can create innovations from the research. Research, itself, is not an innovation; it only becomes an innovation when it becomes useful.  [see Michael Gibbons et al The New Production of Knowledge”, Sage 1994 on the distinction between ‘use-less’ and ‘use-full’ knowledge]

The other model involves innovation emerging in markets, which have needs and which investors, inventors and others are encouraged to respond to. This is called the ‘adoption pull’ model, as it focuses on how markets (that’s you and me needing something and buying it) adopt innovations which respond to our requirements. The value of any research is precisely in the context of whether it feeds this innovation or adoption pull. The research translation process here is about identifying knowledge needs that research can fill, and which in turn can be converted into innovations that people will want and value.

The key distinction is that the needs of academic researchers, to do research, solve problems, learn new things, etc., is not the same thing as the needs people have for innovations. Research commercialisation by European universities is generally very poor, and particularly so in countries which operate the research welfare state. They also have poor access to risk capital, burdensome public ownership of publicly funded research (as though no one learned anything from the role of Bayh-Dole in the United States, or hadn’t gone back to the 1940s and read Vannevar Bush) and generally complex labour market rules which frustrate businesses startups (for those who wonder why this is important, a business start-up is something new, creates employment, is risky, but is where all large companies start from. How they get to become big is not just a function of their products and innovation, but the flexibility by which they can grow, and that is often a function of the perverse impact of national bureaucracies.)

Spending more on research won’t address the development of innovation or create jobs as such. Spending more on research will of course expand the research system, and possibly expand the research welfare state.  I am not ignoring the real challenge of what proportion of research funding should be for pure or curiosity research and which should be mission directed (or linked to Grand Challenges, which are proving such an effective way to align researchers’ interests with compelling real-world challenges.

If you want innovation to create jobs, as apparently 93% of people surveyed want, then you want different things from just more research spending; you need things that in Europe and particularly in some Eurozone countries are proving particularly hard to do, namely:

  1. You need a risk culture where it is easy to start companies, try out new things, and if they don’t work, start again; but many countries penalise innovators who go bankrupt, for instance, while other countries load small start ups with massive social costs, inflexible labour rules, so the company can hardly get going for the tax-burden.
  2. You need an environment which encourages adoption of research findings; perhaps better, you need the academic institutions to be more proactive in encouraging entrepreneurialism amongst academics. Secure employment contracts that restrict freedom to explore alternatives are not help. Key concepts here are: flexible academic employment contracts, real-world incentives within universities to encourage a career focus on problems as well as new knowledge.

Of course, this list can go on. The key message is that equating research spending with innovation investment is a broken paradigm that should be quickly abandoned.

Want to know more?

Well there is a lot out there. I’m going to recommend these for starters:

Roger Miller and Marcel Cote, Innovation Reinvented: six games that drive innovation. University of Toronto Press, 2012.

An older book that is worth a read about companies and innovation (remember that the SME is the engine of job creation, not the public sector) is this one:

Ikujiro Nonaka and Hirotaka Takeuchi, The Knowledge-creating Company: how Japanese companies create the dynamics of innovation, Oxford University Press, 1995.

And because this blog is about healthcare, everyone must be mindful that research and innovation in healthcare, as in other sectors, can be highly disruptive (this creates unemployment and new jobs at the same time and may even bend the cost curve down), I’m suggesting a read of this new book:

Eric Topol, The Creative Destruction of Medicine: how the digital revolution will create better healthcare, Basic Books, 2012.

 

 

In this Age of Austerity, good ideas risk being lost. The dynamics of funding of innovations has always been full of risk. But as various debt-laden governments try to balance bloated public balance sheets, should we worry about where the ‘next big thing’ will come from? Yes, if you believe that governments can find and fund winners (the evidence says they can’t by the way, but can act as catalyst or midwife), no if you believe that the wisdom of crowds, otherwise known as markets, might be a useful driver of innovation development and adoption.

The diagram below summarises the funding of innovation, identifying in particular the so-called ‘valley of death’ where good and bad ideas go to die for lack of funding. The risk we, as taxpayers, face is that governments will continue to fund innovations into the valley of death, perpetuating what I call the ‘research funding welfare state’, where research happens, but innovations don’t. Hyperactive civil servants with indelible portfolios will continue to pursue dead-end projects despite evidence that the world has moved on. The real problem for governments isn’t finding money for funding research (though that is hard enough), but realising a simple algorithm:

  1. the world is characterised by change
  2. the world will change faster than our ability to respond
  3. this will not change.

Europe has a shortage of innovation gorillas compared to other countries, and if the politics of some countries are to be believed, would rather retreat into a safe haven of social solidarity and protected interest groups, than face the harsh realities of the modern world. This Fortress mentality will not keep the disruptive wolf from the door and will only add to domestic turmoil as native talent packs up and leaves for more encouraging countries.

The harsh reality of innovation is that it can be violent, overthrow trusted ways of doing things, and challenge what may be thought of as defining cultural norms and social innovation is just as much part of innovation as the inventions themselves. The other true thing about innovation is that it knows no favoured nation or culture — anyone and any country can do this.

Find the risk

A Mongolian woman condemned to die of starvation

Starvation (Photo credit: Wikipedia)

In June, Mike worked with colleagues in Brussels to develop a range of innovative research and commercial development programmes in the biotechnology, food and agriculture sectors through a research brokerage event hosted by ERRIN.

The KBBE programme — Knowledge-based BioEconomy — is a European Commission programme focused on the food, agriculture, fisheries, biotechnology and oceans. Partnering opportunities for SMEs lie in a number of areas, as some aspects of the call offer specific opportunities to firms in North America, or India for instance. Up to 50% of the call requires SME participation, and they are elegible for 25% of the funding in those programmes.

There were few SMEs at the event, while many universities sent representatives, rather than research principals so brokering opportunities were limited. However, SMEs in this sector should take note of this programme especially firms outside the EU as this offers one way to get into the EU market.

Commercially-minded higher education institutions in Europe are few, given the levels of assured public funding they receive, but noteworthy commercially partnering can be had with institutions from countries that have prioritised this such as the UK, Sweden, Denmark, Finland, Netherlands, Germany, Hungary and Poland for instance. Other countries offer many potentially beneficial relationships, but SMEs may find state bureaucracies difficult, ownership of relevant IP being mainly public sector with little incentive to commercialise, or universities unsophisticated in structuring commercial relationships with industry.

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The Grand Challenge Equations

If only the Grand Challenges were that simple!

The State of the Union message by President Obama focused around key challenges facing the United States to embrace the changing world. His list included:

  • education
  • innovation
  • infrastructure
  • government reform

This is not a bad list for starters. In my own work with clients, these are key recurring issues, which today take on new urgency, and are as relevant to the US as the EU and emerging countries. The one issue that does wake ministers of finance up in the middle of the night is the rising cost of healthcare, and that is its own challenge.

Let’s briefly reflect on each of these four, though, for now:

Education

A 10-year old girl in a public school will enter the world of higher education or employment in perhaps the year 2020: how is her experience of education preparing her for that world? Are her teachers the very best for developing her for the future, encouraging curiosity and helping her be adaptable and courageous? Is the higher education system ready for the challenges of the future? I somewhat despair about our universities, and do think they need to revisit their social mandate, as they are at present our key and only institutions for the inter-generational transmission of knowledge, yet academics seem pre-occupied with other matters (such as the length of the CV and research), while teaching seems to suffer. We need to re-energise the learning part of higher education, and not just through a technological fix of e-learning, but through the invention of new institutions of learning. Increasingly scarce public funding should not be wasted on unreformed higher education, but should reward innovative and potentially disruptive learning opportunities.

Innovation

Yes, more and better and faster. The historical forces that got us to the present have been silenced as we have become trapped in regulation and rules that discourage risk-taking, and reward the compliant at the expense of the disruptor. Companies and government, both, have trouble with trouble makers who don’t adopt the institutional rhetoric. Access to early-stage funding for innovations is weak and research suggests likely to be harder to get but governments may find themselves unable to provide all the necessary funding under current circumstances. Innovative ways to innovate and commercialise are necessary and which bridge the ‘valley of death’ with effective strategies that de-risk the innovation development process. Regretfully, to some extent, our universities frequently have a small view of their role here (technology transfer), but leaving this to others to take the risks is no longer an option. Entrepreneurialism is needed within the research communities, linked to real-world challenges (I am not ignoring the need for pure research to create new knowledge). And perhaps some better priority setting: while it may be nice to have the latest smartphone, we do need to solve the problem of malaria, unclean water, poor quality nutrition. These challenges do not go away just because we can text our friends more easily — yet within the smartphone technology may lie ways to solve these threats to humanity if we are creative enough to think those thoughts.

Infrastructure

This is the never-ending struggle for government and industry. Capital investments in public infrastructure offers opportunities for innovation to build faster, cheaper, better. Innovations in building technology can give us better roads, improved rail-links, better public housing. While we are focused on the digital technological infrastructure (of wireless and web), we cannot ignore the need to drive forward new infrastructure thinking around energy and transportation to name two big ones. Many (Western) governments may be trapped with legacy infrastructures, making it hard to leapfrog to new approaches. But perhaps we are at the point where we need to literally junk industrial-era infrastructure logic and make that leap of faith — in ourselves and our future. Timidity is no longer an option.

Government reform

“Smart government”. Is that an oxymoron? How has the digital revolution altered the size and structure of governments? Having looked at this issue, I find that governments are frequently wedded to ponderous and very hierarchical internal processes, characterised to a great extent by caution (legislate in haste, repent at leisure?).  We also find protective practices, which can make it hard to reform government working practices even when there is the will to act. Governments are expensive; indeed, governments are monopoly suppliers of government, and if they do their job badly, we all suffer. The next ‘bubble’ will likely be from the public sector, and in particular from central governments, where the need for reform is greatest. Open and transparent government has all of us as stakeholders and the more we take an interest as taxpayers in the functioning of government the greater the likelihood we will get the reforms for the government we need.

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