Post on 20-Dec-2014
description
Commissioning for Value
A Systems Thinking Approach to
Designing and Commissioning Advice
Services
Simon Johnson
AdviceUKLondon Advice Conference
3 July 2012
Thinking governs performance
... if we asked different questions we could do better things
… we work on doing things better ...
When we want to improve performance...Performance
System
Thinking
Systems ThinkingSystems
• Where and how do people come to our service?
• Why do people come to us and what matters to them?
• Do we do what matters?• How do we know?• How does work flow
through the organisation?• Why is it how it is?
Thinking
• What are our underlying assumptions about how work should be organised?
• What do we think our purpose is?
• Who decides and how?• What do managers pay
attention to?• How do they spend their
time?
We treat all demand as though it is useful work and manage it through rationing
Understand what demand is preventable (failure) and design it out
Pay attention to costs and costs will fallUnderstand that cost is in how work flows.
Identify the causes of waste and design only to do value work
Standardisation improves performanceUse scripts, procedures etc.
Design against demandDesign the system to absorb variety
Control work using targets and activity measures Understand and improve based on measures derived from purpose and what matters
We have a people problem – find ways of managing their performance
95% of the causes of ineffectiveness are in the system. Paying attention to individual
performance is focusing on the 5%
Managers make decisions, workers implement them
Decision-making is integrated with the work
Traditional Thinking Systems Thinking
Unlearning how we think
We have a contractual relationship with people. We provide a service and they choose to use it
We work alongside people to understand their problem and what matters to them
We have a contractual relationship with commissioners. They procure and monitor:
we deliver and report
We have a partnership that uses measures data to continuously improve the service and outcomes
It’s the System Stupid!
●30 – 40% of the demand for advice shouldn’t be there. It’s caused by the failure of public services to get it right for their customers
●The way advice services are commissioned typically drives the wrong behaviour
●Pressure to hit targets causes cherry-picking of easier cases and a revolving door – if clients don’t get their problems fixed, they keep coming back
Look at work a bit differently...
“The performance of anyone is largely governed by the system he works in.”
If we set targets and make people’s jobs depend on meeting them...
“...they will likely meet the targets – even if they have to destroy the enterprise to do it.”
Dr W Edwards Deming1900 – 1993
What we learned about demand in
PortsmouthNot all demand is the same:• 56% ‘value work’ – what we’re here to do• 41% preventable, generated by other
agenciesAgency % Preventable
% of Demand on Advice Services
Job Centre Plus 25% 8%
Pension Service 10% 3%
Disability & Carers Service 5% 1.5%
Social Fund 10% 3%
HMRC 10% 3%
Other 25% 8%
Purpose
“Help citizens to pay their rent and council tax by making a decision and paying benefit
quickly”
Portsmouth Approach:Background
• Portsmouth CLAC opened on 1 April 2008• PCC felt that LSC contract inflexibility meant
service not meeting residents’ needs• CLAC partnership dissolved and interim 1-year
contract let while commissioners learned about the service
“What gets us into trouble is not what we don’t know…
It’s what we know for sure ... that just ain’t so.”Mark Twain
1835 - 1910
What are we here for?
How well do we do it?
How do we know?
Why is our performance like this?
Get Knowledge and Understanding (Check)
• How the work works
• What gets in the way?• Thinking
• Purpose• What matters?
• Demand
• Measures• Capability
?
Understanding demand: ‘getting in the work’
Understanding purpose as commissioners:• Listening to customers at front desk• Sitting in on interviews• Finding out what matters – really matters – to customers• Understanding the system• Realisation that the system was driving the work, not vice versa
56% Value 44% Failure
205 - 345 per week
Take ticket from
machine Take a
seat
Called to reception &
handed green form
Take a seat
and fill in form
Hand in form to
reception
Take a seat
Form details entered on IT, ticket number on form, board
in back office updated and form placed in tray
Advisor picks up oldest form from
tray and calls client number
Advisor and client go to interview
room
Advice givenClient leaves
Average 69 minutes : could take 2 hrs 39
mins
Client enters centre
Avg 33% of clients leave
before adviser is free
Purpose: Give me the right advice and appropriate level of support to help me resolve my
problem
On 56% of days we are open for less than 50%
of advertised hours
What we learned
Waste Steps
Waste = Spending time doing things again which have not been done right the first time
Waste = Duplication of effort
Waste = Doing things which add no value to the client
Capacity = Value Work + WasteCapacity = Value Work + Waste
Levels of Need
I need something done on my behalf
31%
I need advice about something
51%
I need some guidance /
information then I can sort it out
myself18%
Type of help requested
Defining purpose
Better understood our customers’ needs Defined purpose in customers’ terms Purpose supported by underlying principles Learning then drove the commissioning
process:
Invitation to TenderPurpose:To provide an advice service that supports the people of Portsmouth to solve their problems.
Principles:•Responsive•Enabling •High quality•Professional•Flexible•Collaborative
Working with The Wider System Preventable Demand (Failure)
Advice Portsmouth
PCC
People
Other Agencies
egDWP
‘The Wider World’
If we did something different in Advice
Portsmouth we could prevent this demand
coming in
If PCC did something different we could
prevent this demand coming in
If other agencies did something different
we could prevent this demand coming in If the wider world did
something different we could prevent this demand coming in
Commissioning:• Learning drove the commissioning and tender
specification• Purpose, principles and measures are specified –
method is free• Applicants required to demonstrate, against each
principle:– understanding of the continuous improvement approach– evidence of where they have designed and delivered
services in a similar customer-focused manner– how they would apply the learning to the Portsmouth
model
Commissioning:
How did the process feel?•Looked very different to previous tender specifications•Needed to get procurement ‘on board’•Element of risk
– would organisations ‘get it’?– would commissioners be able to assess objectively?
•Changes the relationship from commissioner / provider to a partnership approach, with learning and improvement at the heart
Commissioning:Did it work? Yes!The framework demonstrated clearly how far: •bidding organisations understood the approach;•they could relate it to ways they had worked previously; and – most importantly...•they could think about the work in a new way, building the service around what matters to clients
Measuring success• Number of people trying to access the service by type and
frequency of demand• Number of people successfully accessing the service by type
and frequency of demand• Number of people who abandon trying to access the service by
type and frequency of demand• Number of repeat visits• ‘End to end’ measures i.e. length of time taken for customer to
receive service, total time taken for customer to resolve their problem
• % value and failure demand• % of people referred to other agencies
Redesign Principles
• We are open when we say we are open and we never turn anyone away
• We stop doing things that create queues• We have expertise on the front line• The people who use our service define what matters• We have conversations with people that help us to
understand their problem and what matters• We only do things that create value for the people who
use the service• Minimise hand-offs – pull expertise when required• We design the service based on knowledge. If we don’t
have data we go and find out• Everyone has two jobs: do the work and improve the
work
Just the beginning• New transformed service launched beginning April • Steering Group using measures data to have meaningful
conversations about continuous improvement• But still lots of work to do:
• Deeper understanding of root causes to inform response• Exploring common areas of failure demand across the
wider advice services in order to switch it off• Building on the measures• Building on the partnership – shared Risk Register,
monitoring meetings ‘in the work’, understanding external failure demand
• Working with partners to switch off external failure demand