Radical results through different thinking

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Presentation transcript:

Radical results through different thinking Designing public services that work Barry Wrighton, Senior Partner Vanguard

Changing thinking, changing performance The good news: Amazing service is cheaper The not-so-good news: You have to be prepared to change the way you think

‘You can’t go back’ But let me take you back...

Some features of industrial designs: Front- and back-offices Specialisation Standardisation Activity management (targets, SLAs, standard times) Out-sourcing transactions IT-dominated ...all features being driven in to public services

Are you working on the 5% or the 95%? “95% of variation in workers’ performance is governed by the system” W Edwards Deming www.vanguard-method.com

The Vanguard Method Studying the organisation as a system reveals counterintuitive truths Change is a normative process

The core paradigm in service org’s… How much work will there be? How many people do I have? How long do they take to do things? Managing activity against financial targets Seeking ‘economies of scale’ www.vanguard-method.com

A counter-intuitive truth All demand is ‘work’ Value demand and Failure demand Demand is the greatest lever for performance improvement

Failure demand is a systems concept …what are the causes? Separation of front and back offices Specialisation and standardisation Arbitrary measures: SLAs, standard times, targets, activity management

Reflect... How would you describe the culture? It started with ‘study’ Targets and people management driven by the ‘core paradigm’ The better alternative: design against demand

The Vanguard archetype: transactional services Train against HFPVD ‘Pull’ expertise Understand type and frequency of demand Work as single piece flow; ‘close’ Measure actual time Measure actual performance in customer terms Or put ‘clean’ into flow (prevention) (knowledge) Key measures: Capacity and capability

A counter-intuitive truth Transaction = cost Cost is in flow If you manage costs you create costs If you manage value you drive costs out of the system

A counter-intuitive truth Change by ‘tools’ and projects Change is emergent Your problems are different from those you imagine Knowledge is the prerequisite for effective change

The Vanguard Method Change starts with STUDY No plan required!

How do you halve your costs? Management’s measures: Manpower costs Value (£) of work completed Sub-contractor costs WiP Vehicle maintenance Fuel Overheads (finance, admin, HR) Repair targets

Day 1 summary Improved performance requires a change in thinking – its Counter Intuitive. Changing thinking requires a ‘normative’ method. A normative method requires valid data and informed choice – Double loop. (Chris Argyris) So what data is needed and how do you get it?

The Vanguard Method Studying housing repairs as a system reveals the ‘what and why’ of current performance, providing the knowledge required for effective change.

How do you halve your costs? Management’s measures: Manpower costs Value (£) of work completed Sub-contractor costs WiP Vehicle maintenance Fuel Overheads (finance, admin, HR) Repair targets

Housing repairs Call Centre Works order Supervisor Access Tradesman Materials

Housing repairs – learning to ‘see’ Target Times Call Centre Works order Supervisor Cancelled works orders 45% Failure Demand ‘Favouritism’ S.O.R Diagnosis Access Choice 40% failure Re-work 95% Tradesman Materials Access Queuing (bonus)

Design for perfect As we design for perfect, how many management conventions do we challenge? But what is the impact on customers and costs?

How do you halve your costs? Manage value (not cost) And that requires different measures

Purpose, measures, method Creates de-facto purpose Think about purpose in customer terms Impose targets Derive measures from purpose Constrains method Liberates method

Thinking System Performance

The Vanguard model for ‘check’ (transactional services) 1 What is the purpose (in customer terms)? Thinking 6 System Conditions 5 Flow : Value work + Waste 4 Capability of response 3 Demand : T + F What matters? 2

And so to health care Like housing repairs, costs are halved as service is improved... www.vanguard-method.com

Demand into health and care services Politicians repeatedly assert that demand is rising... ... but demand is stable

What happens to people whose lives fall off the rails? Studying reveals an alarming reality... ...but also provides the knowledge required to make a huge difference

What happens to people whose lives fall off the rails? Not one but many ‘front doors’ Repeated ‘assessments’, most often ‘referred on’ ‘Thresholds’ used to avoid service provision When a service is provided it fails to meet the need Thus further demands into the system... ...which are treated as episodic

What system conditions govern performance? Specialisation of services Targets to complete assessments Budgets and thresholds (refer people on, close cases) Commissioning versus specifications So service providers can be rated ‘green’ while people don’t get the help they need

What was discovered during Check – a case study What Ruth said she wanted - what mattered to Ruth: “I need help with housework and...” “...gaining access to the upstairs of the property.” “These two things would have such a profound effect on mine and the children’s lives.”

This is why they mattered • Ruth a serial victim of domestic abuse • The system knew what mattered in 2001. • Health deteriorated so could not go upstairs so children took advantage and caused chaos. • Ruth did not meet threshold for wheelchair so borrowed money from friends and family. • Sanctions and threats to remove children. • Threats to evict her due to state of property. • Ruth labelled as ‘deviant’ and ‘working the system’ by social workers. • Children finally removed by police.

What was discovered during Check – a case study What Ruth received: The same anger management course, twice, for two boys The same parenting programme, twice Help cleaning one bedroom Toilet frame, perching stool and bath board for a bath she could not access Family intervention programme

What was discovered during Check – a case study Cost of what Ruth received: £106,777 Cost of what Ruth needed: £20,760

What was discovered during Check – a case study And failing to help Ruth involved: 8 social workers 22 support workers allocated 30 referrals 16 assessments 36 teams/services

T S P We worry about risk!!! Needs are complex Knowledge is power, we are more special than you are We focus on activities and targets!!! Referrals between agencies are the way to get things done T Protect our budgets/ income We don’t trust each other or citizens We record everything We focus on doing our bit and then pass it on We process issues rather than fix them We use standard risk assessments to decide whether this one is for us or if we can pass it on We close the case if other agencies are involved Referrals lead to more referrals We pass info to other agencies even when we don’t expect them to do anything There are real barriers to sharing data S There are multiple assessments by multiple agencies We only do what we have to We notice and record when people aren’t coping but don’t do anything about it No-ones taking responsibility for helping me solve my problem Thanks but that does not help me My problem is getting worse Everyone's got a bit of knowledge but no-one’s doing anything even when its getting worse P

What was discovered during Check – a case study Between 1996 and 2012 Ruth had 129 different interactions with public-sector agencies. From running a successful business with her first husband she deteriorated to having ill health, her children were removed and she became entirely dependent on the public purse. Ruth was taken on by one of the new ‘Wellbeing’ teams; she is now in suitable accommodation with her children and her situation has stabilised.

Principles for action: wellbeing teams Understand demand in context Help people define what a good life would look like to them Help people take responsibility for achieving that ‘Pull’ needed expertise only as required Measure achievement of purpose in person’s terms

Using better measures From assessments, checklists and paperwork To person shaped measures - based on ‘me, my life and what’s important to me’

Profound results: Lives back on the rails At a fraction of the cost One local authority expecting to save £50m, Similar savings for local partners A fall in demand

The problems/issues citizens want help with.

The trouble with ministers... They think they are experts in management! Or... They believe in anything plausible

Ministers believe in Payment by results Shared services IT-led change Digital services Commissioning ... thinking these things will drive down costs

Re-thinking regulation: from compliance to innovation Purpose Measures Method