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

2. 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

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

5. 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

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

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

9. 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’

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

11. 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

13. 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

14. 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

15. 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

16. 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

17. The Vanguard Method
Change starts with STUDY
No plan required!

19. 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

20. 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?

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

22. 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

23. Housing repairs Call Centre Works order Supervisor Access Tradesman
Materials

26. 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)

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

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

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

30. Thinking
System
Performance

31. 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

32. And so to health care
Like housing repairs, costs are halved as service
is improved...

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

35. 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

36. 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

37. 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

38. 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.”

39. 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.

40. 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

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

42. 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

43. 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

44. 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.

45. 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

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

47. 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

48. The problems/issues citizens want help with.

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

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

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