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

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-officesSpecialisationStandardisationActivity management (targets, SLAs, standard times)Out-sourcing transactionsIT-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 thesystem”

W Edwards Deming

www.vanguard-method.com

The Vanguard Method

Studying the organisation as a systemreveals 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 targetsSeeking ‘economies of scale’

www.vanguard-method.com

A counter-intuitive truth

All demand is‘work’

Value demand andFailure demand

Demand is the greatest lever for performance improvement

Failure demand is a systems concept…what are the causes?

Separation of front and back officesSpecialisation and standardisationArbitrary 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

Understand type andfrequency of demand

Work as singlepiece flow; ‘close’

Measure actualtime

(knowledge)(prevention)

Train against HFPVD‘Pull’ expertise

Key measures: Capacity and capability

Or put ‘clean’into flow

Measure actualperformance in customer terms

Transaction = cost Cost is in flow

A counter-intuitive truth

If you manage costs you create costs

If you manage value you drive costs out of the system

Change by ‘tools’and projects

Change is emergent

A counter-intuitive truth

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 costsValue (£) of work completedSub-contractor costsWiPVehicle maintenanceFuelOverheads (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 costsValue (£) of work completedSub-contractor costsWiPVehicle maintenanceFuelOverheads (finance, admin, HR)Repair targets

Housing repairs

CallCentre

Worksorder

Supervisor

Tradesman

Materials

Access

Housing repairs – learning to ‘see’

CallCentre

Worksorder

Supervisor

Tradesman

Materials

Access

Cancelled worksorders

45% FailureDemand

DiagnosisAccess

TargetTimes

Queuing

40% failure

S.O.R

Re-work95%

(bonus)

‘Favouritism’

Choice

Design for perfect

As we design for perfect, how manymanagement conventions do we challenge?

But what is the impact on customers andcosts?

How do you halve your costs?

Manage value (not cost)

And that requires different measures

Purpose, measures, method

Purpose

Measures

Method

Impose targets

Creates de-facto purpose

Constrains method

Think about purposein customer terms

Derive measures frompurpose

Liberates method

Performance

System

Thinking

The Vanguard model for ‘check’ (transactional services)

What is the purpose (in customer terms)?1

Flow : Value work + Waste4

Capability of response3

Demand : T + FWhat matters?

2

Thinking6

System Conditions5

And so to health care

Like housing repairs, costs are halved as serviceis 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 makea 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 provisionWhen a service is provided it fails to meet the needThus 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

Knowledge is power, we are more special than you are

We don’t trust each other or citizens

We worry about risk!!!

Needs are complex

Protect our budgets/income

We focus on activities and

targets!!!

Thanks but that does not help me

My problem is getting worse

No-ones taking responsibility for

helping me solve my problem

There are real barriers to sharing

data

We focus on doing our bit

and then pass it on

We close the case if

other agencies

are involved

We use standard risk assessments to decide whether this

one is for us or if we can pass it on

We pass info to other agencies even when we

don’t expect them to do anything

T

S

P

Referrals lead to more

referrals

Referrals between agencies are the way to get things

done

We process issues rather

than fix them

We record everything

Everyone's got a bit of knowledge but no-

one’s doing anything even when its getting

worse

There are multiple assessments by multiple

agenciesWe only do what we have to

We notice and record when people aren’t coping but

don’t do anything about it

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

From assessments, checklists and paperwork

0

2

4

6

8

10

I am listened to and heard

I have more confidence

My financial problems are

sorted

My children can sleep in their

own room

My children have space to

play

I have some space of my

own

I am able to manage my

home better

Our sleeping arrangements do not affect …

Start

29.06.12

24.09.12

To person shaped measures - based on ‘me, my life and what’s important to me’

Using better measures

Profound results:

Lives back on the railsAt 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.

Health Home/CommunityHelp me to feel better about my life/me (anxiety/depression) 17% Help me to move to a more suitable property 33%Help me to deal with my addiction (drugs/alcohol) 25% Help me to find a home of my own 17%Help me to feed my children/family 8% Help me to live closer to friends/family for support 25%Help me to manage my home better (cleanliness) 17% Help me to move into my new home 4%Help me not to feel isolated (anxiety/depression) 8% Help me/my family to feel safe in our home 8%Help me to live successfully/independently in my home 13% Help me to keep my home 29%Help me to look after myself better (cleanliness) 4% Help me to get essential/basic furniture for my home 21%Help me to access the right support for my children (behaviour/YMHS) 17% Help me to get the necessary repairs to my property 21%Help me to keep my home warm 4% Help me to manage/maintain my garden 8%Help me/my family to be safe in our home 13% Help me to resolve the issues I have in my community 4%

Help me to resolve the issues I have with my landlord 8%

Work/EducationHelp me to get/keep employment 67% Family/ChildrenHelp me support my children with their education (Access & Equipment) 21% Help my family to care for my children whilst I cannot 4%Help me to access training 21% Help me to cope with children that are not mine 8%

Help me to be a good parent to my children 4%

Finance Help me to get equipment for my baby 4%

Help me to claim the benefits I am entitled to 42% Help me to look after my baby in prison 4%Help me to manage my finances 67% Help me to get my children back 4%Help me to set up my utility accounts 4% Help me to manage my childrens behaviour 13%Help me to manage/understand my CT 17% Help me to stay safe from domestic violence 4%Help me to appeal a DLA decision 8% Help me to improve my relationship with my family 13%

Help me to access childcare that meets my needs 4%Help me to access things to do with my child(ren) 8%

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