Journey to the Interface by DEMOS

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Journey to the Interface by DEMOS

  1. 1. Engagement and The Journey to the InterfaceThe Journey to the InterfaceHow public service design can connect users to reform co-production will growFrom cleaning the streets to checkouts, fromlooking after our elderly parents to selling public, private and voluntary sectors, Journey to the Interface makes the case for a fresh approach only out of a deeper, richer understanding ofus holidays, more than 20 million people in the to public service reform – an approach that is lessUK work in service. The ‘service economy’ now about competition and contestability and moreaccounts for 72 per cent of our gross domestic about closing the gap between what people want how services relate inproduct. Most of us work in service; all of and need, and what service organisations do.us depend on it. But expansion of the service This pamphlet argues that service design cansector has not heralded a service revolution. offer policy-makers and practitioners a visionToo often people’s experiences of service for the transformation of public services, as well practice to people’s Sophia Parker and Joe Heapyare alienating and frustrating. as a route to get there. It outlines an agenda Drawing on the principles and practices for action that spells out how service designof the emerging discipline of ‘service design’,this pamphlet argues that the common challengethat all service organisations face is how to create approaches can be applied systemically. Sophia Parker is deputy director of Demos. everyday lives Joe Heapy is a director of Engine.more intimate and responsive relationships withtheir users and customers. Drawing on over50 interviews with service innovators from the The Journey to the Interface How public service design can connect users to reform Sophia Parker Joe Heapy
  2. 2. Acknowledgements Sophia Parker, deputy director of DemosWe are very grateful to PricewaterhouseCoopers LLP for supporting Sophia is deputy director at Demos. She works on organisationalthis project. Thanks in particular go to Nick Jones, Andrew Knott, strategy and business development, which involves developing newDuncan Lampard, Ed Straw and Seema Malhotra for making it such a partnerships and research priorities. She has a specific interestfruitful collaboration, and for offering invaluable advice, constructive in service design – looking at ways in which public services suchcriticism and research leads throughout the project. as education and health can be designed from the user outwards, There are countless individuals in the many organisations we visited and Demos’s families and parenting work, which she leads on.who gave generously of their time and thoughts. Our conversations Before joining Demos, Sophia was development manager withwith them have provided the backbone to this piece of work. A full list the Design Council’s learning programme, which used design-basedof contributors can be found on pages 109–111, and we are indebted participatory methodologies to engage with practitioners andto them for the time they spent talking to us and participating in policy-makers. She has also worked as a civil servant at the Cabinetour workshops. For now, thanks to Joel Levy, Jim Maxmin and Deborah Office, where her projects included the consultation ‘EqualitySzebeko for their support in framing the project. Their insights, ideas and diversity: making it happen’ and the development and bringingand inspiration made all the difference in the early stages of the to fruition of the Sex Discrimination (Election Candidates) Act.research. Also to Lynne Maher, John Proctor and Isobel Rickard for Sophia is co-author of Disablism: How to tackle the last prejudiceproviding us with the rich material for our extended case studies. (Demos, 2004), Strong Foundations: Why schools must be builtThey helped us to see how powerful service design principles can be on learning (DfES, 2006) and The Other Glass Ceiling:when put into practice. Alison Miller and Paul Rigg made it possible The domestic politics of parenting (Demos, 2006).to bring together the fantastic group of local authorities that weworked with. At Engine, huge thanks to Oliver King for his advice and Joe Heapy, director of Engine Service Designreassurance, and to Kate Dowling for her ongoing support and good Joe is a co-director of the service design consultancy, Engine, andhumour. Elena Oliva deserves a very special mention for her patience. is an advocate of the social value of design in improving people’s lives.At Demos, we would have been lost without the research and As a strategist, he looks at how best to marry business objectives withcoordination effort of Sophie Middlemiss. Her cool and calm approach evolving consumer expectations and needs. Joe has worked with manykept us going throughout an intensive phase of research. As ever, of Engine’s clients including Orange, MSN, BUPA, Visa, BT andTom Bentley, John Craig, Catherine Fieschi and Simon Parker made the Guardian newspaper. Founded in 2000, Engine has approachedincredibly valuable contributions to the writing of the report and the design of services by using design-led methodologies that put userswe feel very lucky to have such a stellar cast of colleagues. at the centre of the process. Engine recently helped Orange to develop Lastly, thanks to Claudia Boldt, Julie Pickard and Martin Vowles a European customer experience strategy for its retail operationsfor working with us to turn a lot of words into the good-looking and has been working with Virgin Atlantic on its developmentpamphlet you are now holding in your hands. As ever, all errors and at Heathrow’s Terminal 3. Engine has worked with Demos and DfESomissions remain our own. – and 30 headteachers – to develop Picture This!, a workshop toolkit for use by schools in planning for a future of more personalisedSophia Parker learning. Joe has also worked with six schools in the UK to instigateJoe Heapy design projects involving staff and students in improving their experiences of being at school.July 2006
  3. 3. About DemosWho we areDemos is the think tank for everyday democracy. We believe everyone shouldbe able to make personal choices in their daily lives that contribute to thecommon good. Our aim is to put this democratic idea into practice by workingwith organisations in ways that make them more effective and legitimate.What we work onWe focus on six areas: public services; science and technology; cities and publicspace; people and communities; arts and culture; and global security.Who we work withOur partners include policy-makers, companies, public service providers and socialentrepreneurs. Demos is not linked to any party but we work with politiciansacross political divides. Our international network – which extends across EasternEurope, Scandinavia, Australia, Brazil, India and China – provides a globalperspective and enables us to work across borders.How we workDemos knows the importance of learning from experience. We test and improveour ideas in practice by working with people who can make change happen.Our collaborative approach means that our partners share in the creation andownership of new ideas.What we offerWe analyse social and political change, which we connect to innovation andlearning in organisations. We help our partners show thought leadershipand respond to emerging policy challenges.How we communicateAs an independent voice, we can create debates that lead to real change.We use the media, public events, workshops and publications to communicateour ideas. All our books can be downloaded free from the Demos website.www.demos.co.uk
  4. 4. First published in 2006 About this pamphlet© Demos This pamphlet grew out of a series of conversations about projects in ourSome rights reserved – see copyright licence for details respective organisations. We realised that many of the organisations we were working with – Demos in the public sector and Engine in the private sectorISBN 1-84180-164-X – faced a similar set of challenges around the provision of great service. ThisCopy edited by Julie Pickard led us to explore whether or not there are some common principles of serviceDesign by Ispeaktoyou innovation.www.ispeaktoyou.co.uk The Journey to the Interface brings together what Demos and Engine haveIllustrations by Claudia Boldt learnt from working with service organisations, along with the contributionswww.claudiaboldt.com of over 50 professionals from private, public and voluntary organisations andPrinted by Upstream, London a number of independent experts in service design. The purpose of the pamphlet is to bring together and organise some of the language and concepts of user-centred service. We have couched this work in the context of theFor further information and priorities for public service reform in coming years.subscription details please contact: We hope that the pamphlet provides a useful resource for service organisations, as well as a conceptual framework for approaches to reform.Demos In that spirit, each of the core chapters (1, 2 and 3) concludes with a setMagdalen House of challenges – questions people can ask to test the extent to which their136 Tooley Street organisation is focused on creating deep relationships with their users – andLondon SE1 2TU some shared language for service innovation. After each of these chapters you will find case studies of public service organisations that are putting sometelephone: 0845 458 5949 of the principles described here into practice. And at the end of the pamphletemail: hello@demos.co.uk there is a glossary – a ‘shared language of service’ – that summarises the new concepts we introduce here.web: www.demos.co.uk Although many of the tools and concepts described here can be applied to existing organisations, the transformative potential of service design as an approach really comes to life only if it is applied at a systemic level. After the concluding chapter, which explores this in more depth, you will also find an agenda for action that describes what service design principles and practice might might mean for people operating at different levels of the system. We welcome your contributions to this work as it develops. Do get in touch. Sophia Parker sophia.parker@demos.co.uk Joe Heapy joe@enginegroup.co.uk
  5. 5. ContentsIntroduction Chapter 1 Chapter 2 Chapter 3 Chapter 4 An agendaThe common Seeing services Professionals Measuring success The politics of for actionchallenge of as people do and practitioners service designserviceThe shift to a service Services need to be Find ways of enabling Find ways of measuring If applied systemically, Just as outcomes need toeconomy has not understood as a journey professionals and people experiences as well as service design can be co-produced, so doesnecessarily heralded or a cycle – a series of to work together: create systems: life is more offer a vision for the transformation: howa service revolution. critical encounters that spaces for simultaneous complicated than a key transformation of service design principlesOften as recipients take place over time empowerment. performance indicator. public services, as well can be applied at everyof services we feel and across channels. as a route to get there. level of the system,that someone else from local authoritiesis benefiting. and policy-makers to politicians.Pages 6–17 Pages 18–43 Pages 44–63 Pages 64–79 Pages 80–96 Pages 97–103Learning to have more See services from the Treat professionals and Measure success Don’t let existing A sharedintimate relationships vantage point of the practitioners as explorers’ obsessively, but not organisational language ofwith people and seeing interface, and constantly working things out with through operational boundaries limit serviceservice as support rather seek to understand more users and customers efficiency alone. Two demand. Find newthan as a commodity may about how services relate – but rather than doing other crucial dimensions ways of supporting There is a small butnot only generate the to people’s everyday lives this in isolation, they include success in terms of and investing in the growing disciplineoutcomes we are looking – how we use them and should do it on behalf reducing ‘failure demand’ ‘in-between spaces’ of service design.for, but also offer the route how we relate to them of the system. Put the (the cost of not getting through the formation This glossary bringsto securing the legitimacy – rather than simply frontline centre stage things right the first time), of partnerships and together key toolsthat public services in the focusing on the internal through designing and success in harnessing social enterprises where and concepts of thistwenty-first century so workings of service recruitment, appraisal, the underused resource new models of service discipline to create adesperately need. organisations. professional development of people’s energy and have a chance to develop. shared language of and feedback channels commitment. Make the systemic service that cuts across that empower staff. challenge one of scaling all sectors. up these approaches. Pages 104–108
  6. 6. 6/7 IntroductionIntroductionThe common challenge of serviceFrom cleaning the streets to checkouts, from looking after ourelderly parents to selling us holidays, more than 20 million peoplein the UK work in service. The so-called ‘service economy’ nowmakes up 72 per cent of our GDP.1 Most of us work in service;all of us depend on it for many aspects of our existence. Thegiving of service and the receiving of it is an unmistakable partof everyday life. Yet the shift to a service economy has not necessarily heraldeda service revolution. Many of our interactions with serviceorganisations are characterised by profound frustration, hangingon the end of a phone, arguing over our consumer rights, feelingignored and misunderstood, worrying about the workingconditions of those who serve us. Too often as recipients of serviceswe feel that someone other than us is benefiting. Too often itfeels like ‘producer interests’ or profit incentives matter more thanhow we feel. Public services are not exempt from this sense of frustration.Since 1997, the public sector has expanded. Public service jobshave grown, as have the levels of investment being poured into ourschools, hospitals, cultural institutions and security infrastructure.NHS spending will be 90 per cent higher in 2007/08 whencompared with 1996/97. Schools spending will be 65 per centhigher and transport will be 60 per cent higher.2 Yet these
  7. 7. investments are doing little to shift the stubborn figures which another. Progressive politicians urgently need to create a vision 8/9indicate that we still have low levels of satisfaction and trust for public services that puts people and places, not targets and key Introductionin public services overall. performance indicators (KPIs), at its heart. But if people are Two problems lie at the heart of this disconnect between people going to believe this vision, equally urgent is the need to refreshand services. First, people are changing faster than organisations and renew the approaches that are taken to public serviceare. Decades of expanding choice and growing wealth have left transformation.people looking for more than simply quality products and services. In this pamphlet we argue that this common challenge, facingThe search for meaning and recognition, autonomy and control is all service organisations, leads to two major consequences. First,a defining part of our collective psyche in the twenty-first century. learning how to create deeper forms of satisfaction and wellbeingThe second problem is that ‘service’ is still seen as a commodity through service is the long-term priority for public service reform.rather than as something deeper, a form of human interaction. Second, a distinctive approach to ‘service design’, which seeksMany large organisations still seek to provide service for the to shape service organisations around the experiences andlowest cost and maximum profit. This, we argue, eats away at the interactions of their users, presents a major opportunity forfundamental purpose of service: to provide support and to help the next stages of public service reform: a route to get there.people live their lives to their full potential. This pamphlet makes the case for acknowledging the common The search for real meaningchallenge of service in thinking about how to transform public For many people, relative material comfort is no longer enough.services. Starting here leads to a different diagnosis of the problem. Twenty years ago, when asked what people looked for whenIt is not that public services need to be more like commercial making purchases, the most common response was ‘quality ofservice providers. It is that all service organisations need to find product’. In 2004 the most common answer was ‘honesty’. 3new ways of connecting intimately with their users and customers, The result of the massive expansion in material wealth is that,of listening and responding in ways that reassure us all that we in Ulrich Beck’s words, ‘people demand the right to develop theirare being understood. In order to develop our thinking we spent own perspective on life and to be able to act upon it’. 4 The searchtime with a wide range of organisations – from all sectors: public, for meaning, for authenticity, amid a world of brands, competingprivate and voluntary – that appear to be making inroads in messages and demands, now characterises the lives of many peoplebuilding strong relationships with customers and users. in affluent western economies.Drawing on the interviews, workshops and case studies we As one of the interviewees for this project put it, ‘we are tiredconducted, we have generated a set of service design principles of being treated as nobodies with no personality by monolithic– practical tools and concepts – that offer fresh approaches to institutions, we want to be recognised and understood.’organisations seeking to close the gap between what they do and And as Michael Willmott and William Nelson argued in theirwhat people want and need. book Complicated Lives, ‘the self is now something we seek The current managerialist narrative about public service reform to understand and express, not something we simply accept.is out of sync with what people want and need from services at This raises difficult issues for individuals as well as our companiesprecisely the time that a febrile political environment is awakening and public services who are still struggling to escape thea fresh debate about how people and services should relate to one historical legacy of mass provision.’5
  8. 8. As employees and citizens, we’re tired of working and want our his particular model of mass production – the greatest number 10/11work–life balance; as consumers we’re impatient of being nameless of goods for the lowest cost and the largest number of people Introductionand faceless, fighting for our needs; we want relationships not – has become a defining feature of how we see service.transactions; we want real voice not meaningless choice. Shoshana Ford’s model had three characteristics that are particularlyZuboff and Jim Maxmin have argued that the sheer scale of the significant for modern public services. First, costs were loweredsocial and economic shifts of the last century, combined with the through standardising the customer or their needs. Second,new possibilities offered by technology, add up to a wholly new it drew a firm line between production and consumption. Goodsenterprise model.6 In this model, it is not products or services that were created out of the right combination of raw materials,we value most: it is support. Support that helps people to lead their machines and people; these goods were then marketed and soldown lives as they wish, and support that helps us to navigate an to the consumers – whose interests and needs had little impactincreasingly complex and information-laden world where it is hard on any activity within the firm. In other words, the value chainto know who to trust. was linear, and the recipients of the products were placed firmly at one end of the chain. Third, this separation of production andThe commodification of service consumption created demand for managers – professionals whoseImagine signing up to a luxury sports and leisure club. In exchange primary role was to match supply and demand in the most efficientfor a significant monthly fee, you are able to attend unlimited way, and whose positions were defined through access to expertsessions, use as many large soft towels as you wish, pick and choose knowledge and insight not otherwise available to the customers.from a range of treatments and relax in the social area. Imagine if, For a long time, businesses sought to import this manufacturingone day, you visit to find a large notice limiting each customer model of mass production into service provision. More recently,to just one towel each. When you go to the reception desk to as these organisations discerned a shift in consumer expectations,enquire about something, you notice a printout charting profits there has been a greater emphasis on personalised services andper month over the last quarter. The prices of refreshments have products. But when personalisation and manufacturing modelssuddenly gone up and you notice that a treatment that had once collide, a very particular form of personalisation is created. Thislasted a luxurious hour now takes only 40 minutes. differentiation is based at best on ‘mass customisation’ – the Good service cannot be reduced to nothing more than an breaking down of a particular service or product into modulesefficient operation: its value lies in the less tangible sense that the which customers can then pick and choose from, or add andservice is supporting you, meeting your needs, working for and on subtract elements of.behalf of you. The real problem with service is that it is still treated Despite the best efforts of public service innovators up and downas a commodity – as Will Hutton has argued, a commodity ‘to be the country, our public services continue to be defined by a massproduced at the lowest cost by the most sweated workers’. 7 This production model. This has created a system that works againstmental model of service has a long and deep legacy that colours professional desires to provide service in the form of supportattitudes in both the commercial and the public sectors. and dialogue to people. Although there are pockets of success This legacy began when the first cars rolled off Henry Ford’sproduction line. Although his business was focused on products,
  9. 9. around the country in genuinely providing service to people, these the desired outcomes, public services need people to get involved. 12/13successes are more often thanks to professionals circumnavigating The notion of co-production, initially dismissed as jargon that Introductionthe formal system, rather than working with it. featured only in the lexicon of aspiring ministers and seasoned This government has not been blind to the limitations of mass thinktankers, has become part of the new consensus about futureproduction in creating public services fit for the twenty-first approaches to public service reform. Contrary to Ford’s model,century. Since 1997 their approach to breaking out of this co-production demands that production and consumption areparticular model has been guided by an emphasis on the brought together, so that both can take place simultaneously.diversification of providers, finding ways of increasing competition As Sue Goss has argued:and contestability and combining them with central targets andpressure to perform. The almost continuous re-engineering of Many of the new priorities – ‘respect’, an end to ‘binge drinking’,services that has taken place has been driven in part by a belief ‘recycling’, ‘improved public health’ – cannot be achieved bythat creating a market will bring the consumer values of customer a smart government delivery machine; they require changes infocus, responsiveness and efficiency into a public sector drowning behaviour from the public. This means not simply reconsideringin bureaucracy and paternalism. how to deliver using public or even private resources, but how to But all the evidence suggests that our commercial service access the ‘ free’ resources of public energy, engagement and action.9experiences are, in general, not much better (and arguably far So a child learning is both consuming an education and producingworse) than our public service experiences. According to research a cohort of lifelong learners. Someone attending a smokingby the National Consumer Council, 81 per cent of people had cessation course is both consuming a health service and producinga bad experience purchasing services last year. Words that came a healthy population. The idea of co-production demands thatup frequently in relation to commercial service transactions public servants and politicians focus not only on the internalincluded ‘distant’, ‘clinical’ and ‘uncaring’.8 There is no guarantee workings and efficiencies of existing services, but also on howwhatsoever that introducing private providers and market people engage with those services, and how they can be mobilised,disciplines into the public sector will close the gap between what coached and encouraged to participate in the ‘common enterprise’service organisations do and what it is that people are looking of generating positive outcomes.for. There remains a common challenge of service: that large In many ways the concept of co-production is not new: ourorganisations struggle on a daily basis to build genuine and children are not the first generation of students who need to bemeaningful interactions with their customers and users, and engaged in order to learn. More, what has shifted is ourfrequently fail to build any kind of responsiveness, flexibility understanding of the role of the state. The ‘five giants’ of theor ability to adapt into their organisational forms. postwar welfare state saw the role of the state as being limited to developing systems that would help to avoid crises such asWhy this agenda matters for public service destitution, and provide cures and treatments for problems suchorganisations as illness and unemployment. There was a powerful sense thatCommercial service organisations that are unable to connect with benefits came duties, built into a stable institutional andwith their customers risk losing business and profits. However, social framework that has now unravelled. In many ways, debatesthe risks for public service organisations are far higher. To achieve over the balance between individual responsibilities and state
  10. 10. intervention was the leitmotif of twentieth-century politics, in a state of perpetual change. As Peter Taylor-Gooby has 14/15generating huge debates within political parties as well as cutting argued, ‘the rational incentive-based system that has driven Introductionacross party divides. New Labour’s approach [to public service reform] risks neglecting The current emphasis on influencing the behaviour of the relationships that are so very important in forging trust’.11individuals and engaging them in the co-production of outcomes This pamphlet offers some practical tools and insights from thecould be seen simply as the latest chapter in a very long book. small but growing discipline of service design as a first step towardsHowever, it also reflects an unsung triumph of New Labour. re-balancing the emphasis that has been placed on managerialism.Even if they have not succeeded in transforming public services, Service designers do not see service as something that canthey have succeeded in turning the tide of public opinion away be reduced to a commodity. They focus on how people actuallyfrom low taxation. A significant majority of the population now experience services, in order to understand how large servicepositively expects investment in public services. Politicians owe organisations can create better relationships with their usersit to all of us to respond to these expectations, and frame a new and customers.story about what public services are for, and why they matter. Experiences and relationships are the recurring themes of this pamphlet. In chapter 1 we argue that engaging peopleThe search for a narrative: people, places in co-production does not happen through consultations, onand service citizens’ juries or at council meetings: it needs to happen at theDespite the government’s attempts to engage people in point of delivery and through conversation and dialogue rather thanconversations about why public services matter – for example, choice alone. Therefore, learning to understand and mapthrough 2003’s ‘Big Conversation’ or this year’s ‘Let’s Talk’ how people experience the point of delivery, the interface betweencampaign – it has in practice put managerialism over vision when a service and their lives, is essential for creating the conditionsconsidering how to improve and transform public service for co-production. As we discuss, although smart use of dataprovision. Performance management, targets and public service is important, spreadsheets are no substitute for people.agreements became the ‘levers’ – in the rather mechanistic world Chapter 2 explores the pivotal position played by professionalsview of new public management – for improvements. Alongside in building relationships between people and services, andthe regular spending reviews, commissions such as Gershon and understanding how people experience services. We argue thatLyons have been set up to consider how to improve operational two shifts – one in professional identity and one in the shapeefficiencies and service processes.10 ‘Driving out bureaucracy’, of the organisational hierarchy – need to take place if serviceinspections, regulation and audits simultaneously indicated that organisations are to take a relational approach to service design.this government meant business, and that it believed efficiency Chapter 3 looks at how service innovators are learning tocould be wrought from a combination of digitisation, process understand these experiences through the eyes of many differentre-engineering, back-office rationalisation and restructuring. and equally complex people, and how they can connect such But in all the flurry of activity that has characterised the last a diversity of need to the design and evaluation of services withoutten years, we appear to have forgotten that a reform programme resorting to the mass production model of standardisation.designed to improve the existing safety net was never likely It describes how the most successful service organisations areto connect to the challenge of meeting the needs of a society
  11. 11. complementing the ways they measure overall service performance 16/17with ‘experience metrics’ to build up a much richer picture of Introductionwhat really matters to people, and therefore where there is roomfor improvement. The fiction writer William Gibson once said, ‘the future’salready here, it’s just unevenly spread’.12 Throughout this pamphletyou will find a handful of ‘near future case studies’ of the publicservice innovators up and down the country who are demonstratingthe impact of relational approaches to service reform. By startingwith experiences at the interface, these case studies demonstratethat relational approaches combine personalisation and efficiency,at the same time as challenging our current understanding of whatthese terms mean. Finally, in chapter 4, we set out the main elements of a differentapproach to reform – led by the service design principles of thispamphlet – as it applies to the whole system of public services,with different changes occurring simultaneously at different levels.In doing this we pose some questions and challenges for politiciansand policy-makers working on public service reform in comingyears, and make some suggestions about where they might lookto learn more about relational approaches to service. None of these arguments are about throwing away the positiveaspects of current approaches to public service management andreform. But engagement and co-production will grow only outof a deeper, richer understanding of how services relate in practiceto people’s everyday lives. And in learning more about these‘interface spaces’, it is possible that we could also uncover the seedsof a renewed sense of legitimacy for public services. People’s levelof trust in services is far higher when they are asked about theirlocal secondary school rather than the education system as a whole:we trust that which we know. Learning to have more intimaterelationships with people and seeing service as support rather than Photo by Frank Baronas a commodity may not only generate the outcomes we are lookingfor, but also offer the route to securing the legitimacy that publicservices in the twenty-first century so desperately need.
  12. 12. Service stories 18/19 PeopleIn order to improve their UK business, BUPA relies heavilyon the concept of the ‘end-to-end patient journey’. Everyquarter, senior staff at BUPA Hospitals work with ahandful of their customers to trace what happens from themoment someone begins to feel unwell – often some timebefore that person gets in touch with BUPA. As AlisonPlatt, head of BUPA Hospitals, says: 1 Doing this exercise immediately colours how you think you’ll treat that person – the language, the anxiety, the Seeing services as people do bureaucracy.Having traced this, BUPA then maps its own processes, Services need to be understood as a journey ortechnology and interventions to the end-to-end journey. a cycle – a series of critical encounters that takeSenior staff ask themselves what each interaction looks place over time and across channels.like, what transactions are possible, what information anypatient really needs. Finally, they add a third line – onethat looks at behaviours. As Alison says: The biggest mistake that large organisations can make is to assume that they know what their service users and customers want. The A call isn’t just a transaction, we need to ask: ‘How do I common challenge of service – the emotional distance between the want to make you feel?’ board and its customers, between local authorities and their citizens – is reflected in low levels of trust and satisfaction. People inA tangible change that has emerged from doing this general do not often believe that their needs are met by large serviceexercise regularly is that customers calling to discuss their organisations in either the commercial or the public sector.hospital visit are now offered a checklist of things that If the primary cause of dissatisfaction people have with serviceother people in similar situations have asked. This was organisations is that they feel misunderstood, ignored, and treatedintroduced after BUPA realised that people often didn’t as faceless and nameless, then service organisations need to find newknow what to ask when the call finished with the question ways of getting to know their users, in all their messy complexity.‘is there anything else I can help you with?’ Alison, again: The attitude here at BUPA about customer research used to be like You have to do as much as possible to manage getting that of the interested spectator – now we use it to drive decisions. into people’s shoes – psychologically, emotionally, In recent years, public sector organisations have demonstrated physically. a growing interest in the tools of the marketing and advertising industries in a quest to learn more about how insights about people
  13. 13. can be used to improve what public services offer and how they and engaged with rather than driven out. Responsive, relational 20/21offer it. The service innovators we met dedicate people and teams models of service must find ways of visualising users and Peopleto worrying about the question of what it is that people need understanding their needs, fears, aspirations and preferences.and want. They constantly search for ways of gaining more – and Between them, all the local authorities across the countrydeeper – insights about their customers. They are alive to the fact probably hold more data than the commercial study noted here.that these needs, expectations and desires are subject to change The question is how these data are being used. There has beenover time and across circumstances. And – most importantly a growing interest in segmentation, and in understanding how– they constantly strive to connect the insights they gather to to turn raw data into useful insight that improves and targetsorganisational strategy, product development, communications particular forms of service. For example, the London Boroughand priority-setting. of Hammersmith & Fulham recently cross-referenced detailed Alongside the focus on contestability and competition, measures census data with information about the use of services inof customer satisfaction and the increasing use of segmentation the borough to target services and communications in eachtechniques are seen as the routes by which public services can neighbourhood. Their Customer First programme has identifiedclose the gap between what they do and what people want. In seven customer types including ‘childfree prosperous youngthis chapter, we begin by exploring the most innovative practice adults renting from private landlords’, and ‘older people inaround the use of customer insight. However, the service innovators poorer health with moderate prosperity’.we spoke to as part of this project recognised that, while vital, Some remain cautious about the value of demographic orcustomer insight alone will not generate solutions to the common social class segmentation. Any approach to dividing down largechallenge all large-scale service organisations face. People, in all numbers of people into subgroups is limited by the assumption oftheir complexity and unpredictability, can never be reduced to data. homogeneity within each segment. Certainly social class is a likelyIn the latter part of this chapter we look at how successful service indicator of the types of services someone may or may not use butorganisations keep a steady focus on experiences – as a means of used alone it provides little information about how to design theguarding against the temptation to put people into boxes or reduce experience of that service for that group. The real richness comesthem to a spreadsheet. from cross-referencing multiple sources of data.Knowing your users, part one Beyond the basicsHumans are complex beings. Our organisations are constantly The immutable complexity of people needs to be seen as a sourcetrying to catch up. An ongoing commercial research study13 now of insight for innovation rather than a productivity headache.segments all 24 million UK households into 11 groups, 61 types New approaches to the design of services use segmentations toand 243 segments. The study describes each household type break down the more complex dimensions of need, belief andin terms of its values, patterns of consumption, likely financial behaviour that shape peoples’ responses to service. Such modelssituation and where in the country they are likely to live. This are developed more rapidly through smaller-scale qualitative studieslevel of complexity can easily feel daunting, but if public service that are designed to inform service re-design and innovation – andorganisations are going to close the gap successfully between what indirectly to derive customer-value metrics from which performancethey do and who people are, this complexity needs to be explored can be measured.
  14. 14. Attitudinal segmentation seeks to understand the meaningful 22/23distinctions between the values and beliefs of users with respect Peopleto a particular service. This type of segmentation might identifysubgroups by statements such as, ‘I’m fiercely independent and wantto be treated so’, or ‘I’ve paid for this service – I’m entitled’, or ‘I don’twant to be a bother’.Behavioural segmentation groups the practical reasons why peopleare using a service or channel as the basis for understanding whatis required. A behavioural segmentation model might group usersby statements such as, ‘I need help’, ‘I need some support’, ‘I needto complain’.Journey segmentation recognises that there may be many routesto a single destination such as achieving a healthy body weight.As a nation we need to eat less and do more exercise but simplyreminding people of the consequences of not doing this is notgoing to have a huge impact. Services need to be accessible, butthe designers of services also need to have understood the breadthof starting points and the complex emotional journeys that peoplewill need to be motivated to embark on. These responses to the challenge of complexity reveal newinsights that go beyond ‘what to provide?’ and begin to answer‘how to provide?’ Increasingly service providers are using what they know abouttheir users to create segmented service propositions based looselyaround customer types but inviting customers to self-segment – tochoose from a small number of similar offers and channels basedon what they think best matches their own needs. The sameoffer may be packaged in a number of different ways so thatit is not about the choice of which service but the choiceof which experience. The customer takes control of the choice. Photo by Graham Turner Self-segmentation is one response to the realisation that peopleincreasingly defy segmentation and do not like to be told who theyare by big organisations. People exhibit what marketers call multiplepersonas. We can be professionals, parents, pleasure-seekers and
  15. 15. NIMBYs all in the same afternoon. Elderly people are no longer As systems get larger, management levels increase . . . but the 24/25just elderly. Teenagers are no longer a homogenous group all visibility of the consumer or user is critical. This isn’t to do with Peoplebuying the same music and clothes at the same time. focus groups, but real involvement and development. The consumers People are constantly shifting – or are shifted – between need to stay as real individuals, not just statistics.15the segmentation models of different service providers. A bank Knowing your users, part twoidentifies someone as one type of person and a phone company Using customer insight to tailor services – both in terms of whatidentifies them as another. Generally this is not a problem: as is offered and how it is offered – does not necessarily shift theconsumers, people are in control of these relationships and they stubborn legacy of mass production services. Using data to tailorare not looking for their bank to sell them phones or their phone products and services is similar to drawing information out ofcompany to look after their money. It suits people to be seen and users, re-calibrating and responding. The people represented by thistreated differently by different providers when each is offering goldmine of data are still kept at arm’s length from the operationsdifferent things. and decision-making processes of the organisation. Similarly, The frustration begins when an individual wants to be seen as a for people working in those organisations, insights turn peoplewhole person and the system can view them only as a collection of into numbers, making them two-dimensional.isolated segmented subgroups across multiple segmentation models.Speaking at Demos, Jim Murphy MP highlighted the difficulty In the end, your success will depend less on customer segmentationgovernment has in seeing citizens as individuals.14 As he pointed and more on your ability to describe the needs of your customer without, a single mother is viewed as being at least seven different people great vividness.16across government agencies, including a parent, an employee, a road Many of the service innovators we spoke to have recogniseduser, a taxpayer and so on. the limitations of customer insight models, even at their mostThe limits of the model sophisticated. As a result, they have begun to make the long, slowIn other words, models of segmentation in the private sector and difficult journey to the interface themselves. Rather thando not necessarily translate wholesale to the more complex service sucking data in, they are experimenting with tools and techniquessystems in the public sector. In fact the focus on customer segments that take them to the points at which people actually experiencedisguises the system of relationships that impact on people’s services. Making this journey enables organisations to understandexperiences and outcomes. Used in isolation, customer in much greater richness how people and services relate in practice.segmentation carries the risk of reducing service interactions For public services, we believe these tools and techniques are ofto a series of one-to-one transactions and reinforcing the ‘provider particular interest. The desire to empower users and involve themknows best’ paradigm. Such use of data and insight works best in co-producing outcomes is now so common it is almost a truism.when used alongside some of the techniques and methodologies Yet, even with the most determined staff and leaders, the legacyoutlined in the next section – techniques designed to prevent service of mass production makes it almost impossible for such servicedesigners from reducing real and complex people to statistics or organisations to escape their own vantage point on services – assegments, and to keep a constant focus on the lived experience of functional institutions and ‘episodes’ that interrupt people’s livesthe user journey. Data and insight will never replace people. – to look afresh at what they are doing from the eyes of users.
  16. 16. And it is hard to escape these prisms. The mobile phone the level of dissonance between what an organisation says it cares 26/27company, Orange, knows from experience that ‘making the journey about (for example, personalisation or user empowerment) and People[to see services from a customer’s eyes] is very hard, as people how people experience that organisation lies at the heart of whetherhave a job within an organisation. Their concern is usually with or not people trust such services. People become suspicious ifdelivering their part of the service, not putting themselves in experiences do not match the expectations created by rhetoric,the position of the user. Experiencing services from a person’s customer charters and organisational commitments.viewpoint is very difficult.’ The need to map public service touchpoints and explore the Seeing your services as your users do is not, unfortunately, a extent to which they support the commitment to personalisationroute to simplifying the picture, but it enables organisations to see and co-design is illustrated by the comment of one of oura different kind of complexity, a complexity that sheds new light on interviewees about a recent hospital experience he had:how best to prioritise operational, organisational and policy change. You get the feeling they don’t want you there, that they think you’reFor service designers, the building blocks of service are not episodes the problem . . . they seem to be saying ‘my life running this hospitaland institutions. They are the touchpoints, channels, architectures would be so much easier if you weren’t here’. . . . My experienceand journeys that describe services from the starting point of the is that hospitals perpetuate my anxiety; when I find myself ininterface. It is those concepts that the following sections explore. this system I feel helpless. There is nothing you can do to easeThe tangible elements of service: touchpoints your anxiety. Information provision is appalling – there’s noTouchpoints are the people and tangible things that shape the hand-holding. You find yourself asking several dumb-soundingexperience of services (see pages 28–29). The interest in touchpoints questions to various people behind desks – it seems as thoughoriginally grew out of organisations seeking to reinforce their brand the system somehow requires you to do so.in ways that went well beyond marketing and mass advertising In this comment, it is possible to identify a whole range ofcampaigns. In practice, this recognises that as customers of an touchpoints – people, desks, information provision, the hospitalairline, we are more likely to remember something about the brand building itself – that together combine to disempower the personfrom our interactions with cabin staff, for example, than we are from needing the service.looking at the design work on the tailfin. The forgotten touchpoint: service environments Everything we do should be characterised by obsessive and Almost all public services have an implicit association with uncompromising attention to detail. We know that any journey is a designed and built environment. Some of the most profound and made up of many little experiences and that it doesn’t take much to emotionally charged interactions with public services happen turn a happy customer into an unhappy one. We cannot afford this between four walls where furniture, fixtures, fittings and the design and we must not let this happen.17 of information play a significant role in shaping people’s experiences.Although branding may not be the top priority for many public Yet so often, they are treated as neutral spaces where ‘stuff happens’.service organisations, there is a crucial principle here. Touchpoints In fact, our behaviour is shaped by the environment. Chris Gerry,are the places and spaces where people experience services. The head of New Line Learning Federation in Kent, told us thatextent to which their ‘brand’ invites people in or frustrates them ‘the kids behave differently in here [the school] to out there anddetermines the extent to which those people are engaged. And yet the rules aren’t written up, they’re embedded’.
  17. 17. 28/29Touchpoints
  18. 18. Intuitively it’s impossible to ignore the impact the builtenvironment has on people’s sense of self and agency. For example, 30/31one student participating in a Guardian book about experiences Peopleof school18 commented that ‘the basic aspects of the buildingswe are taught in do not promote learning, but instead, enhancefeelings of negativity’. Spaces are not empty vessels; they are sociallyconstructed and as such can communicate powerful messagesabout value, the importance of users and the extent to whichthey can play an active role in service. One of our commercialinterviewees commented: People get psychologically managed by rooms and corridors to adopt behaviours that suit the organisations and support its systems – the spaces are not configured to the needs of those people.There is unprecedented capital investment going into there-design of public service environments at the moment, acrossschools, hospitals and other public buildings. While such highlevels of investment are welcome, there will be a return only if theconstruction of new buildings grows out of a focus on how spacescan be designed to empower users. This is not about re-creatingmodernised versions of old buildings. We need to turn the focusto how these buildings relate to the services enacted within them,and communicate to people that they are in control. In turn, this requires that public services considering newbuilds start with architectures, rather than architecture. This isa term borrowed from the world of web development. It meansthe complex and dynamic arrangements of objects, dialogues,information, content, processes and navigation that they workwith online. By focusing on architectures, service providers start byconsidering customer behaviour first, and built architecture second. For example, many shops and leisure venues create a range ofpersonas to imagine the needs and preferences of people using aspace. From this they are able to explore how to respond – throughthe design of the environment – to the various motivations of their
  19. 19. customers. ‘Service blueprints’ are developed alongside building strategy’ (as set out in the Budget earlier this year) needs to start 32/33blueprints. In this way organisations can design environments that with people’s experiences and preferences for different channels, Peopleare both instructional and inspirational to a diverse group of users. rather than efficiencies alone. Today, it is no longer possible to assume how a user will accessGreater access through the proliferation of service channels and use a service once many channels are available for them to doIn the past, the customers of services tended to stick to a single so. Therefore every channel needs to some degree to accommodatechannel. People booked holidays by sitting in front of a desk in every kind of user and must be joined-up so that users can movea travel agents, they bought bread from a baker and got their milk easily between them. Orange, for example, uses a single customerfrom the doorstep. Public services have in recent years begun to account, which enables them to provide a consistent experienceexpand the number of ‘ways in’. Andy Carroll, a strategy manager regardless of whether customers decide to call up, go onlineat the Pensions Service, told us that ‘we’ve made a huge investment or visit a store on the high street.in moving from a local paper-based organisation to a national This is important because channels are not simply new routescontact organisation’. The goal for the Pensions Service is to move for delivering services. They remain ways of engaging users, ofaway from office-based services, instead supporting people over drawing them in, of helping people to look after themselves.the phone, or via one of the 2500 outreach workers who are Therefore individual channels and the relationships betweennow working to support such a major ‘channel migration’. them need to be mapped onto people’s lives. As a member of the The story of the Pensions Service is mirrored all over the public Transformational Government team told us, ‘solutions need to besector. To access health support people can attend a medical drop-in about services, not IT’.centre, go online or call NHS Direct – which now receives 600,000 To make this real, the government is going to need to do morecalls per month – in addition to making an appointment with their than ‘promote responsible channel choice by telling people howgeneral practitioner (GP). This trend is likely to grow: last year, much the use of more efficient channels saves, and what that savingthe Cabinet Office published Transformational Government where could achieve in terms of reinvestment elsewhere in the publicthey argued: services’.20 Building the functionality of e-government must not Over the next decade, the principal preferred channels for the distract government or users from the more difficult challenges delivery of information and transactional services will be the of improving services. Technology is of course part of this, but it telephone, internet and mobile channels – as well as increasingly is by no means the only part. important channels within the digital home . . . government will The interaction of different touchpoints: journeys innovate its services to take swift advantage of new technologies Greg Nugent from Eurostar told us: as they emerge.19 Mapping the customer journey brings together services, productsIn this proliferation of channels, of ‘ways-in’ to services, there and experiences . . . it’s the only way you can see how they interactare two key questions all service organisations need to address. and how the brand adds up to more than the sum of its parts.First, how can they understand the different channel needs and Doing the journey made people admit where it was going wrong,preferences of a diverse set of users; and second, how can they because they could see it all in front of them.understand the different interactions and relationships betweendifferent channels. Any attempt to create an ‘integrated channel
  20. 20. Earlier in this chapter we noted that often service experiences ������������������������������������������������������������������������� 34/35are treated as ‘episodes’ – interruptions to people’s everyday lives. PeopleBy starting with people and asking them to describe their experiences ��������� ��������� �������� ����������– as BUPA does, in the example that began this chapter – the focus ������������shifts from looking at episodes, to thinking about journeys: how allthe touchpoints and channels come together over a period of time ��������������and interact with people’s lives, needs, interests and attitudes. When someone enters prison, they are assessed seven times ���������in the first three days – for level of risk, for health, for learning and �������������development and so on. Each of these assessment touchpoints couldbe perfectly designed; however, for many prisoners it is frustrating ��������to provide the same information time and time again. It serves todisempower them, to leave them as little more than a figure on an ��������� �������������assessment sheet. Focusing on individual touchpoints and exploringthe extent to which they ‘live the brand’ of user empowerment is avital part of a relational approach to public service transformation.However, equally important is the need to understand the As the example of BUPA demonstrates, mapping a user journeyinteractions between different touchpoints and channels. Equally, is a far more powerful way of understanding where services couldif the information taken about these different needs is not pulled be improved and how engagement could be better encouraged thantogether by the organisation, how can it ever provide an integrated any kind of large-scale customer satisfaction survey.service to the prisoner? But journeys can be used for more than simply identifying Services need to be understood as a journey or a cycle – a series problems or points in the service where there is room forof critical encounters that take place over time and across channels. improvement. As the users of services are given more choice, andThis is key to integrating the organisation of services around their are empowered to make decisions that may previously have beenuser, and to combining distributed organisational resources to made by experts, it will become more important to include toolscreate experiences and outcomes. to help people manage the uncertainty associated with choice. The concept of ‘service journeys’ is familiar to designers. As a Talking about ‘equipoised choices’ in healthcare, Bernard Crump,technique it was pioneered and trialled extensively in Scandinavia; chief executive of the NHS Institute for Innovation andit has been used to design everything from aeroplane cockpits to Improvement argued:financial trading systems and is increasingly being applied to services We need tools to help what need to be sophisticated and pacedin the public and private sectors. As a method, it enables people conversations about decisions to be made – these decisions don’tto create a rich picture of how service experiences play out in the lend themselves well to the seven-minute outpatient model . . . wecontext of everyday life. The objective here is not to understand and need to surround that consultation with tools to help people decideoptimise operational processes but to determine the best experiential what to do.journey for the users of a service.
  21. 21. A service journey is often characterised by a series of choices, 36/37which in some instances may have life-changing consequences. Challenges PeopleWell-designed service journeys should first anticipate and design- • How are you segmenting your users? What combinations of dataout the likely errors that users could make when using services do you use to create insights?– many of which can be put down to poor information design– and reduce the negative effects of any errors that are made. • Who is responsible for ‘user intelligence’? How are they connectedWhen possible, service users should be able to undo choices and to the management of your organisation?re-choose without incurring penalties. Another strategy to reducethe uncertainty of choosing is to provide the means for users to • Are you genuinely looking at your services from the vantage pointsimulate choices – to play out scenarios and to experiment with of the interface?the options available. Through the simulation of future journeys thelikelihood of making the right choices increases, and the risk and • Can you map all the touchpoints of your service? Do you knowinefficiencies associated with making the wrong choices are reduced. how people feel about these touchpoints?The new building blocks of service • How do the different channels of online, phone and face to faceInsights, segmentation, touchpoints, channels, environments, interact for different kinds of service users?journeys. It is these, not data, functional institutions and episodes,that constitute the building blocks of services from a user’s • How are you ‘designing in’ deliberation, dialogue andperspective. If the commitment to creating user-centred services opportunities for co-creation to the touchpoints and channelsis going to add up to any more than hollow rhetoric, then service of delivery?organisations need to become experts in the methods, tools andways of seeing service that ensure they can genuinely make thejourney to the interface, and see their services as their users do. The picture of service is no less complex from the interface asit is from a systemic perspective. What is different, however, is that A shared language of servicethe interface focuses on how people and services relate, not simplythe shape of existing services. In tackling the common challenge Journeysof service that this pamphlet is focused on, we need to recognise Channelsthat generating positive outcomes requires engagement, and real Segmentationengagement comes through experiences. Therefore, being able Propositionto map and shape those experiences is the only way that public Touchpointsservice organisations will be able to create strategies for genuine Architecturesimprovement and ultimately the transformation of services. Service environments Personas Definitions on page 104–106
  22. 22. 38/39 Case study Luton and Dunstable Head and Neck Cancer Services The multidisciplinary team meeting at the Head and Neck Cancer Clinic starts at 8.30am where some patients’ cases are discussed by the team to make decisions on treatment and care. At the same time patients start to arrive at the clinic waiting room. This is an anxious time for patients and sometimes parts of the clinic process heighten that anxiety rather than reduce it. The way the chairs are arranged in the waiting room leaves patients facing a wall full of official notices or looking directly at others; the number of different professionals that seem to be around can be bewildering as are some of the processes. This often leads to a feeling of helplessness, and thinking ‘if only the experience could be different’: You have to get there early to claim a seat otherwise you’re standing . . . by the time the consultants arrive at the clinic it is already busy as the clinic shares its waiting area. There are patients and carers standing all over the place, waiting quietly to be seen. The consulting rooms at the clinic are much like a dentist’s; the patient sits in the chair and stares upwards, surrounded by an average of seven members of staff, and it is in this situation that most patients are given their diagnosis. Across the NHS patients are rarely involved in healthcare improvement beyond mechanisms such as focus groups and questionnaires. Luton and Dunstable Hospital Head and Neck Cancer Services has been taking an innovative approach to the ongoing re-design of their service, which is putting patients and staff right at the centre of the process.Photo by thinkpublic
  23. 23. The project has been sponsored and supported by the NHS journeys through the service. These touchpoints then formed 40/41Institute for Innovation and Improvement and is co-produced the key focus for re-design. Many of the touchpoints that were Case studywith the service design consultancy, thinkpublic, anthropological identified can be re-designed very easily and would makeresearchers from University College London and, importantly, a huge difference to the patient experience. For example, staffpatients and staff from the hospital. The objective has been not moved weighing scales out of sight of the waiting room – theyto solve any specific problem of service delivery, but to achieve hadn’t noticed how embarrassing patients found it to be weighedan improved experience of the service by involving staff and patients in front of everyone.in the process of re-design. To do this, a range of techniques has Film was also used as a way to encourage involvement – literallybeen used to help patients and staff describe their experiences handing over the lens through which the service was viewedwith a specific focus on the touchpoints. to patients and bringing their lived experiences to life for others. A project team was brought together that comprised patients, Patients found this process to be an incredibly powerful waycarers, healthcare staff, researchers and improvement leaders. The to share their stories and be heard. When patient’s films werecore project team knew that the initial engagement with patient shown during working sessions it immediately created a sharedcarers and staff would be critical, so in the build-up to the project understanding and a new empathy for the deeper needs of patients.they engaged with their audience through a range of communication The effect was to connect and energise the group towards a commonmedia including posters, leaflets and a low-tech newspaper to create purpose – to improve the patient, carer and staff experience.interest. Patients and staff were invited to become involved in As Deborah told us:examining the service in ways that were unfamiliar to most of them. While we did have some concerns that re-living and sharing these A participatory design project like the one at Luton and types of experiences might be difficult for patients, the majorityDunstable is not something that staff can be coerced or targeted felt that it was invaluable in helping them to move forwardto get involved in. Vital to its success is that those who take part and in building relationships with other patients, carers and staff.are willing and energised participants. As a subtle mechanism ofrecruitment onto the project, all staff were invited to keep log books Many patients suggested that the project methodology ofand to note their own thoughts, frustrations and ideas about the filmmaking that they had been invited to work on should becomeservice they were providing. Deborah Szebeko, a member of the part of the patient journey itself – an example of how handingservice design team, told us: control over to users in the context of a designed methodology becomes an aspect of service in its own right: We had a strong sense that patients wanted to get involved because they felt that they wanted to give something back to the service. Staff We’ve had one patient working closely with us and visiting our were excited to work with patients in a way that was different from studio to edit his film; he has helped bridge a gap and get staff on their usual relationship with patients. board with film. He is extremely passionate and just really wanted to help; he has taken time off work to get involved withInsight was generated in a number of ways including further work the project. He also feels he is learning new skills.with the log books and patient interviews. The patients and staffmapped a set of touchpoints that they felt formed their experienceof Head and Neck Cancer Services and re-played their emotional
  24. 24. In this example, service design, service delivery and insight The project is still work in progress but staff appear to be more 42/43generation happen simultaneously and collaboratively at the motivated to work with patients. Patients are calling staff to Case studyinterface. As one patient of the service said: arrange times to meet; they appear to be mobilised and active in co-designing and trialling ideas. The perceived risk expressed by I enjoyed meeting everyone – feeling I was eating properly for the some staff that involving patients in this way would unfairly raise first time, possibly because I was in company. their expectations and lead to disappointment has not transpired.This type of participatory design intervention led the team As one member of the team pointed out:to conclude that the principle of building continuous serviceimprovement mechanisms into the everyday experience for both Patients and staff are not asking for gold taps, in fact most of theirpatients and staff – rather than being an independent activity – can suggestions are quite achievable with a little budget. I would say oneadd an incredible amount of value to the service. And importantly, of the most important things is providing space for relationships toit helps to improve communication between patients and those build and supporting that with communication.staff who are providing care. The experience of connecting patients and staff in this way has Through mapping user journeys, patients articulated clearly that proved to be extremely valuable in changing beliefs about what theythis clinic represented a ‘pinprick’ in comparison to their whole can achieve. This combination of experience and belief has led tojourney, which involved many other departments and hospitals – as positive action, resulting in change that will actually improvewell as touchpoints outside of the formal system. This demonstrates experiences.the wider challenge for health services in working together acrossthe whole patient journey. The process so far has opened up a new dialogue between staffand patients. The project – which now has its own active blog– has connected people with the same interest in improving thetouchpoints of the service and has given ‘permission’ and a structureto make small but significant changes happen. Lynne Mahar at theNHS Institute for Innovation and Improvement commented:‘The process so far has challenged traditional views and experiencesof service improvement, giving patients and staff a new energyand commitment for change.’ Together they are trialling how theclinic’s space is used; instead of the consultants having rooms,which patients move in and out of, patients now have roomsand staff move to see them. The clinic is now building a closerrelationship with neighbouring Mount Vernon Hospital, whichprovides radiotherapy, to build a better understanding of thewider patient experience.
  25. 25. Service stories 44/45 ProfessionalsPeter Gilroy, now chief executive of Kent County Council,told us that ‘the quality of interactions is my obsession . . .relationships are the glue that hold everything together’.In his previous job, as strategic director of Kent SocialServices, his first step towards achieving 3-star status wasto work on improving the experiences of his staff working atthe council: ‘If we can’t look after our staff, they arenot going to look after our customers.’ He produced a 2ten-point plan that focused on two dimensions: people’s Professionals and practitionerswork ‘on the job’ and their quality of life overall.Training and career progression was a major focus, as waswork–life balance and staff health. But Peter’s approach Find ways of enabling professionals and peoplewent beyond simply making life better for his frontline to work together: create spaces for simultaneousprofessionals: he took that focus and used it to demand that empowerment.people re-imagined the shape of the organisation: I wanted to create a paradigm shift to show that the front of our business was more important . . . you’ve got to take Richard Elliot, former manager of a drugs action team in Bristol, very seriously the behavioural and care aspects of the found himself dealing with a tangle of 44 different funding streams, workforce – and I don’t mean of your senior people, your nine planning grids and 82 different objectives. By his estimation, priority must be the front of the business . . . transformation he and his team spent little more than 40 per cent of their time actually working to tackle drug issues. Unsurprisingly he resigned, isn’t just about things, it’s about behaviours and mindsets. writing that ‘monitoring has become almost religious in status,High expectations are rewarded with recognition and as has centralised control . . . the demand for quick hits and earlyvalidation for good work. Kent has regular ‘Oscar’ wins is driven by a central desire analogous to the instantceremonies for frontline staff, and employees from any gratification demands made by drug users themselves’.21area of the council can qualify for exchange trips around Richard’s story is echoed in a wider complaint about the impactthe world if they have performed excellently. Under Peter’s of targets of professional autonomy and identity. Public serviceleadership, Social Services reached 3-star status and Kent professionals and practitioners are growing increasingly vocalis now one of four 4-star councils – suggesting that his about the unintended consequences of targets, arguing that theirdetermination to put the frontline centre stage reaps powerful cumulative impact adds up to disengaging, frustrating andbenefits not only for the people working there but also for alienating experiences for service users. Practitioners recognise thatthe citizens of Kent. many people approach a service organisation and are made to jump through a set of complicated hoops in order to meet an apparently

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