Commissioning for Value      A Systems Thinking Approach toDesigning and Commissioning Advice ServicesLondon Advice Confer...
Thinking governs performance  Thinking        ... if we asked different questions                         we could do bett...
Systems Thinking       Systems                       Thinking• Where and how do            • What are our underlying  peop...
Unlearning how we think           Traditional Thinking                                  Systems ThinkingWe have a contract...
It’s the System Stupid!●30 – 40% of the demand for adviceshouldn’t be there. It’s caused by thefailure of public services ...
Look at work a bit differently...“The performance of anyone is  largely governed by the  system he works in.”If we set tar...
What we learned about                demand in PortsmouthNot all demand is the same:• 56% ‘value work’ – what we’re here t...
Purpose“Help citizens to pay their rent and  council tax by making a decision    and paying benefit quickly”
Portsmouth Approach:              Background• Portsmouth CLAC opened on 1 April 2008• PCC felt that LSC contract inflexibi...
“What gets us into trouble is              not what we don’t know…              It’s what we know for sure ...            ...
Get Knowledge and                             Understanding (Check)                                                       ...
Understanding demand:          ‘getting in the work’Understanding purpose as commissioners:• Listening to customers at fro...
What we learned                                                                           Called to          Take a       ...
Waste Steps        Capacity = Value Work + WasteWaste = Spending time doing things again which have not been done right th...
Levels of Need                     Type of help requested   I need some    guidance /information then I  can sort it out  ...
Defining purpose Better understood our customers’ needs Defined purpose in customers’ terms Purpose supported by underl...
Invitation to TenderPurpose:To provide an advice service that supports the people ofPortsmouth to solve their problems.Pri...
Working with The Wider System                  If we did something   Preventable Demand (Failure)                    diffe...
Commissioning:• Learning drove the commissioning and tender  specification• Purpose, principles and measures are specified...
Commissioning:How did the process feel?•Looked very different to previous tender specifications•Needed to get procurement ...
Commissioning:Did it work? Yes!The framework demonstrated clearly how far:•bidding organisations understood theapproach;•t...
Measuring success• Number of people trying to access the service by type and  frequency of demand• Number of people succes...
Redesign Principles• We are open when we say we are open and we never  turn anyone away• We stop doing things that create ...
Just the beginning• New transformed service launched beginning April• Steering Group using measures data to have meaningfu...
120703 commissioning for value
120703 commissioning for value
120703 commissioning for value
120703 commissioning for value
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120703 commissioning for value

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Commissioning by value presentation by Simon Johnson of Advice UK.

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  • Also add – we design services inside-out, not outside-in. We decide what the service should look like and expect people to be service-shaped instead of designing outside-in and making the service people-shaped
  • Consequences of OLD World Delays in paying benefit increase the risk of evictions, especially for private tenants. Stress and confusion for people: well-documented links between financial problems and health and wellbeing. High levels of preventable demand and delay for both services, reducing capacity. Additional enforcement costs for Council Tax recovery, with refunds and cost to the taxpayer if the result of benefit delays. Knock-on effects on other services, such as homelessness service. Advice services have reduced capacity to see more people and to work in preventative and enabling ways. Pilot Individual gets a decision in 5 days rather than 100 days Advice worker – 41 minute interview and hand-off. No more progress-chasing. Benefits Officer. Where interview needed (existing claims could often be resolved by phone) 51 minute interview and decide. Largely eliminated evidence chasing. 27% of demand that was “ What ’ s happening? ” and 20% demand that was “ I don ’ t understand ” stops. More decisions are ‘ right first time ’ and explained, so none of the new cases coming through went on to be challenged or appealed.
  • Take time to understand what we want: 1 st April 11 : PCC awarded interim one year contract placed with previous providers; Interim service called ‘ Portsmouth Advice Centre ’ , based at same location Interim contract period used to review service and better understand customers ’ needs. Learning informed procurement process for new contract (which started Apr 12)
  • De facto purpose: manage the queue don’t get sued
  • Absolutely key – not about delivering advice transactions but prompts different questions: “ What are the things we need to do to help people solve their problems?” Deep understanding of causes (demand in context) and ‘what a good life would look like’
  • Very early days.
  • 120703 commissioning for value

    1. 1. Commissioning for Value A Systems Thinking Approach toDesigning and Commissioning Advice ServicesLondon Advice Conference Simon Johnson3 July 2012 AdviceUK
    2. 2. Thinking governs performance Thinking ... if we asked different questions we could do better things System … we work on doing things better ...Performance When we want to improve performance...
    3. 3. Systems Thinking Systems Thinking• Where and how do • What are our underlying people come to our assumptions about how service? work should be• Why do people come to organised? us and what matters to • What do we think our them? purpose is?• Do we do what matters? • Who decides and how?• How do we know? • What do managers pay• How does work flow attention to? through the organisation? • How do they spend their• Why is it how it is? time?
    4. 4. Unlearning how we think Traditional Thinking Systems ThinkingWe have a contractual relationship with people. We We work alongside people to understand their provide a service and they choose to use it problem and what matters to them We treat all demand as though it is useful work and Understand what demand is preventable manage it through rationing (failure) and design it out Standardisation improves performance Design against demand Use scripts, procedures etc. Design the system to absorb variety Control work using targets and activity measures Understand and improve based on measures derived from purpose and what matters We have a contractual relationship with We have a partnership that uses measures data commissioners. They procure and monitor: to continuously improve the service and outcomes we deliver and report Understand that cost is in how work flows. Pay attention to costs and costs will fall Identify the causes of waste and design only to do value work Managers make decisions, workers implement Decision-making is integrated with the work them 95% of the causes of ineffectiveness are inWe have a people problem – find ways of managing the system. Paying attention to individual their performance performance is focusing on the 5%
    5. 5. It’s the System Stupid!●30 – 40% of the demand for adviceshouldn’t be there. It’s caused by thefailure of public services to get it rightfor their customers●The way advice services arecommissioned typically drives thewrong behaviour●Pressure to hit targets causes cherry-picking of easier cases and a revolvingdoor – if clients don’t get theirproblems fixed, they keep coming back
    6. 6. Look at work a bit differently...“The performance of anyone is largely governed by the system he works in.”If we set targets and make people’s jobs depend on meeting them...“...they will likely meet the targets – even if they have to destroy the enterprise to do it.” Dr W Edwards Deming 1900 – 1993
    7. 7. What we learned about demand in PortsmouthNot all demand is the same:• 56% ‘value work’ – what we’re here to do• 41% preventable, generated by other agencies % of Demand on Agency % Preventable Advice Services Job Centre Plus 25% 8% Pension Service 10% 3% Disability & Carers Service 5% 1.5% Social Fund 10% 3% HMRC 10% 3% Other 25% 8%
    8. 8. Purpose“Help citizens to pay their rent and council tax by making a decision and paying benefit quickly”
    9. 9. Portsmouth Approach: Background• Portsmouth CLAC opened on 1 April 2008• PCC felt that LSC contract inflexibility meant service not meeting residents’ needs• CLAC partnership dissolved and interim 1-year contract let while commissioners learned about the service
    10. 10. “What gets us into trouble is not what we don’t know… It’s what we know for sure ... that just ain’t so.”Mark Twain1835 - 1910
    11. 11. Get Knowledge and Understanding (Check) • Purpose What are we here for? • What matters? • Demand How well do we do it? ? • Measures • Capability How do we know?Why is our performance like this? • What gets in the way? • Thinking • How the work works
    12. 12. Understanding demand: ‘getting in the work’Understanding purpose as commissioners:• Listening to customers at front desk• Sitting in on interviews• Finding out what matters – really matters – tocustomers• Understanding the system• Realisation that the system was driving the work,not vice versa
    13. 13. What we learned Called to Take a Client Take ticket reception & Hand in enters from Take a seat form to handed and fill centre machine seat green form reception in form 56% Value 44% Failure Av er Take a ag Avg 33% of seat e clients leave205 - 345 69 before adviser is mper week in free ut es Form details entered on IT, :c ou ticket number on form, board Purpose: Give me the right ld in back office updated and ta ke form placed in trayadvice and appropriate level of 2 hrsupport to help me resolve my s 39 problem m in s Advisor picks up On 56% of days we are oldest form from open for less than 50% tray and calls client of advertised hours number Advisor and Advice client go to Client leaves given interview room
    14. 14. Waste Steps Capacity = Value Work + WasteWaste = Spending time doing things again which have not been done right the first timeWaste = Duplication of effortWaste = Doing things which add no value to the client
    15. 15. Levels of Need Type of help requested I need some guidance /information then I can sort it out myself 18% I need something done on my behalf 31% I need advice about something 51%
    16. 16. Defining purpose Better understood our customers’ needs Defined purpose in customers’ terms Purpose supported by underlying principles Learning then drove the commissioning process:
    17. 17. Invitation to TenderPurpose:To provide an advice service that supports the people ofPortsmouth to solve their problems.Principles:•Responsive•Enabling•High quality•Professional•Flexible•Collaborative
    18. 18. Working with The Wider System If we did something Preventable Demand (Failure) different in Advice Portsmouth we could prevent this demand People coming in If other agencies did something different we could prevent this demand coming in If the wider world did something different we could prevent this demand coming in Advice Portsmouth Other ‘TheAgencies Wider eg World’ DWP PCC If PCC did something different we could prevent this demand coming in
    19. 19. Commissioning:• Learning drove the commissioning and tender specification• Purpose, principles and measures are specified – method is free• Applicants required to demonstrate, against each principle: – understanding of the continuous improvement approach – evidence of where they have designed and delivered services in a similar customer-focused manner – how they would apply the learning to the Portsmouth model
    20. 20. Commissioning:How did the process feel?•Looked very different to previous tender specifications•Needed to get procurement ‘on board’•Element of risk – would organisations ‘get it’? – would commissioners be able to assess objectively?•Changes the relationship from commissioner /provider to a partnership approach, with learning andimprovement at the heart
    21. 21. Commissioning:Did it work? Yes!The framework demonstrated clearly how far:•bidding organisations understood theapproach;•they could relate it to ways they had workedpreviously; and – most importantly...•they could think about the work in a new way,building the service around what matters toclients
    22. 22. Measuring success• Number of people trying to access the service by type and frequency of demand• Number of people successfully accessing the service by type and frequency of demand• Number of people who abandon trying to access the service by type and frequency of demand• Number of repeat visits• ‘End to end’ measures i.e. length of time taken for customer to receive service, total time taken for customer to resolve their problem• % value and failure demand• % of people referred to other agencies
    23. 23. Redesign Principles• We are open when we say we are open and we never turn anyone away• We stop doing things that create queues• We have expertise on the front line• The people who use our service define what matters• We have conversations with people that help us to understand their problem and what matters• We only do things that create value for the people who use the service• Minimise hand-offs – pull expertise when required• We design the service based on knowledge. If we don’t have data we go and find out• Everyone has two jobs: do the work and improve the work
    24. 24. Just the beginning• New transformed service launched beginning April• Steering Group using measures data to have meaningful conversations about continuous improvement• But still lots of work to do: • Deeper understanding of root causes to inform response • Exploring common areas of failure demand across the wider advice services in order to switch it off • Building on the measures • Building on the partnership – shared Risk Register, monitoring meetings ‘in the work’, understanding external failure demand • Working with partners to switch off external failure demand

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