1. This document summarizes a meeting about integrating complex systems around individuals. It discusses measuring outcomes rather than just activities, and designing services around individual needs and data. 2. It emphasizes understanding individuals holistically rather than just through the services they use. Data collection should focus on outcomes relevant to people's lives and be consistent with national frameworks. 3. Service design should be human-centered, collaborative, iterative and focus on solving problems, not just delivering predefined solutions. Outcomes and data collection should continually improve services.

1. Integrating Complex Systems Around Individuals
Neighbourhood Network Event
Venue - The Strategy Unit, Kingston House, West Bromwich
Date - Tuesday 23rd July 2019
Facilitators - Darren Wright and Alysia Dyke

2. How do complex
systems work?

3. The danger of the microscope
Defining people by the services they use, and the data
we choose to collect on those services,
leads to data reductionism

4. Not understanding the person can lead to
Solutionism:-
The providing of a solution or solutions to a customer or client
(sometimes before a problem has been identified)

5. Tracey is 24.
Tracey grew up in Chelmsley Wood until she was
21. She lived at home until she fell out with her
family and came to stay with friends in
Birmingham. After a couple of months it was
obvious there wasn’t enough room in the one bedroom flat she was staying in
and without anywhere else to go she ended up in a hostel in Birmingham. It’s not a
great part of Birmingham and Tracey doesn’t feel safe walking around there.
Tracey can’t stay in the hostel during the day so spends a lot her days in friend’s flats.
During the day her, and her friends, watch TV and usually drink quite a lot of vodka.
She has completed over 2000 levels of Candy Crush
Traceyple

6. Tracey:
● In debt
● Socially isolated
● Lives in a hostel
● Been to see GP 7 times in 3 months
● Stressed and anxious
● Attended A & E on two occasions with alcohol related
alcohol related issues
● Smokes
● Misuses alcohol
● Poor diet
● No exercise
Traceyple
Socio-economic factors
Clinical factorsHealthy behaviour

7. Built environment – 10%
Clinical care – 20%
Healthy behaviours – 30%
Socio-economic factors – 40%
Contributors to Overall Health
Outcomes
Source: Robert Wood Johnson Foundation and
University of Wisconsin Population Health Institute

10. We all love the idea of measuring outcomes rather than activity

11. Being Busy vs Being
Effective

12. Challenges with Measuring
Outcomes
Attribution –
Did you cause that
outcome to happen?
Place vs service

13. Integration around the individual
GP
A&E
Smoking
Cessation
Alcohol
Services
Job
Centre
Money
advice
Gym
Housing
Health
Trainer
Collective
Outcomes
Collective
Outcomes

14. To understand a system you have
to understand demand

15. Impact of Service Design

16. What is service design?
1. Human Centred: Consider the experience of all the people affected by the service
2. Collaborative: Stakeholders of various backgrounds and functions should be actively engaged in the service
design process
3. Iterative: Service design is an exploratory, adaptive and experimental approach, iterating towards
implementation
4. Sequential: The service should be visualised and orchestrated as a sequence of interrelated actions
5. Real: Needs should be researched in reality, ideas prototyped in reality and intangible values evidenced as
physical or digital reality
6. Holistic: Services should sustainably address the needs of all stakeholders through the entire service and
across the business
This Is Service Design Doing: Applying Service Design Thinking in the Real World
Book by Adam Lawrence, Jacob Schneider, Jakob Schneider, Marc Stickdorn, and Markus Edgar Hormess

17. What is NHS service design?
1. Design with compassion.
2. Design for the outcome
3. Be inclusive
4. Design for context
5. Design for trust
6. Test your assumptions
7. Make, learn, iterate
8. Do the hard work to make it simple
9. Make things open. It makes things better

18. The basic process
Identify
users
Ideate
solution
Prototype
solution
Implement
solution
Identify
problem

19. Traditional Service Design Model
This often the point where we
start getting involved
Build service
model
Test model with
patient/user
groups
Decide on some
metrics
Go out to
contract
Measure
metrics

20. Alternative Service Design Model
Set out
problem to
be solved
Go out to
contract
Define user
needs
Identify data
to meet user
needs
Design
service
Adapt service
Test service
against user
needs
Prove the
problem is
being solved

21. The Key Components of A Service
Problems to
be solved
People that
will deliver
solutions
Culture of
organisation
Structure of
organisation
Technology
of
organisation

22. Business Modelling

23. The Value Proposition
www.strategyzer.com

24. Service Design at a System Level

25. The process of strategy
Challenge
to be
addressed
Policy
response
Specific
actions to
be taken

26. Start with the person
Think about data that is relevant to the person
Be broad in the data you collect
Make data collection as simple as possible
Iterate regularly
If the data says the service isn’t working then change the
service
Don’t set specifications

27. Practical Ways To Measure

28. Challenges With Commissioning
• The difference between commissioning and procurement
• Co-designing services is more expensive
• What if the public don’t agree?
• Where do you get your data from?

29. What is the purpose of
collecting data?
Is it purely to measure
transactions?

30. Data has value
Continuous service improvement
Wider social value

31. Wisdom
Knowledge
Information
Data
The Wisdom Hierarchy of Data
Value

32. There are two types of outcome
1. Systemic outcomes – e.g. A&E attendance, GP appointments
2. Individual outcomes – measurable improvement in health and
social situation

33. There are two types of activity
1. Value demand
2. Waste demand

34. A focus on outcomes should fundamentally change
the way we commission and design services

35. By focussing on measuring services
we miss the opportunity of
human-centric design

36. Data Collection should be
Consistent and Aligned
with National Outcome
Frameworks

37. Data Collection is Structured to Match the Life Course
Starting
Well Data
Dictionary
Developing
Well Data
Dictionary
Working
Well Data
Dictionary
Living Well
Data
Dictionary
Ageing Well
Data
Dictionary
Diabetes
Data
Dictionary
But also service specific
Mental
Health Data
Dictionary
Supported
Housing Data
Dictionary
End of Life
Data
Dictionary
Domestic
Abuse Data
Dictionary
Each has been defined and is monitored for any change in policy.
We are adding to this list all of the time.
Each is available under an open license for you to use
Refugees &
New
Migrants

38. Living Well Data Dictionary
Personal Circumstances:
• Domestic Abuse
• Homeless
• Temporary Accommodation
• Unsuitable Accommodation
• Vulnerable Adult
• Financial Hardship
• Social Isolation - Loneliness
• Environment - Noise
• Environment - Outdoor Spaces
Behaviour:
• Very Low Fruit & Vegetable Intake
• Low Fruit and Vegetable Intake
• Significant Fried and Processed Food
Intake
• Excessive Sugar
• Nutrition - Iron
• Physical Activity - Moderately
• Physical Activity - Inactive
• Alcohol Misuse
• Smoking
• Substance Misuse
Status:
• Weight - Overweight
• Weight – Obese
• Mental Health – Low Reported
Wellbeing
• Mental Health - Stress and Anxiety
• Sexual Health - Unwanted Pregnancy
• Sexual Health – Sexually Transmitted
Infections
• Pre - Diabetes: Non - Diabetic
• Screening - Increased Blood Pressure
• Screening - High Blood Pressure

39. Household
income is
>60% of UK
average
Reduce
households
where
neither
parent is in
work
Healthy Child
Programme
The family can
afford food
and clothing
items
Social Justice Outcomes
Framework
Department of Health
Department of Work and
Pensions
Financial Hardship
After
required fuel
costs the
family
remains
above the
poverty line
Improving
Outcomes
Supporting
Transparency
Reduce the
proportion of
those on
work-related
benefits
The number
of working
age adults
engaged in
work related
activity

40. Continuous service improvement
Value
Identify data
Gather data
Analyse data
Identify service
improvement
Implement service
improvement
Wisdom
Knowledge Information
Data

41. Neighbourhood Metrics
Map of Demand in Birmingham

42. Darren Wright
To discuss any of the content please contact me on
darren@insideoutcomes.co.uk
@insideoutcomes
0121 288 7487