Designing and Commissioning To Tackle

Demand

Simon Johnson

AdviceUK

Kate Kennard

Portsmouth City Council

Systems Thinking: a counter-intuitive approach

Doing different things

…Doing things differently...

When we want to improve performance...Performance

System

Thinking

Thinking governs performance

By helping organisations change the way they think…

…the system changes…

… and performance improves as a consequencePerformance

System

Thinking

It’s the System Stupid!

●30 – 40% of the demand for advice shouldn’t be there. It’s caused by the failure of public services to get it right for their customers

●Procurement of advice typically drives the wrong behaviour – eg activity targets lead to transactional services

●Pressure to hit activity targets cause cherry-picking of easier cases and a revolving door – clients don’t get their problems fixed so keep coming back

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• Partnership between You Trust and Portsmouth

CAB – funded by PCC and LSC• LSC contract inflexibility meant service not

meeting residents’ needs• ‘CLAC’ partnership therefore dissolved

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The commissioning maze: where do we go from here?

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Understand what we want!

• 1st 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) as follows:

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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 Deming1900 – 1993

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Systems Thinking – Advice Services• Previous experience of systems-thinking approach in

Portsmouth:– Repairs– Rent arrears– Community Wardens

• Partnership with AdviceUK (Nottingham work)• May 2011 Interventions:

– Portsmouth Advice Centre (PAC)– PCC’s Tenancy Support (TS) and Money Advice Team

(MAT)11

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 – to customers•Understanding the system•Realisation that the system was driving the work, not vice versa

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Waste Steps

Waste = Spending time doing things again which have not been done right the first time

Waste = Duplication of effort

Waste = Doing things which add no value to the customer or the organisation

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56% Value 44% Failure

205 - 345 per week

Take ticket from

machine Take a

seat

Called to reception &

handed green form

Take a seat

and fill in form

Hand in form to

reception

Take a seat

Form details entered on IT, ticket number on form, board

in back office updated and form placed in tray

Advisor picks up oldest form from

tray and calls client number

Advisor and client go to interview

room

Advice given

Client leaves

Average 69 minutes : could take 2 hrs 39

mins

Client enters centre

Avg 33% of clients leave

before adviser is free

Purpose: Give me the right advice and appropriate level of support to help me resolve my

problem(s)

On 56% of days we are open for less than 50%

of advertised hours

What we learned

Levels of need• Low level need – ‘Give me the information/tools I

need to solve my problem myself’ - 42%• Medium level need – ‘I need help/support to solve

my problem’ – 36%• High level need – ‘Sort my problem out for me’ – 24%Service needed ability to respond flexibly to each level

of need, designed around the high frequency demand we identified

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Defining purpose

Better understood our customers’ needs Defined purpose in customers’ terms Purpose supported by underlying principles Learning then drove the commissioning

process:

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Redefined Purpose:To provide an advice service that supports the people of Portsmouth to solve their problems.

This advice will be offered in the areas of: Debt* Money Welfare benefits* Employment* Housing* Consumer rights Family law

* Indicates those areas that are predictable, high-volume demand. However list should not be considered exhaustive and providers should assume that the needs of the citizen may change during the term of the contract.

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PAS – Principles

• Responsive• Enabling • High quality• Professional• Flexible• Collaborative

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Knowing what we didn’t want to commission:

• Understanding the customer journey and blockages in the system (mapping flow)

• Understanding what was value work (always back to purpose); leading to

• Understanding what wasn’t value work (failure demand – our own and other agencies – waste steps)

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Commissioning:

• Learning drove the commissioning and tender specification

• Purpose and principles overarching framework• Applicants presented with learning through

open day presentation and tender documentation

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Commissioning: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 21

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’?)

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Commissioning:Did it work? Yes!•The framework used for submissions demonstrated clearly whether organisations understood the approach;•whether they could relate it to ways they had worked previously•and most importantly, whether they could think about the work in a new way, in accordance with our particular needs

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Measuring success• Number of people trying to access the service by type and

frequency• Number of people successfully accessing the service by type

and frequency• Number of people who abandon trying to access the service by

type and frequency• 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

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Just the beginning• New transformed service launched beginning April • 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 ‘inthe work’

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