Interesting to read this article in the guardian that the issues with the NHS are not just about ‘fixing people’ when they are unwell. But that loneliness has a large impact on people well-being, demonstrated in the figures for 50% less life expectancy to those that are lonely.
When I did some work in the NHS, and we looked at the demand into hospitals and also helping people in the community - going to the GP, or after they have left the hospital. Something about what we were learning about the demand seemed to need further analysis. It is easy to treat different types of demand as common categories - broken leg, diabetes, etc. But when we looked at the time taken to help people get back to a normal life, there was great variation in the resources and time used with the same category.
We discovered that certain people absorbed far more resources, visit their GP, or were admitted to hospital far more than others. These people often had a level of complexity to their situation that was not obviously identified when looking at their records. When we analysed a cohort of patients it was obvious to attribute age to the cause of increasing complexity. But looking at each person in detail we discovered the causes were various. And what was the highest cause of complexity? Loneliness.
It surprised everyone around us, that this was the result of the analysis. And how well had this health trust geared itself up to respond to this problem? Well, apart from having weekly public social gatherings, the problem was not on anyones radar as being important.
What we did
What we did was to tackle the loneliness head on, taking a cohort of people that were in the health system. The result was that their interaction with the health system went down, in some cases so dramatically, that they stopped seeing anyone in the NHS.
Its how we view our demand
Prior to this analysis, the NHS had been looking at demand using categories that they had created and defined each person. However, this is a good example of looking at a complex system, and applying system thinking principles and techniques to its analysis and design. Then the demand is understood outside-in, how people interact with the system, and what matters to them. This simple approach allows an organisation to fundamentally alter their approach to how they deal with people, so that their resourcrs are cut by 30%, and the outcomes are improved. Predefined categories tend to limit our ability to really understand our organisation and the workflow clearly.
Copyright, John Klossner
Data sharing, often a major stumbling block to joined-up working in the public sector. How to use a systemic approach to thinking about the problem and delivering a different and far easier solution.
Lets start with a real case study and define the problem that this organisation had.
I came across a new data sharing issue in a new Hub we were redesigning recently. In this situation local government Council staff were newly sitting next to and working with the Police. The question was:
How do we now share information between us?
This was a project started to develop the workflows, policies and practice in the Hub. The Police, and Council front line staff were in a multi-disciplinary change team, and the managers were connected to that team.
What the Police Did
If anyone works with the Police you will find that they have a quite different way of making decisions than any other type of organisation. In the situation with the Hub, they made a local decision to share data in the way that supervisors on the ground thought was reasonable. However, when they went and asked their Data Controller, and the Controller replied they could not share any of the data. As simple as that! The Police then spent the rest of the three months in this position - frustrated, but unable to proceed.
The Standard Solution
As is usual, the purpose has to be defined or understood. It will be defined by managers, and may be defined something like;
we need a set of rules on how to legally share data between us, that protects people and allows us to work together efficiently.
This is the usual approach in most organisations to solve a problem like this. They will ask a consultant with analytical knowledge to look at this as a project and study the data. They also need to be fully aware of the legislation, so they ask the Data Controller and get a copy of the Data Protection Act, and read it in detail.
This consultant then takes the data types from a data analyst, and attempts to categorise the data into the categories that make sense, and that show different levels of risk. They would look at the job roles of all the people involved and attempt to make a judgement as to the data they are required to view and why. And engage with the Data Controller and put all the collected findings on the table.
The outcome will be a report, that will be approved, and then circulated down through the hierarchy - as each manager makes sure that their particular concern or point is contained in the final report. In some cases this step in the process can take many months and the problem is seen as:
the needs of different stakeholders, which must be taken into account.
Staff groups are put on a schedule to listen to their managers tell them what the new rules are.
The Systemic Approach
Again, the first step that has to happen is that the problem has to be understood. This is done by going to where the work is. The change team listen to demands coming into the Hub, by actually listening to the conversations. They have to understand the whole problem and what matters to the person making the demand.
The purpose they define for the sharing of information remains undefined.
The next step, after listening to the demand, is to undertake the work - by just doing the work that matters to fix the problem - together with the person.
So what of the data sharing? Well, the example above is looked at by the team, and the key information that was needed to provide the knowledge required to solve the problem is written down.
The above process is repeated several times, until the team understand enough about the demands and the knowledge. They might do 20 or more demands.
Then the team sit together and analyse what knowledge is needed, and where it is usually held. Interestingly it is quite often held in peoples memories rather than simply in a computer.
The purpose they define for the sharing of information now emerges from the evidence.
This analysis is then used to define the agreement on the sharing of knowledge. If a manager does not like this, or wants to add other rules, then they have to work with the team to demonstrate that the evidence proves that this change should be made.
The word data is not included in any document or discussion. The purpose of this exercise is the sharing of knowledge
From a systems thinking perspective, what is important in this problem is not about data, but pertinent information regarding a council officer about to visit the property of someone. As soon as you make it data you have entered the world of concepts and ideas. Systems thinking has to be firmly rooted in the reality of what the the system is really about.
The solution was surprisingly easy, focus on the information - not the data. When there is a new demand, and the council officer wants to know about the what we know about the person making the demand, then they ask a police officer in-front of a computer if there are any issues I need to be aware of when I visit Mr. Smith.
The officer could respond with;
After the demands were understood, It took about two weeks to define, and make into a workshop for staff.
The Difference Between Systems Thinking and our Usual Approach?
Point 1 - there is are no stakeholder needs, as the person and the demand defines the need.
Point 2 - there is no inflexible set of rules that applies to certain categories of demands.
Point 3 - the managers do not initially define the outcome, the evidence does. Then the managers agree the analysis the team undertook.
What is needed is not the data, its the knowledge I need before the visit and during the process. This real need by-passes all data arguments, as the real basis of data sharing is the sharing of knowledge. The sharing of data can be a side issue to the main principle, that is often used when sharing is between people far away from each other and who are unable to collaborate. If you can collaborate with your colleague in the other service, then the sharing becomes one of knowledge - and a different and much easier problem to fix.
In addition, this approach supports the front line staff and is flexible to every situation. So no detailed procedures or rules are necessary - just the creation of a set of principles to work to in a framework that front-line staff can be coached to use.
This is an real example of using systems thinking to the problem of data sharing. The problem is redefined from data to knowledge - which is should have always been in the first place, if the legislation had been looked at from a systemic perspective then maybe the problem so many public sector organisations are having would be made alot easier.
The data protection act in the UK is actually written to help data sharing and to prevent private organisations from marketing our data. But we tend to see it only as the method of restricting communication. Certainly those who wrote it made a big error in the way that it puts across the central concept of what it is about. But, it really does focus on DATA, and in public sector operations we are far more interested in information.
In my time, 15 years improving the public sector, and so many projects I lost count. In every single one, the IT is always a barrier. Why is that? Because it is almost always designed as a stand alone IT solution, and not viewed as a solution to a service end to end - systemically. And I was used to be IT and still remember...
The managers who received the suited IT sales person usually tells me a grief story, several years after the visit. Hopes dashed, money spent, and the system is installed and wont be budged. For managers who are increasingly searching for easy solutions to austerity, IT is attractive, and so is outsourcing, and so are sharing management teams, and so are... etc.
CRM is a project that failed. The systems are still there but the concept is meaningless to people in need. Those still working tey main functions have been switched off.
The front office - back office system is based on simple transactional flows - thats not the majority of work in local councils. The indexing and scanning process introduces the most admin waste I have ever seen anywhere.
The choice based letting system, taken from Delft, is hugely wasteful, and is quietly being modified out of existence in many councils, that are trying to work helping people with their housing problems. This system actually prevents people getting the help they need.
The ERP systems are hugely wasteful, in the way they were implemented. I end up working round them.
Digital front ends - I have never seen one that works for the majority of the demands that service gets. The planning one hardly ever used for real demands.
Then the national systems - thats an international disgrace. The IT providers had an inkling, in some cases, that the national NHS and integrated control systems would not work.
In the article that I am referring to here, they talk about the IT focusing on the transactional simple flows - but these flows only take up around 20% of the resource of the council to deal with. I would suggest managers focus on the 80%, those more complex issues, and those most needy, and fixing the root causes in our communities.
So, I am not disagreeing with the benefits of robotic automated systems, I would suggest that its a matter of priority, and busy public sector managers would do well to focus on the real problems to solve. Before I was helping the public sector, I was in IT, and I can see how it works from the IT industry perspective. Now I am on the other side of the fence, and I can see that IT has to follow the redesigned service, and not the other way around.
Customer experience is a top priority, its one of the main things that creates a successful organisation. - I disagree with this statement.
Is it not true that customer experience is merely a priority? Customer experience is far more than that, it defines an organisation; it is what happens in your organisation after a customer has started their interaction. It is as fundamental a thing as you can define.
If you get it wrong and do not align yourself well with the customer from the start, then you are always simply trying to catch up with the customer - any spending time and resources doing it. Get it right, and things get alot easier. If you delegate customer experience to simply a priority, then think again. Tell-tale signs your organisation is making this mistake would be customer feedback reports landing on your desk. Those reports should be focusing on learning about customer workflows feedback.
So, if you want to sort your organisation operations out, and have a good efficient and effective customer workflow, start with the initial customer demand, and align your organisation from that point on - cutting out the barriers to a good flow.
The evidence is proven when working with organisations with a contact centre. It takes a day or so to gauge how effective the customer facing staff are at aligning your customer to do business with you. Then, the next day, the impact of the whole organisation workflow on the customer can be measured. In may contact centres the measurement of wasted work is 20 - 40%.
This is then a very good time to have a conversation, with evidence, about where to start improving your workflow. And technology is not the saviour, you leadership decisions from this point forward are.
From a methodology perspective its not about smiley faces, and questionnaires. this is about seeing an organisation as a system, and then responding to this knowledge with systems thinking leadership - which is surprisingly easy.
It is interesting to watch our fascination with the power and capability with digital computers in the last decade. Not only do they now dominate out work technology, they they also have a certain fascination for us.
Is it because they come in a discrete box, and they do exactly what we want them to do?
Is it because they do not answer back?
is it because they do not behave in ways that are illogical?
What about the people that we employ, are they being marginalised by technology?
Someone asked a great thinker that I know; "What is your view on the use of computers in the workplace. Does it help or hinder?"
Has answer was,
"When I look at a workflow, I not cannot see it, and it is locked into IT. So how can we understand and improve it?"
As a modern manager it requires work and effort to motivate, build a great team, and empower staff. I suspect that many managers love technology solutions because they do not have deal as much with real people?
Just do what the computer tells you...
If we analyse some of the most flexible, efficient and effective organisations, they still value empowering people above IT technology. Their managers work hard to develop their staff so that they can utilise the most of peoples abilities. And I know thats a well worn statement, but before we forget, is the message still:
IT technology vs people, its people that have more of many (not all) of the attributes required for success. Until that changes, true success still lies with engaging people.
This is a message I have to use when I work with helping managers transform their organisations to the next level of performance. I do this by proving it to them; using their staff as the team to undertake the learning and transformation. Keeping well away from technology, to develop the new workflow, and create a motivated and effective team first. Make it work. Then introduce IT.
Helping others to learn how to do better things