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.
So, you have decided to log demand into the police. Make sure you look at all the demands coming in, they come in on the phone, by email, and into the enquiry counters. And what about when officers are on the beat, and from the phone at enquiry counters, don't forget those...
Then a table is made up of demand. And if youre thinking a little further, you decide to focus using an outside-in perspective, to see what REAL demands are coming in. So split the demand into value and failure demands. Take a systems thinking view of demand.
The demand coming into the police are far more tricky to analyse than transactional based system. Why? well, because these demands are:
1. They are varied. Some demand is a simple questions, some are for requests for police service, and others are just plain calls for help. If you try and combine them together, on a spreadsheet, then you may be working with data that is just too summarised to make any real decisions on. A demand for a shotgun licence, to a call to attend a historic burglary, to a call for a domestic issue, to a call asking about help on a civil matter. Some of those demands will take a great deal of time to answer, and what matters to the caller and the subsequent response is vastly different.
2. In a simpler system, like a bank, a demand is a call for service, and the service delivery follows that demand. With the police a demand may be followed up by subsequent demands, that are of value. They represent communciation that is part of the flow of work. Maybe in these cases it is better to view these demands as in process demands.
If you treat the demands above as the same for computational and analysis purposes, you will aggregate apples and pairs as being the same fruit. And how useful will the information be? Maybe a better way is to look at the police system from an outside in perspective, and group demands into:
a. Transactional demands - that starts as a demand from the public, and the police provide a service or answer, and then it is complete. These transactional demands can then be further categorised.
b. Help me demands - where a member of the public needs help and support. These cases are sometimes complex, sometimes not directly do with the police, and their resolution may be long term.
c. Different types of demands follow different flows of work. If they do, then these demands are different and be wary of aggregating them into statistics.
So, whats the best thing to do with demands into the police? Be very wary of categorising them to any standard apart from that from the outside in perspective, and use what matters as a guide. Then you will create groups of demands that will truly be useful to operations to analyse how to deal with them.
Lean, or systems thinking gives a view of your organisation that is often difficult to view, in todays pressured and prioritised environment. Using it will help you to see why certain issues remain resistant to change, regardless of how many consultants, or how much money is thrown at it.
A link to Joan Donnelly article on Demand, from Policing Insight here
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