System Integration and Productivity 2019: Our Approach in Social Care

Monday, January 7, 2019

For the first of our exploratory thought pieces in 2019, we’ve looked at how Social Care systems and processes have adapted to meet ever-increasing demand, and whether we truly are thinking differently about how our services evolve and transform to meet customers’ needs.

Working with over 40 Councils in both Children’s and Adults Services, we have asked the questions and challenged the answers to understand what it really takes to manage demand and become more productive in 2019.  The below offers some critical thinking to how we currently measure and deliver services, and what we might need to do differently to be successful.

A key theme to the below is integration – and, whilst the interface between health and social care, multi-agency, place-based, asset-based approaches are already squarely on the radar – this focus sometimes misses the just-as-important integration within and between social care departments.

 

The Productivity Question – How we Plan, Do, and Review

Productivity isn’t about doing more work for the same hours, or even trying to get the same work done for less input.  It’s about getting it right first time – removing waste, identifying practices that don’t add value and ensuring goals are aligned to meet the same outcome, across all participants in the system (customers, providers and commissioners).  Here are some key system elements that we’ve discovered require some rethinking to get to the heart of the productivity question.

 
 

  1. Reframe your front door performance measures

    A front door performance measure might look like “no. of calls taken” or “reason for call”.  However, when we asked what do our customers and other professionals want from their first point of contact – the answer that often comes back is: “To speak to the right person who can help me straightaway”.  We’ve found that often this is not measured, or the relative importance of it gets lost in volume statistics and signposting information.

    To ask the question, “did our front door solve the customer’s reason for calling the first time?” is not the same as our front door being able to give advice and guidance, with no further action required.  It means being able to conduct critical tasks such as identifying that an assessment is needed and having the assets to book this directly with the customer, or liaise with other departments directly to respond to actions, not just queries i.e. changing requirements or short term interventions.

    A service cannot do the above without skilled front of house staff and a strong internal communication network.  This measure asks the critical questions and focuses resource on getting it right first time.  It allows management to align resources correctly and minimise the transfer of customers from one department to another, which only delays the process, increasing risk and costs in the long run.

     

  2. The best Assessment is on-going, iterative, and focused on change, not keeping things the same

    A social care assessment is focused on the long game.  It considers the path a customer might take over months and years, and what could and should happen with them, for them and enabling them to do as much as possible with the faculties and assets available.  This being said, it is also a relationship between the customer and their service navigator (whether this is a social worker or other professional) that must be established and evolves over time – the best assessment might take weeks and months to turn into the perfect support plan, and over several visits and interactions.

    Whilst one or two conversations and a ‘best fit’ of support might speed up the initial assessment, this can be at the cost of a much deeper relationship – and one that would risk missed opportunities in meeting the right outcomes, searching for new and innovative provision and holding the long-term view of the customer’s journey to ransom – our case auditing experience within Councils has shown that there are  plenty of missed opportunities in the assessment, that feed into lessons learned for when the next cohort of customers come through our doors.

    Think an extended assessment is unachievable without an increase in capacity?  See point (1), realign resources in the right place at the right time and your assessment resource will spend less time responding to queries and more time to truly generate customer relationships.

      

  3. Steer the ship little and often, generate good habits quickly, and follow-up in short bursts

The most productive (and best-led) organisations have frequent, small time windows to undertake their day-to-day review and focus on just a small number of measures to ensure that the work is on track.  I’ve personally worked across a number of examples in both health and social care, and share just two here:

Example #1:  During an improvement programme focused on length of stay working in a mental health hospital, an experienced medical consultant adopted a new process to ask just 3 questions of every single patient on their staff ward rounds twice a week:

  1. Has the initial crisis that brought the patient to the ward now been stabilised?
  2. Is the onward destination for the patient ready to receive them?
  3. Would we have avoided admission if the patient was presented today in their current state?

There is, of course, a system of checks and balances which sits behind this, however the analysis is always the same: A “yes” to every question means the patient can and should be discharged.  A “no” to any single question generates an action to be reviewed at the next ward round. Within a number of weeks, average length of stay dropped by 25%, patients reported more time spent with the consultant, and staff were more consistently able to meet planned discharge dates successfully.

 

Example #2:  In an integrated Children’s Services department (bringing together Education, Social Care and CAMHS partners), the problem of high caseloads was reframed to focus on the simplest actions first in order to move those service users which required complex interventions on to the next stage of their journey. 

A once lengthy caseload review held once a month between peers which prioritised complex cases and often lacked the time to discuss the simplest of actions to close cases, turned into an efficient weekly meeting which discussed every case and the actions required.

Within 18 weeks, throughput in the department increased by 27% and waiting times for assessment and therapy reduced by 43% and 49% respectively.  In addition, agency staffing was reduced by 20% and the same volume of cases was handled with a smaller, permanent workforce.