Treat your customer as valuable

Hospital
Treating your customer as valuable could be the first step to understanding what your customer values.
 
Shopping Carts
Shopping Carts

I went shopping in my local supermarket. It was eventful for the number of things that went wrong for me, all of which could have been prevented with some foresight and some real-world gemba.

 
It was early in the morning so I had chance to see the store operate with fewer customers. This also meant that I could move around the store quicker than usual. So from that perceptive, the shopping expedition was a success….at least until the checkout process.
 
For a large supermarket, there were no checkout assistants at that time in the morning. Instead, there was a bay of 4 self-service checkouts. That’s not too bad, I find them very useful when I have a handful of items. However on this occasion I had a full trolley and had no choice but to use the self-service checkouts. The first issue with this is that there is very little space to put items once you’ve scanned them. To keep scanning more items, I had to swap out each bag once I’d filled it. Every time I did this, the machine told me off. This meant that a checkout supervisor had to come across and tell the machine to ignore the missing bag. That dance occurred several times since the trolley was full.
 
I valued the speed and efficiency of being able to pick my items at my convenience. I didn’t mind whether I scanned the items or whether they were scanned by a checkout assistant. However I did mind the lack of planning for catering for shoppers who had more than a basket. And I minded being reprimanded by a machine for solving a problem that it was creating. I’m confident enough that I have zero issues with being reprimanded by a machine; it’s just a set of algorithms encoded by another human. In this case, a human that didn’t foresee the machine being attached to a tiny tray and being used by a shopper with a trolley. But I did mind the rigmarole that it created.
 
Discharge
Discharge

I had a brief stay in hospital a few years ago. Everything ran smoothly until I was discharged. From my perspective, I was still a patient regardless of the official status. I was in hospital, feeling lousy and weak after 5 days of little to no food or drink and due to continue with medication for a further 7 days. Nothing major, but enough that I was allocated a hospital bed (if you’re familiar with the UK’s NHS, that’s a good measure of a condition). I was discharged in the morning, roughly 9:30am and was due the following dose of medication at 10:30am. Unfortunately, medication after discharge isn’t dispensed by the ward staff, it comes from the hospital pharmacist. I spent 3 hours waiting for the hospital discharge to deliver my medication to the ward so I could go home. That meant I couldn’t arrange transport since I didn’t know when I could leave. More importantly to me, the medication I was due at 10:30am didn’t arrive until the afternoon. During this time I occupied a hospital bed, although I think I would have been moved to a day room had the ward been full to capacity.

 
 
 

Analysis

At that time, NHS hospitals in the UK had a 28 day return policy, in that they were fined for patients who were readmitted for the same condition within 28 days of discharge. That goes some way to ensuring that discharges are medically appropriate. Unfortunately it doesn’t go to check that the discharge process itself is appropriate. It’s still focussed on the condition that the person was originally admitted for, rather than the smoothness of the discharge process. It’s as if the patient is no longer a patient once medically discharged, assuming they will be safe in their environment (e.g. home). The actual situation is somewhat more intricate than that but the effect on the discharged patient isn’t any different. To them, they’re still in hospital, still expecting the rest of the hospital services to be working to achieve the full discharge (not just the medical discharge).
 
Similarly, for the supermarket. The main experience was great but marred by the part of the process where I actually get the goods I pay for.
 
In neither of those cases did I feel fully valued. In the case of the hospital, I can forgive easily. However, from the perspective of efficiency, there’s a lot to be said for getting me out of the hospital as quickly as possible, so as to free up resources for others who need them. The more time I spent in the hospital following the medical discharge, the more failure demand I created (simply by being there, not that I created it on purpose). And the more risk of something happening while I was on the hospital grounds.
 
This leads onto the peak-end rule where we attribute a large portion of our memory of the experience based on the peak and the end of the customer journey. So no matter how good a service you provide to your customers, they’ll remember how it ends.
 

Your Customers’ Problems Are Your Problems

bathroom

I’m writing a new book, this will be my second*. I’d written a couple of chapters last week, one of which focussed on how organisations leave problems for the customers to resolve, but that they don’t think of it that way. In one chapter, I used the example of “Warning. Hot Water.” signs, stipulating that the organisation has decided that rather than fix the problem, they’ll leave it to the customer to work around the problem. Every day, every day they use the tap. When viewed like that, putting a sign up doesn’t really resolve the problem.

I was in a hotel at the weekend and I tend to think of hotels as having solved this particular problem a long time ago; it’s usually workplace offices that still have these signs. But enter the bathroom and it’s plastered with “Warning. Hot Water” signs. And it was seriously hot, close to scalding. For IHG, you’ll find this out when I review the hotel. It was just one of a list of issues. I travel a lot. I’m pretty flexible and lenient as far as hotels go. If there’s a problem, as long as it’s resolved, I’m happy. By that, I meant that I recognise that there are faults in any system, in any organisation and that’s ok by me. But if it’s a systemic failure, then I’m concerned. This hotel had a number of repeated failings. A quick look at trip advisor shows the issues are not isolated.

At what point does someone responsible for fixing a problem decide that a sign is enough? That the customer can have the problem? Did they work through a customer journey? Did they wonder what it would be like to be tired after travelling, hungry, thirsty, maybe a headache? Maybe not speaking English as a first language. Maybe not being used to English norms regarding taps (plumbing doesn’t seem to be standardised across the world)?

Why would we expect a foreign guest and customer to be familiar with the quirks our hotel’s plumbing?

Signs such as this protect the organisation. They inform the customer, but they do not remove the problem.

I go into more detail in the new book. If you’d like to be informed, subscribe to the newsletter.

 

*If you’re curious why you haven’t seen the first book, it’s because I haven’t released it yet. The first draft is ready and I’m taking a short break from it to gain some distance before returning for the final push.

Failure in public sector – The Reprise

support-2355701_1280

I read Vim‘s article on What Does Failure Mean for Public Services  and I wanted to respond. I wanted to build upon Vim’s thoughts from my own perspective. I’ve developed that perspective over a couple of decades working across front-line teams and supporting teams, transforming workforces across public and private sector. This results in me having to balance many different levels of change (including success and failure) ranging from a conversation discussing funding allocations over £100m, followed by a conversation discussing attitudes to change, shortly followed by another discussing the approach for very local decision-making such as choosing the ideal location for a printer.

It’s mostly the same

We should see failure in the public sector in the same way that we see failure in the private sector with the one, not so subtle difference; the public sector is there to make a difference to the population. Pick a public sector service, if it’s not making a positive difference to the population, then it’s failing. I can’t think of a simpler definition. Every other private sector metric (perhaps with some tailoring in the case of profit metric) should apply to the public sector.

Unfortunately, the more we pick it apart, the more difficult it becomes to define failure. And most of that difficulty comes from the difference between providing for the population and providing for an individual.

Most of the failure is seen at the individual level, but not extrapolated quickly enough to realise that the service is failing. Most of the success is also seen at the individual level but we don’t really celebrate these as much unless they’re specifically health-related. For many services, we only notice when they go wrong. For instance, how many local authorities celebrated 0 people in the queue for social housing back in the 70s when it was feasible? Perversely, we may be able to achieve 0 in the queue now, but that could be because eligibility thresholds have risen. It’s not the same service or the same level of service anymore.

At one extreme, we see the death of an individual, we see one person homeless. Then we see multiple people homeless due to congregating together, but it takes longer for social consciousness to become more aware of the deaths of increasing number of individuals. All of this could be failure.

Criminal or Incompetent?

“He’s either criminally incompetent or incompetently criminal”

It’s a phrase I heard years ago from a charitable organisation that raised no money after holding an event where lots of people attended and money changed hands but no profit was made to turn into funds for the charity. We’re talking small money here, margins were very tight, but even so, no-one quite knew what happened.

That’s partly how I think about the systemic failure within public services although I’ll broaden the definition of criminal to include unethical, immoral or against the mass of service users you’re meant to be serving. When a service is failing, I wonder where the decision was that caused it to fail. Was someone competently unethical or incompetently ethical? Competently immoral or incompetently moral? Bear in mind that leaves out the options of competently ethical (where they’ve chosen to improve services and made it happen) or incompetently unethical (where they tried to restrict services but enacted it poorly).

Was it an implementation or management decision by the team manager to assign a lesser-skilled worker to the case where a more experienced one was required? Implying incompetence on the manager’s part.

Or was it because there wasn’t enough money to pay for more experienced workers, resulting in only newly-qualified workers being available? Implying a deliberate decision to underfund on the funder’s part.

Did the funder underfund because they’d allocated more funds to other services? implying an incompetence on the funder’s part.

Or did that funder not have enough money to distribute to the services because of a reduction in centralised funds, e.g. from central government? Again, implying a conscious decision to underfund numerous services.

Expectations

Public services are funded to meet the demand that’s expected to present to that service, e.g. through referrals from other services and bodies, through walk-in or through outreach (where the team goes out educating the population on the service available). It’s always a balance between who is at most need of the service, the funds available, the skills and experience of the team available and the time available to respond.

Considering public services have a duty to provide for the population, if a service cannot meet the demands placed upon it, who is criminal and who is competent/incompetent?

The manager should understand the costs of the service and the variation based on demand being presented. At the point that it becomes underfunded, it’s time to shout. For many services, that point was passed many years ago. Underfunding results in some people not being served or the quality of service (in terms of what can be provided, e.g. the duration of engagement such as number of CBT sessions) is reduced. That then has a further human impact, e.g. people being homeless or in debt which both can lead to homeless and in debt, which leads to decreasing health, which leads to inability to work (but possibly not recognised as inability). Even one day of no service provision can escalate quickly, exacerbated by the climate of mistrust and unbalanced power between those services with funds and those people applying for funds. That one day can result in missing benefits, resulting in deteriorating health (have to choose between rent, paying heating/lighting bills, feeding children and self, getting to a job interview, clothing, etc). So underfunding a service so that it can’t provide to all it’s designed to deliver to has a cascading effect on the system through shifting referrals elsewhere or to a position of no services available and has a cascading effect on the individual.

When viewed that way, is the funder criminal (or at least unethical or immoral) if they don’t fund the service?

Reducing Inefficiency

The issue and opportunity to this point over the last couple of decades has been the inefficiency inherent in the public sector system. Public sector services do not get the same level of investment as private sector. A telco can choose to spend multiple millions of pounds on a transformation programme and it will happen. No questions (or at least no scrutiny other than board approvals and monitoring). A public service has to jump through many hoops (each costing time, effort and money) to prove it’s spending the money wisely. So public sector transformation programmes usually start smaller than private sector counterparts to make the programme easier to approve, and end up being smaller still after being watered down through many approval boards. Each of these transformations leaves an effect, usually positive in terms of efficiency, but often negative in terms of morale and capacity to flex for the next transformation.

There is still room to go in terms of efficiency. There are still pockets with severe inefficiencies, but they’re rarely on the front-line teams to the scale that’s expected. And it’s these teams that are usually the focus of funding pressures, especially in response to changing demographics, e.g. people living longer and living with more serious needs.

Active Maintenance

In addition, services need active maintenance, to some extent in the same way that you take your car in for regular maintenance. However it’s more than that. Active maintenance is not simply day-to-day management and keeping it running. It’s observing the service from multiple angles to understand what’s happening that shouldn’t be, to uncover why it’s happening and to resolve it so it doesn’t happen again. That takes an investment of time and energy.

In most public sector hierarchies that responsibility falls to the manager. The better managers (there are a few of them) have empowered their team to do this daily. They’re succeeding in keeping the service to acceptable levels (although still probably underfunded to do the job they were originally tasked to do) and keeping ahead of changes in demand. Then there are others who are just managing the day-to-day or take on adapting to change themselves. Even if competent as day-to-day managers, they’re incompetent overall since the service remains static.

Failed Culture

Vim mentions that “Failure in the public sector is also rooted in a culture that means you can’t fail”. The issue is wider than that. It’s already failing. It’s already underfunded. Austerity or not, there isn’t sufficient money to meet front-line services at their current level of demand in the way that they are currently working. Asking a team to be prepared to fail is an awkward request since in their hearts, they’re already aware of the people they’re not able to help. Most of the professional health colleges put a focus on treating the person in front of you, not those in the queue later on. Give proper treatment to the person that you’re currently treating. In a throughput setting, such as a hospital ward with a flow of patients in and out, that makes sense. In a setting where you have a caseload, such as found in most social care settings, that makes less sense overall. The opener to this conundrum of supply and demand is that we may be able to help more people and help them better than now through experimentation. And that has to be allowed to fail. 

Even with that opener, bear in mind that there are ethical considerations in most public sector departments, especially those in education, health or care settings. The Authority has a duty to treat everyone from an equitable position, not necessarily equally. So it can’t create an experiment that disadvantages a customer segment. This can be inadvertent, e.g. by promoting one customer segment’s needs, it alters that principle of equitability. So by improving the service for one segment, it can’t make the rest of the service worse. It’s also widening the gap between the treatment of segments. That’s not a blanket “no”, just be prepared to think it through and complete an Equalities Impact Assessment before you start.

How much is too much training?

Hospital ward
I’m divided in this, but lean towards only brief training, just enough to inform them, rather than enough to practice.
 
On one hand, it pays to understand why change in general is necessary and specifically, why the change that you’re about to implement is necessary. Often I see professionals who spend time with the person sat in front of them (and so they are patient-centred) but ignore the mass of people also requiring the same service. It’s not that they can’t see the queue (whether a real standing queue or a waiting list), it’s that if they recognise the queue then they realise that they can’t serve everyone to the same level. For some, it’s a question of professional ethics, where their professional body demands that they treat the person in front of them to the best of their ability, regardless of the needs of others. There are good reasons for that approach.
 
Usually, someone, e.g. a manager or budget holder, recognises the capacity issue and so increases the eligibility threshold or reduces the professional time available for that treatment. This is an attempt to average it out. However it misses the point that some treatments take time to work, if you half the time available, then you may get zero results, not 50% of the results had you allowed the necessary time for full treatment. It also leads to a worsening service as the capacity gets further reduced through a series of cuts, so that wouldn’t be the answer that we’d choose given a choice.
 
More fundamentally, the communities that the local and regional health providers serve are different to those that existed 30 years ago and the changed communities have different needs. So, it seems obvious that we have to adapt the service to meet the changed needs.
 
On the other hand, the health professionals are just that; professionals in health. There will be some with additional skills; some complementary, some tangential. I wouldn’t expect health professionals to be experts at change. However they do need to be aware of the change and why they have to contribute. As do we all, no matter what job we perform, no matter which sector we work in.
 
By recognising the above issues, we can more easily understand why we have to continually change. It’s a matter of adapting to needs. However that doesn’t feel like it requires a formal training in the guise of a university module, more an hour or so during induction combined with some questions during the interview to assess their attitude to change. I expect the professionals to know the service best, so they should be best placed to change it rather than having budgetary changes applied without thought to impact on patients.
 
To get this message across and gain acceptance and commitment from the group, I usually go through the need for change at the start of any change programme and definitely before each intervention.
 
One area where I think some training could be useful is in negotiating and debating how services will change. The changes will happen, but being able to influence the changes could be invaluable. Oddly enough though, it’s probably not the health professionals who need the training, instead it’s for anyone who’s trying to change the service, e.g. performance improvement staff, HR/OD, commissioners, etc.
 
I think the reason for my varied opinions above is that I see a difference between management and change management. I acknowledge that management techniques should be taught in advance as well as broad concepts of changes management, whereas the required, more detailed parts of change management can be taught as required.
 
I don’t believe we should conduct changes without speaking to the end customer. Taking on the role of patient, I’d much prefer the consultant to have spent their time learning how to treat patients, rather than learning how to manage change. Let’s permit some degree of functional specialisation, with front-line professionals continuing to be good at what they do and change professionals helping them create/design the service that the patients need.
 
However, I recognise that many front-line professionals either don’t have access to change professionals or do have access but that they’re not listened to. Hence the need for a book that’s applied for front-line staff.

How accurate is your testing routine?

Traynor Guitar Amp

Testing is not just for software, but for the business processes, organisation or service that you’re implementing?

I’ve seen many test routines that are too artificial, too removed from the reality of what the users will go through. Fortunately this factor has improved over time, especially with more focus on user stories.

Let’s consider one of the best examples of testing I’ve ever seen. Guitar amps are generally fragile. They’re usually robust enough for scrapes and minor bashes as you’re carrying them through doorways, but they don’t survive being dropped down stairs very well.

One amp manufacturer had a test routine of removing the glass valves (they’re replaceable consumables) and then throwing the test amp from the roof of the building to emulate the journey that some amps go through. On the ground, they inserted valves and powered it up to see if it would work.

How does that compare to your test routine? Is yours as accurate to the reality that it will be used in?

Here’s a clip of the actual test

Art requires rigour, science requires creativity

RigourAndCreativity

I heard this quote the other day, but I didn’t catch who originally said it.

Art requires rigour, science requires creativity

The first point is that it’s contrary to the standard view. The second point is that both perspectives are valid and that there shouldn’t be that much of a difference.

It then made me think of typical transformation programme roles and the relation between creativity and rigour. Most roles have a balance between the two, with that balance changing according to the standard role and, at times, according to the demands on that role.

RigourAndCreativity
Rigour And Creativity

For instance, process analysts should generally follow a set of standards. Business Analysts have to be more creative, but still have methodologies to follow. Service Designers have less rigour methods, usually a composition of tools and techniques rather than the standardised methodologies of previous decades. At the more rigorous side, project managers have their methodologies and frameworks to follow. Programme managers see a wider scope and have more creativity in organising the interdependencies. Which then fits nicely with my normal comment that a Business Architect has more in common with a Programme Manager than a Project Manager; there are more skills in common, even though the professional methods involved are different. Which leads me to the Business Architect who has to know when to be standardised and when to be creative. There has to be the flexibility to modify the approach to suit the needs of the client, depending on the stage of transformation.

 

 

 

 

The Parallels Between RPA and Fax Automation

Fax Machine

There are times when the cheap and nasty solution is so economically efficient that it can preclude doing it properly later on.

Background – The Fax

Just under a decade ago, I was working with a local authority client and their NHS hospital partner. The interpretation of the law at that time was that email was considered a non-secure channel. Fax was at the time the chosen channel since it was considered to be secure.

So documents were sent from the hospital, via the fax machine to the fax machine in the social care offices. Continuing Health Care panels met to decide on whether the NHS or the local authority paid for the care, based on whether the primary need was a health need or a social care need. That’s simplifying the logic behind the process and the decision but it’s enough detail for this article.

To be able to make that decision on tens or hundreds of thousands of pounds per year per person, that panel needed to review the data about that individual carefully. So this meant that 40-150 pages per person would be faxed from the hospital to the social care office.

The process for this was relatively convoluted:

  • the hospital professional (therapist, nurse, discharge planner, etc) collates the documents
  • they ring the social care office and tell them they’re about to send the documents
  • they feed the documents into the fax machine
  • they’re sending more than the fax machine can fit into its auto-document feeder, so they have to standby to top it up
  • at the other end, the fax machine starts printing
  • the social worker picks up the paper before it falls onto the floor
  • the fax machine runs out of paper (several hundred pages per panel and it’s likely that you’ll have to refill the paper)
  • the social worker obtains blank paper, loads the fax machine with the new paper
  • the social worker collates all the faxes
  • the hospital professional rings the social worker to confirm that they have the documents.

The First Proposal – Email

Naturally, the partners want to make this more efficient so the design conversation usually reverts to proposal of email. But, as mentioned earlier, that’s not considered secure. Or at least the email solutions available at that time were not secure.

But there is a strange alternative.

The Implemented Solution – Fax Gateway

We used fax gateways at either end. It turns an email into a fax to be communicated on the phone line, to then be converted back to an email at the other end. The revised process was a lot more efficient:

  • the hospital professional (therapist, nurse, discharge planner, etc) collates the images ready to be sent (e.g. prints to file or scans in the remaining few that they don’t have electronically)
  • they send an email containing the fax header and the documents to their fax gateway
  • at the other end, the fax gateway converts the received fax into an email for the social worker.
  • the social worker reads the email and downloads the attachments ready for the panel

It’s a solution that shouldn’t have existed. It relied on old technology but until the law caught up with the technology (or the technology caught up with what it had to do to be secure, e.g. nhs.net accounts, etc), then it was the cheap, workable solution. But it was messy and I shudder every time I think of it as a solution. However it made it better for the clients, making the process simpler for them as end-users and freeing up time to do more important work.

Front-End RPA

That’s what the current state of RPA feels like to me. Not the whole of RPA, but the element that’s involved in the user front-end of systems. It’s like the fax gateway. So instead of the better solution of orchestrations between the various IT systems involved, we’ll automate the front-ends.

The Parallels

Now I’m wondering if we’ll see the same situation with RPA as we did from implementing the fax gateways. We found ourselves with a cheap and nasty solution which then made the business cases for full integration prohibitive.

Why would you spend hundreds of thousands of pounds on a better solution when the cheap one works adequately?

So if that angle of RPA solves the automation from a front-end, replacing the mundane tasks performed by employees, why would we look to orchestrate the back-end?

Will initial RPA implementations deter us from better integration of products? And, more importantly, is that necessarily a bad thing? After all, my NHS and LA client were still able perform better with the cheap solution than they were able to without it, and they also avoided a costly integrated solution. In the end, it was a temporary measure until secure email became a practical solution for them and their partners. I’d expect to see parallel initiatives nowadays with RPA, with clients improving their efficiency through the introduction of RPA, but avoiding more costly integration. Especially, as a temporary measure that will likely have a longer-than-intended lifespan.

Using Archimate to model OKRs for Business Motivation

A Fabricated Example of Using OKRs with Archimate

Following the theme of moulding different modelling languages, methodologies and toolsets together, I want to take a look at how to model OKRs in Archimate.

Once again, I’m using Archi (or ArchimateTool) with the Archimate modelling language.

OKRs do not cascade

Just because the diagram depicts a hierarchy, doesn’t mean that the objectives cascade down the organisational hierarchy. Following the logic in OKRs don’t cascade, I’ve taken the approach of the depicting the hierarchy, rather than how that hierarchy is achieved. In the article, Felipe mentions that objectives should not be cascaded down the organisation. Instead, objectives and key results should be discussed and agreed at each level. The resulting picture is the same either way, but the content of the objectives and key results may be different depending on the route.

Contributing Goals

Depending on the level of the organisation, many of the components that achieve an Objective will not be Key Results, but instead will be lower level Objectives (e.g. of the next team down in the corporate hierarchy or downstream in case of a flatter hierarchy). The diagram allows both Key Results and Objectives to form part of an Objective.

Modelling Goals and Objectives

Key Results have been modelled as Outcomes. Objectives and Contributing Goals (lower-level Objectives) have been modelled as Goals. In doing so, I’ve allowed for a hierarchy of Objectives to fulfil the concept of Contributing Goals. Had I gone with a model of Objective = Outcome, we would have seen a model of hierarchical outcomes which would not have made as much sense, especially to those having to achieve those outcomes.

Alignment

From the perspective of Business Architecture, I’m interested in the alignment of actions to the overall vision. I like to see a clean line connecting actions of the workforce to corporate objectives to vision. Many organisations suffer because the objectives are cascaded down rather than agreed at each level. Combining OKRs with a culture of joint-goal setting has a good chance of resolving that core issue.

Notes about the diagram

The content is fabricated; completely artificial. I haven’t populated every single branch, but enough to indicate what could be captured. For those areas that I did populate, I kept to the concept of 3 key results per Objective, of which any of the Key Results can be replaced with Contributing Goals. You can flex that as you wish.

I’ve created a tiny environment in which the OKRs operate, featuring an internal driver for change, an external driver, the assessments for both and the corporate vision and missions.

Implementation

The interesting concept for me regarding business motivation is that the diagram is agnostic of the organisation structure in that it doesn’t indicate which team or who is responsible for achieving which objectives or key results. I’ve done that on purpose.

If we imagine a typical organisation of 400 people. Each of those named 400 individuals could have Key Results to deliver. Some of those Key Results would contribute to team Objectives. Some of those team Objectives would coalesce to fulfil higher level Objectives and so on. That’s the bottom-up picture.

The top-down picture is that the strategy needs to pervade the organisation and steer the choice of actions and the delivery of those actions. At the top level, the objectives may be independent of who is going to deliver them, but shortly thereafter the key results or contributing goals would have to be assigned. And it’s likely that they’ll be assigned to relevant directors (in the case of stretch targets and keeping the operation running) or delivery teams (in the case of changes). However each of the delivery teams should have a sponsor. It’s that sponsor that’s actually accountable in this case for the delivery of the key result, whereas in many organisations it would be the delivery team.

Overall, OKRs force a concept of personal responsibility or rather, a concept of personal accountability if we follow a RACI model. For the majority of a workforce, the individual is likely to be both accountable and responsible for their key results.

What I haven’t address is the non-aligned use of OKRs, e.g. allowing or encouraging the setting of key results that do not fit with corporate objectives.

A Fabricated Example of Using OKRs with Archimate
A Fabricated Example of Using OKRs with Archimate

Look at the Evidence – the Spike and Delay Pattern in Social Care

signature
A number of years ago, I was transforming a city’s social care directorate and, as part of that transformation, we aimed to reduce the time it took to do anything when interacting with the service. The transformation was based on a more fundamental need to free up workers to be able to do the work they were meant to do rather than having to fight the fires caused by delays and resulting failure demand. I instigated a methodical approach for identifying which cycles to focus on first. As the team progressed through the cycles, I noticed a pattern; it’s the spike of activity followed by a lengthy delay as discussed in a previous article.
As we looked in particular at a few cycles of spike followed by a delay, I routinely advised the team to question the need for that common feature of bureaucracy: the signature.

Why require a signature?

In the case of social care, signatures are often required from service users or their representatives. This can be as proof that the content of a form is accurate or as a record of the service user providing consent (either for data to be shared from the form or for the authority to request data from other agencies).
These signatures create the spike-delay pattern in which a short spike of activity is followed by a lengthy delay while the authority sends the form to the customers and waits for the return of a signed copy. Part of that delay is caused by the postal service in both directions. Part will be the time it takes the service user to open the letter, read the form, make amendments, find an envelop and stamp and then go to the post box. Considering the high percentage of infirm service users compared to the general population, that sequence of activities can take a long time. Then we have the additional wait time caused by processing the response as it arrives into the authority.

First approach

So, my first instinct is to remove the need for a signature and thereby remove the need for the spike-delay round. This could be changed from requesting a signature to providing information on the form that the data will be used. If you don’t agree, don’t submit the form. The response from staff was that we needed the signature as a record of consent and/or accuracy, depending on the form in question.
On the fact of it, that seems a reasonable and fair response.

What does the evidence say?

However, the data showed a different reality. What actually happened is that, even if the form wasn’t returned, the process could still go ahead. True, it didn’t go ahead for every service user, but the fact that it could proceed implied that the signature wasn’t always required. Or rather, wasn’t required all of the time. We were able to look at the data to understand how many service users progressed without signature, we were able to look at common characteristics, etc.
By presenting this understanding back, we ended up moving forward in our joint understanding of the process; joint in that the consultant and the team had the same understanding. Before that point, they had had different interpretations.

So where does that leave us?

An undocumented process or exception is a risk. In the above case, we had uncovered that some of the cases were allowed to progress without signature, but there was no documentation defining which cases could proceed and which cases had to stop. Instead it was left to individual judgment, but again without defined criteria. So what happens if the usual staff members weren’t present? Were the decisions they made equal and equitable to all involved? How did we measure the outcomes?
Depending on the type of organisation and service involved, there will be a different focus regarding the risk involved.
In this case, we had a process with an unclear gateway, e.g. do we continue or do we halt and wait?
  1. Complete the analysis in terms of understanding when the process can continue.
  2. Engage with service users to understand what they need out of the process, what their engagement should be
  3. As a team, choose a default option, either they progress by default or they pause by default
  4. Help the team define the rules that govern the exceptions
  5. Implement a training and induction programme for ensuring that everyone knows how to apply the rules
I always prefer the default option to be the one that improves efficiency, e.g. the one that’s the most common option or the one that removes a spike-delay pattern.

Impact

The wider understanding that, in most cases, the signature wasn’t required let us to a better solution. Had we not challenged either with data or further questioning, we would have been left with the difficult situation of lack of signatures stopping the process and the resulting action of requiring signatures in order to proceed. Instead by challenging the assumption and developing solutions to the issues of the spike-delay caused by several signatures for a sequence of documents, we were able to reduce the expected time from 6 months down to just over one day (actually 2.5 completions per week). That’s a massive difference in expectations for customer and the organisation serving the customer.
Anything to say, get in touch at @alanward.