How better understanding leads to better lives - PowerPoint Presentation

Slide1

How better understanding leads to better lives

Joanne Gibson

Brendan O’DonovanSlide2

Changing management thinking

Command and Control

Thinking

The Vanguard Method

Targets, standards, service levels; Relate to budget

Make #s + manage people

Separated from work

Functional specialisation

Top-down, hierarchy

Perspective

Outside-in, system

Design

Decision-making

Measures

Role of management

Act on the system

Designed against purpose; demonstrate variation

Integrated with work

Demand, value and flow

Control

Motivation

Intrinsic

Contractual

Attitude to customers

What matters…..?

Contractual

Attitude to suppliers

Co-operation, mutuality

Approach to change

Reactive, projects, by plan

Adaptive, integral, emergent

Extrinsic (carrot & stick)

Ethos

Learning

from this….

Purpose is to move the organisation

to this….Slide3

What matters to you?

5 mins with the person next to you, find out what matters to the person next to you.

10 min feedbackPERSPECTIVESlide4

Hierarchy of what matters

Physiological

SafetyLove/BelongingEsteem – confidence, achievementSlide5

Mrs McKenzie (not untypical)

“

Can Mum go to a lunch club?” (100 spare places)Assessment  Delay  DepressionGP  medicationDiet affectedHospital  infectionCare Home

N.B. It cost £1,000 to assess each £100 of careSee O’Donovan B 2011 ‘Systems Thinking in Adult Social Care’ in Zokaei, K, Seddon, J and O’Donovan, B eds 2011Slide6

What mattered to

Mrs

McKenzieHow much of the work is VALUE work versus ‘what mattered’?What were the missed opportunities?What could a different conversation sound like?What could costs have looked like?

Mrs McKenzieSlide7

Cost &

Capacity

£

Time

1995

2017

X

XX

???

1. What were the missed opportunities?Family with Complex NeedsOlder person with increasing dependencyIndividual who has a “wobble” and falls over

2. If we designed the work differently what would the impact be on the family’s journey?Mrs McKenzie is not untypicalSlide8

The test of a good measure

1) It relates to the purpose of the system. 2) It facilitates learning and understanding about the system; it helps connect actions with consequences. 3) It demonstrates variation over time. 4) It is in the hands of the people who do the work, to understand and improve the work. 5) It is used by managers to act on the system.

How many of your current measures pass this test?MEASURESSlide9

Measures must be derived from purpose

PurposeMethodMeasuresOtherwise you’

ll have a de facto purpose….Help young people to live independent lives Average Unit Costs downReduce demand

Number of young people who leave the service able to get about independentlyUnderstand what matters to young people about how they get aboutProcure the cheapest service

Manage the budgetManage demandSlide10

…

Circumstances Prior to intervention

2 children, 1 bed, 2nd floor flat. Separated. Partner in prison for 10 yrs (attempted murder).Pregnant with 3rd child and birth imminent

High-rent arrears. Evicted from previous property due to rent arrears.No motivation, confidence. On anti-depressants.Children’s school attendance very poor. Not attending their health appointments e.g. dentist.Not able to manage her home at all. Lack of hygiene for her and children.6+ agencies engaged prior to involvement but no support as tenant not engaging.New Measures Case Study ‘A’

Costs from Start of intervention Additional activities include:Help preparing to move.Removing unwanted belongingsMultiple agency time at Core Group and Child in Need Meetings.EST. COST OF ALL ACTIVITIES: £ 2,210

What they said they wanted:Being listened to/heard.

Financial problems to be sorted.More confidence.Being able to manage the property.

My own space.More space for the children to play.Children to sleep in their own bedroom.Sleeping arrangements

do not affect children's sleep.Potential Outcome under ‘old way’Eviction and classed as intentionally homeless. All 3 children would have been taken into care.

Potential admission to hospitalAT WHAT COST?

What was delivered:Frequent ‘understand me’ visits.

Changed property whilst in arrears, helped her to understand finances, change to benefits.Frequent visits from Home Support.

Move to 3 bed houseSlide11

Circumstances prior

to team involvement

- 73yr old citizen who lived at home with his wife prior to his hospital admission 5 months ago - diagnosis – discitis, diabetic – insulin dependent - lived independently prior to admission - members of the local church and also used to go on coaching trips with his wife - married his 2nd wife 4 years ago – very supportiveWhat they said mattersWhat we did / they did“ I want to go home”“ I want to be with my wife”“ I want to have access to the conservatory. This will provide me with an opportunity to take pictures of the garden”. - we have taken ownership of the case from the ward

We have had the “what matters conversation with the citizen and his wife”Pulled in expertise – OT, physio, GP and community nurse. Preparation for discharge – access visit, discussion held with citizen and wife. Citizen has expressed that he wants his wife to assist him with his transfer. Citizen has privately arranged his own wet room. Avoided going through DFG grantsCitizen has declined careline and will instead use his mobile. No need to go through careline system e.g. having care and repair to install the equipment. Potential outcome in the ‘old’ system - case conference – MDT & citizen & additional forms. - case wouldn’t initially have been allocated to community OT – has provided intervention from the start.Unified assessment would have been completed and eligibility criteria would have been implemented. U.A would have been completed after 1 meeting with the citizen. ‘potential costs’

Estimate saving of around £120.54 a week on home care. Traditional care package would consist of 2 calls a day. PEN PICTURESlide12

Are we delivering what matters?Slide13

Early Results – Impact of MDT Integrated Redesign on costsSlide14

Homecare

2015

2014

2013Average Hours/week

6.317.05

7.31Average cost/week

£102.40£105.97

£116.04Enablement

201520142013

Average hours/week7.13

13.567.29

Average cost/week£130.60

£159.53£130.51Slide15

Old System

Redesigned System

Saving (08/09 grants)

End to end time

675 Days

64 Days611 Days

Flow steps291 Steps34 Steps

257 StepsPreventable demand

71% Preventable40% Preventable

31%Average cost of physical works

£7,000£6,509

£491Average cost of delivery

£499.76£319.98£179.78

Capability to complete DFG’s at current spend levels

10 Months7 Months

3 MonthsMileage£10,633

based on 07/0852% reduction

£5,516Dropout

N/ANil

N/ADISABLED FACILITIES GRANTSSlide16

‘

Roll-In

’ (Sample Size: Entire Stroke Pathway)Domain

BeforeNow

% stroke patients treated in ASU60%

100%Time to transfer to ASU

1.6 days2 hours

% patients spending at least 90% of their time on ASU30%

80%Average LOS

16 days6 days

Bed base56 beds

39 beds

Cost per patient£6k

£3kProfit per patient

(£2k)£1k

DomainCost BenefitNet cost benefit released in Acute

23% Neurology Budget, 14% All Hospital BudgetCost reduction in externally commissioned rehab beds

17%Slide17

Children’s services

70% already known to system (repeat/failure demand) - system failing to deliver what was right for the child/family the first time round 80% of social worker time spent filling in forms (c.f. White et al 2010) Functionally specialised, many handoffs meaning child’s story having to be told many times Cases being passed through up to 15 different professionals, including average of 3 different social workersGibson, J and O’Donovan, B 2014 ‘The Vanguard Method as Applied to the Design and Management of English and Welsh Children’s Services Departments’ Systemic Practice and Action Research February 2014, Volume 27, Issue 1, pp 39-55Slide18
Slide19

Children’s services

Early results

End to end time from referral to support being identified - mean of 91.4 days  2.3 daysE2E support being identified to provision of support - dropped from a mean of 41 days  6.3 days However, quality of understanding trumps speed Continuity of care with single social worker Fundamental change in role of manager – ‘how well are we achieving purpose?’ Identify & remove barriersGibson, J and O’Donovan, B 2014 ‘The Vanguard Method as Applied to the Design and Management of English and Welsh Children’s Services Departments’ Systemic Practice and Action Research February 2014, Volume 27, Issue 1, pp 39-55Slide20

To improve performance, change thinking

Thinking

SystemPerformancePurpose

MeasuresMethod