A couple of years ago I attended a conference hosted by Stoke-on-Trent City Council called A radical approach to reshaping public services. It was one of the most informative I’ve ever been to, so I thought a summary might be useful to anyone struggling to navigate public sector services. I’ve re-posted it here because it outlines an approach that’s very relevant to SEN support – person-centred planning.
A team from the city council and another from Bromsgrove and Redditch councils explained how they were applying Vanguard’s systems thinking approach to the way they support local people. The two teams had tackled local issues slightly differently; in this post I’ve amalgamated what they described, to give an overview. Obviously, this is my own overview and I’m happy to be corrected if I’ve got anything wrong.
Although both teams use the Vanguard approach, systems thinking for organisations wasn’t invented by Vanguard, but is based on the principles of systems theory. Systems theory is pretty robust. We know how systems work in many different domains. Because organisations are systems, applying systems theory to them makes a lot of sense. (Management theories, by contrast, usually address only part of the organizational system, and that’s why they tend not to work very well.)
Some key principles of systems thinking as applied to organisations
Form follows function
If you want your organization to be effective, you need to have a clear idea of its function. If its ultimate goal is to make sure local people can get on with their lives (the primary purpose of local authorities) you need to have valid, reliable and relevant information about what services people need to enable them to do that. Then you can decide what things your organization has to do to meet those needs (function) and what structure will best enable it to do those things (form).
Systems should be designed as whole systems
If you’re designing a system, you need to make sure the whole system is actually doing what it’s supposed to do. A system is essentially a set of interacting components. If you change one component, there’s a good chance another component will be affected, so you need to check out the impact on the system as a whole, or the system as a whole might not work.
Good data about the nature of demand is essential
“Demand’ is anything that takes energy out of the system. It includes the processes the system carries out, the number of people using it and the complexity of their needs, the cost of staffing, buildings and equipment etc. It also includes what Vanguard calls ‘failure demand’ – demand due solely to the failure of the system to function efficiently. Failure demand would include duplication, re-referrals, complaints etc.
Variation requires adaptability
A system dealing with high variation (e.g. a large population with a wide range of needs) must be adaptable if it’s to respond appropriately to that variation. The best way we’ve found so far of meeting the wide range of needs across a community is through the classic model of professional expertise. For millennia, communities have met needs through access to people with high levels of expertise, whether carpenters or doctors, tailors or teachers. The key features of these professionals are that they have a high level of both specialist expertise and autonomy. Both qualities are characteristic of the teams using the systems thinking approach.
How do you apply systems thinking to a public service organisation?
Stoke-on-Trent City Council was faced with escalating problems – unemployment, rent arrears, anti-social behaviour etc – at the same time as experiencing significant reductions in funding. It was clear that even before funding cuts, whatever the council was doing to tackle the problems wasn’t an unqualified success, so a radical change was needed to avert disaster. The council applied the systems thinking approach in three phases;
• an analysis of the effectiveness of the old system,
• a pilot study of the systems thinking approach in one location, and
• scaling-up the new system informed by data gathered from the pilot study.
Phase 1: Analysing the effectiveness of the old system
Because it was clear that the old system a) wasn’t working efficiently and b) wasn’t financially sustainable, a detailed examination of its strengths and weaknesses might, on the face of it, appear to be a waste of time. It turns out that several useful outcomes emerge from a detailed analysis of current practice. A analysis enables you to;
• look at the system as a system, not as a set of disconnected agencies and departments,
• see how effective the system is, and why it is or isn’t effective, and
• get detailed information about costs.
The city council already had good city-wide data, so they knew where most of the problems were located geographically, but they didn’t know much about the people with the problems. They couldn’t answer the question “Where do the people who go through your system end up?”
The council team looked in detail at a small number of complex cases from the point of view of the people involved. Analyses carried out by a multi-agency team shed light on how the old system worked – or rather how it didn’t work. The analyses included mapping the pathways followed by people using the system, creating a timeline of interactions with agencies, and comparing what people wanted with what they got.
Mapping the pathways followed by people using the system
Typically, when someone first engaged with the system, the department they contacted dealt with issues within their remit, and then referred the person to other departments or agencies for any other issues. To analyse the pathways people followed, the team drew a map, for each case study, showing each referral. They ended up with some hugely complex diagrams, showing that people often ended up in loops of referrals and re-referrals to the same agencies. Anyone unfamiliar with the system would have found it bewildering and frustrating. Confusion and frustration is what people using public sector systems often report, but until you’ve seen it mapped out on paper, it’s difficult to see where the specific causes of the confusion and frustration lie.
Diagram showing how referrals were mapped
Mapping out a time-line of interactions with different agencies
The team also looked at what interactions people had with different agencies and when. They used used post-it notes to represent interactions, colour-coded for the relevant agency, on a timeline. A typical pattern consisted of a few interactions with a single agency for a few months that then rapidly fanned out into many interactions with multiple agencies. What was clear was that there was no ownership of the case by any specific agency.
Diagram showing timeline of interactions
Asking people what they wanted
The team compared what support people said they wanted with what they actually got. One woman, who ended up with health and mobility problems, no support and her children in care, initially had two ‘wants’; access to the first floor of her home and help with housework. If those ‘wants’ had been met at the outset, the cost to the council would have been relatively low. As it was, the fact that neither ‘want’ was addressed resulted in an outcome that was very expensive for the council and catastrophic for the family.
What these exercises showed is that;
• the problems that people presented with (e.g. rent arrears) were often outcomes of other problems
• people often accurately identified the root causes of problems given the opportunity to do so
• addressing the root causes promptly could result in significant financial savings and avoid problems becoming complex
• people using services often experienced unnecessary referrals to multiple agencies and many agencies were duplicating each other’s work
• each interaction with services added to costs
• each increase in complexity of problems added to costs.
Phase 2: Pilot study in one locality
An area of the city known to have high needs was chosen for a pilot study. A ‘locality’ team was set up to respond to issues raised by people in this area. The team’s brief was to address any problems identified when people living in this area came into contact with any local authority services or with the fire or police services, which were by now actively involved with the project.
The new locality team differed from the old functional teams in several important respects;
• each team member would be responsible for ensuring the support of a small group of citizens
• they ‘pulled in’ additional expertise to the team if required, rather than referring the citizen out to another agency
• they used measures to monitor performance and outcomes but didn’t use targets
Phase 3: Evaluating the effectiveness of the pilot study
After six months, the pilot study was evaluated at three levels, Tier 3 – the city level, Tier 2 – which could be described as the locality level, and Tier 1 – the individual level.
Tier 3: City level evaluation
Two years prior to the pilot study the council had identified 35 key strategic measures in order to monitor the cost-effectiveness of their services, so they already had good data at the macro-level, Tier 3. The team used the ‘triangle of need’ to identify the level of support required by particular households.
Triangle of need
Small, but clear reductions in costs for the pilot area of the city were evident compared to similar localities used as controls. The results are tentative because the intervention had only been in place for 6 months.
Tier 1: Individual level evaluation
During the pilot study, the outcomes for seven people were assessed in detail, so data were then available at the individual level – Tier 1. The results were not what the team expected. Overall, the number of interactions with local authority services had increased, but the cumulative cost of those interactions had gone down slightly. By contrast, the demand on health and police services decreased significantly – in some cases by around 90%. Fire service interactions increased, but costs also plummeted because fire service involvement was around fire prevention, not emergency call-outs.
The seven citizens were asked at the beginning of the pilot study what problems they wanted to resolve and their perception of their progress towards resolution was mapped on radar (spider) charts. After six months most had seen significant improvements. The locality teams also filmed some quite moving interviews with people who’d received support from them. The citizens in question were obviously grateful to the locality teams for providing them with relevant, timely support. And surprised that the council offered that support at all.
Tier 2 – Locality level evaluation
After the first 6 months, the proportion of households in the pilot locality needing multiple-agency or specialist support had dropped from 35% to 20%. The council estimates that there are around 5,000 households in the city that fall into one of these two categories and that if the improvements seen in the pilot study can be scaled-up city-wide, over 5 years the council could save £40-80m.
Some points worth noting emerged during the course of the conference.
Getting other agencies on board was essential
Stoke city council were clear that they couldn’t have proceeded with this work without the active involvement of the police and fire services, and that getting the support of people in charge of other agencies was essential. The massive cost savings to the police, fire and health services suggested their involvement was a worthwhile investment.
Local councillors, often initially sceptical about yet another re-organisation, generally found the facts and figures persuasive.
Seeing the situation on the ground is essential
One housing officer was shocked when she visited the properties that tenants were expected to occupy. So were other team members when they found out what had happened to people who’d contacted their departments. What’s on paper doesn’t always match real life.
It takes time to build up the trust of people using the new system
Finding out more about people’s problems can seem intrusive, and it took time to build up the trust of those with complex problems. But word-of-mouth recommendations about timely, effective support and positive outcomes is beginning to change the relationship between local people and the council.
Staff using the systems thinking approach wouldn’t go back to the old system
Council officers found their working life transformed by the increase in variety, autonomy and effectiveness of their new roles. Most wouldn’t go back to the old way of working. One important factor in improving the time taken to respond to problems, was that the members of the locality team (including a fire officer, a police officer and an alcohol support worker) were based in the same room, resulting in almost instant communication. Other agencies had a designated member of staff to deal with locality team queries.
The main problem with systems thinking – it looks like common sense
One of the drawbacks of systems thinking is that it looks so obvious, it’s easy for organisations to think they are using it already .
For example, many local authority children’s services use multi-agency teams and emphasise the importance of ‘joined-up thinking’, but the teams, their thinking and the outcomes that result bear little resemblance to the locality teams or the outcomes they’ve achieved.
I’ve also seen the triangle of need used by another local authority, not as a way of representing data, but to categorise children with disabilities (low, medium and high needs). Support is available only to families with children with severe or complex needs – those in the top section – meaning there’s a real risk that the problems of families in the middle section will be allowed to escalate.
Systems thinking is based on tried-and-tested principles. It can cope with highly variable demand and results in increased job satisfaction, reduced costs and improved quality of service. The savings and improvements can be significant. A real ray of hope in a public sector facing its greatest ever challenges.
Update: My understanding is that the pilot wasn’t rolled out to the rest of Stoke-on-Trent because of factors such as this – http://www.potteye.co.uk/vanguard-savings-dont-add-up/. In other words, the Vanguard approach revealed the true cost of housing maintenance and the true cost of the backlog, so was abandoned.
Originally posted in October 2013 at https://logicalincrementalism.wordpress.com/2013/10/20/public-services-and-systems-thinking/