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From Home Adaptations to Accessible Homes - redesigning services using business processes

From Home Adaptations to Accessible Homes - redesigning services using business processes 31 st May 2012 Tom Gilchrist. Background to Bristol. Rapidly growing city – 430,000 Fastest growing 0 – 10 age group in England Economically successful

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From Home Adaptations to Accessible Homes - redesigning services using business processes

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  1. From Home Adaptations to Accessible Homes - redesigning services using business processes 31st May 2012 Tom Gilchrist

  2. Background to Bristol • Rapidly growing city – 430,000 • Fastest growing 0 – 10 age group in England • Economically successful • City of contrasts – greater income range and pockets of significant deprivation • Housing profile; social static (19%); owner-occupation in decline; rapid rise in social/Privaterenting

  3. Older and Disabled People • 40% increase in service demand since 2008, will rise further • 20% forecast increase in 85+ population by 2021 • 60% increase in disabled children over 40 years

  4. Background to the Home Adaptation Service • Multi-tenure service (from 2006) • Unit costs competitive • Fast-tracking (within adaptations team) • Demand-led • Budget increases – waiting lists still increasing lagging behind demand • New RP protocol in place (2010) • Top-up funding available for DFG’s • 2 delivery agencies – in-house and HIA

  5. Drivers for Change - Organisational • High satisfaction: Large no. of complaints! • Long waiting times and growing waiting lists • Service split between 3 directorates and 2 organisations (very disjointed) • Inconsistency in waiting times between tenures

  6. Drivers for Change - external • Increasing demand • Political pressure to reduce waiting times • Policy issues: • hospital discharge • community care • Falling resources (PSRG) removal 2011 • Threat of Audit Commission ‘red flag’ due to waiting times: • Private sector 15 months (standard priority) • Landlord sector 18 months(standardpriority)

  7. Approach • LEAN systems/BPR • Learn from customer experiences (journey mapping) • Learn from staff • Manage as a project with board • Use business analysis techniques • External Project Manager; Process Maps

  8. What Did We Discover? • 2 completely separate services (assessment and delivery) and 4 different processes • Little understanding of customer types • Professional and organisational barriers • Focus on product, not on need • Needs assessment/specification divorced from budget decisions

  9. What Else Did We Discover? • Only 20% of staff time was spent with customers • Separate queues • Too many home visits (surveyors and OT’s) • Poormanagement reporting • 4 different IT systems; no interfaces • Average length of process too long

  10. And More…… • Professional silos • Day-to-day focus • No understanding or ownership of whole process • Inward looking • Not outcome focussed; waiting list driven • Heavy reliance on public funding • Lack of customer involvement • Tendered contractors - profit driven

  11. Changes • Re-design and simplification of whole process, eliminating organisational and professional boundaries • Process designed around customer journeys • Outcome-based performance measures • Strong emphasis on diagnostics and triage at beginning – better training • Greater efficiency by reducing home visits and less hands-on contract management

  12. How We Are Doing It Now • Case-workers are at the centre of the new process • Strong diagnostic, based on need, by OT/OTA • Diagnostic carried out at ‘assessment centre’ which is co-located with WOE Home Improvement Agency • Emphasis on meeting needs with simpler/cheaper solutions • Reconfiguring IT systems (little cost saving: improved reporting) • More emphasis on self-funding and re-housing • Standing customer-focus panel • Demand management - new assessment criteria and better information to customer

  13. Consequences • Average ‘end-to-end’ times reduced (new cases) 71 to 30 weeks (7.5 months), many resolved within days. Will reduce further as new process becomes ‘the norm’ • Different processes used for backlog/new cases • One manager with an integrated team of caseworkers, surveyors and OT’s • Capacity increased (assessment centre seeing 6 cases/day) • Lower cost solutions increasingly used – budget stretched • Net revenue savings over 6 years of £609k • Mobile working by OT’s and surveyors • Savings re-invested in IT improvements, more caseworkers and specialist re-housing OT

  14. What Does ThisMean for Real People? – Mrs. K • Diagnosis at Assessment Centre • Small number of aids (bath board & toilet frame) met her needs and were issued • Interested in self-funding a new shower; she tried out various options at the centre • 4 months later she returned aids having had shower installed at her expense • Outcome: • Quick resolution to immediate needs • More choice • Avoided long wait during which time her condition would have deteriorated • Deflected from taking DFG

  15. Mrs. C • Seen at assessment centre within 8 weeks (overChristmas period) • Assessed for bath lift and step. Provided bed and armchair raisers, toilet grab rail and lever taps • All equipment was demonstrated to her • Equipment delivered within a few days of assessment. • Outcome: • Able to take a bath unaided for first time in years • High risk of fall avoided • Mrs C very pleased

  16. Mrs C • Client suffers from Inflammatory arthritis, bowl disease, falls, social isolation and anxiety and depression. • Property accessed via steps to front door and up 18 steps to first floor • Client unable to use bath and perching stool unusable. • Family unable to provide support. Homecare costs incurred. • Projected costs for adaptation £7K (access improvements and intercom) plus monthly pendant alarm. • Support provided to bid for house and handholding/support throughout move. • Minor adaptations installed and small incentive towards move costs (total cost £1,250) • Better outcome achieved: more usable property found (level access, equipped shower room which can be used independently) no further homecare costs. • Client closer to family who call in daily to call daily to provide support • Time from initial enquiry to move: 16 weeks

  17. Mr. & Mrs. J • Unable to manage stairs to first floor RP flat • Applied for re-housing but placed in lowest band • HIA assisted them to have health assessment • Banding increased and successfully bid for 1 bed sheltered RP bungalow • Now very happy; able to go out more, able to hang out washing, reduced risk of trips

  18. Top Tips • Take a customer-centred view: not all customers are the same! • Senior managers/directors need to own the change • Take an end-to-end view of all processes • Get objectives agreed; measure progress against them • Spend time understanding what’s going (As Is) • Be forensically analytical • If possible capture system-wide costs and benefits • Engage all key stakeholders • If possible test out new processes by piloting • Implementing’s not the end of the story, use ‘process ownership’ and benefits realisation to ensure its working

  19. What Next? • Process Ownership Board: multi-agency • change management • benefits realisation • outcome tracking • Re-commissioning of HIA • sub-regional • integration of Assessment Centre with HIA • Introduce IT integration • Continuation of process mapping – re-housing

  20. Questions Tom.gilchrist@bristol.gov.uk 0117 352 1975

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