Sometimes it is difficult to see a way through. Sometimes, what we have always done no longer works. Sometimes the solution is so simple and obvious in hindsight. Of course, in our world of data, there is always a journey of challenges to overcome to reach something meaningful and understandable. This was the case for our recent business models project with our adults social care service. The project came about through a review of existing products, and conversations about how they might be used differently to support decision makers.
We already had multiple reports pulling together information from across the system that would be updated and refreshed periodically. But we wanted to find a way to bring all of the data together into a clear, concise product that would provide up to date insight to support business decisions throughout someone’s journey through the adult social care system.
Working with our adults social care service a plan was devised to produce an insight product to better represent the social care system as a whole, and demonstrate how activity and changes in one area of the service might affect other areas. The business models project was split into two distinct key parts. The first part would address the customer journey through the wider adults social care system. The latter stage would then focus on scenarios. The scenario models focussed on the impact of changes in key parts of the system and how they might impact others.
The result was a business models dashboard providing up to date data on demand, and several additional scenario tools allowing end users to change key inputs to see the effect of changes at different stages of the system.
Understanding the customers experience and their journey through social care
To understand our approach to this project it is worth considering just how complex and vast the social care space can be. Services are tailored and delivered to individuals. Every individual customer is unique, with their own needs and preferences, and therefore their own support needs. Despite the seemingly infinite level of variations and the wide variety of ways that individuals move through the system there is a basic framework that we were able to follow. Our colleagues within the adults social care service had already done a great deal of planning and processes mapping of the key stages of the social care process, and this provided a strong system to base our analysis on. During this phase our focus was on volumes of cases and what decisions were made. We wanted to identify the most common paths through the system and highlight any unusual or unexpected pathways.
In terms of our approach, the first thing we did was move existing reporting around so that we could follow the customer journey flow mapped out by our operational colleagues. We started by gathering all our system entry points as the “Front Door”. This included hospital discharges, contacts and some direct referral services. We also then grouped key activities such as the assessment of need as specific steps and grouped things like our occupational therapy (physical equipment) and technology enabled care (such as falls alarms and monitors) as early intervention services. The logic of forming an early intervention step was that these services are designed to reduce demand on managed services, so it makes sense to evaluate whether they are effective at supporting specific lower level needs and allowing individuals to live independently for longer.
The final stage was to look at need rather than next actions. When determining need, most of our existing reporting and analysis looks at what actually happened next. We took a different approach in this case. We focussed on the social workers analysis and comments throughout each stage of the process. We used the identified needs for this at the relevant stage. This allowed us to understand how needs are being met. Where a specific need was identified, by comparing the identified need to the next actions it was possible to determine whether needs are being met by a specific intervention or service, or whether those needs are being met as part of another service.
This approach allowed our service managers and directors to understand how people are moving through our system and how they are moving between different interventions and services.
“The services network diagram shows us common routes of escalation. It clearly shows where cases individuals are changing services and provides evidence of common routes” – A service director
Finally, we automated the data processes and combined across the system so the report would always show the latest information from our case management systems, meaning our operational managers would always have the latest picture to base decisions on.
Modelling Scenarios – What if we did something different?
The next part of the project was to build on customer journeys and understand how changes in one area of the system will affect another. We decided to look particularly at how waiting lists can impact the wider system, which produced some unexpected and interesting outcomes. We used various regression modelling techniques to track progress through the system from the front door (initial entry point) through to an individual starting to receive a managed service. We built in some variables to allow our service colleagues to explore the relationship between demand, waiting time and outcome.
In terms of outcomes, there were several key findings at this stage. The first was that, in general the longer a case was waiting, the more likely it was that a case would escalate. For escalations, we used safeguarding concerns being raised and hospital admissions. The reason these are important is that each of these events will trigger more work, be that through review or reassessment of needs, additional contacts, or additional safeguarding investigations and implementation of plans.
Despite the relationship between time waited and escalation we made two conclusions through the scenario model. The first conclusion was that waiting times and demand were being by the service. The other key conclusion was that teams are managing their work flexibly. There was a direct link between increases in number of assessments being raised and the number being completed. Essentially, when the number of incoming cases increased the managers were aware and would prioritise this area to ensure there wasn’t a build-up in waiting demand.
“The scenario tool has helped me have conversations with team managers. I was able to talk with a team who are exceeding their targets in terms of time to assess a case. The team manager wished to allow their workers some leeway against the assessment timeliness targets to focus on other areas of work where there was high demand. This enabled us to discuss and understand the effect of various changes to timescales and the likely knock on impact for the team” – A Service Director
The Future
We have recently added to the scenarios with model examining how the length of time in one service leads on to other services and outcomes.
This work provides a base for us to develop more scenarios and to support the service in designing their service offer for the future. This and future scenarios will enable the service identify areas where changes will make the most difference and to evaluate the impact of options in the future. Ultimately, this suite of tools could be used to help ensure that we continue to offer the right services to our residents to meet their support needs.
Leave a comment