These are the symbols on the performance report for that very same service….
Why are these so different?
The faces of the old people are measuring what matters to them.
The managers of the service are measuring what matters to THEM.
They are measuring different things.
The clients have presented the Social Care service with a demand.
They need help with a problem they have.
Typical problems are…
- “I want to continue bathing myself but am finding it difficult getting in the bath”
- “It is hard climbing the stairs, I’m worried I might fall”
- “I can’t manage cooking in my kitchen nowadays”
The typical Adult Social Care response is in two parts
- Assess eligibility; and if eligible
- Deliver care
This is what they do, and therefore this is what they measure.
Typical measures are
- % of clients assessed in 4 weeks
- number of clients waiting to be assessed
- maximum days in queue waiting to be assessed
- average number of days clients wait to be assessed.
- % of recipients of care who got their care package within 4 weeks
- % of equipment and adaptations delivered within 7 working days
These are queue management measures.
They are for people whose job is managing:
- number of items of work in a queue; and
- how long those items have been in the queue for
These are typical industrial management tasks for managing demand and resources to produce services.
This model of work is found everywhere where management see their purpose as the two activitivies of managing the total amount of demand in queues and how long it has been there, it produces weird effects such as
- Call Centre staff will get friends or other staff to ring up when it is quiet to boost answering times to it looks like they are processing work quicker.
- Accident and Emergency room management where patients are admitted to hospital and occupy a bed regardless of their medical need, rather than breach the arbitrary 4 hour target. 59% of admissions were admitted in the last 10 minutes before breaching.
These silly results are produced by a mental model of work for producing. In the service sector it mainly produces sad people though.
- Sad staff, whose job becomes processing people as standard work packages not helping them with their personal needs
- Sad managers, whose job becomes “meet the numbers” and the numbers are always hard to meet; but most of all it produces…
- Sad clients, who don’t get their problem solved
So, back to the top. Why are there sad clients but happy performance figures?
Meet Fred* (not real name).
Fred had operations on his knees and finds it hard to balance now.
He is wary of getting in and out the bath, he is worried he will lose his balance and fall. His daughter lives too far away to pop around all the time.
Fred stops taking baths.
When his daughter finds out she calls the council and speaks with their Occupational Therapy team.
So there is a bathing assessment, a bath seat is prescribed, ordered, delivered and installed.
And it doesn’t work.
Fred doesn’t like making a fuss though, so he doesnt tell his daughter.
He hasn’t had a bath in months, so has been washing himself at the sink all Winter.
Where is Fred in the performance figures?
Fred is there, in the smiley faces and ticks.
Fred is there, in the failure demand caused by the failure to meet his need, when his daughter makes frequent calls to the service to try and chase the case.
Fred is there, in the file sitting on somebodies desk because they are off on leave.
Fred is there, in the increased demand placed on a service trying to reduce their demand by stopping doing things for their clients.
Fred is there, in the increased likelihood he will present again sometime in the future due to all the things that will result from inadequate personal hygiene.
Fred is most easily seen in a different sort of performance report though…
This is a different sort of assessment done by Gloucestershire Health Services. They concentrate on finding out what matters to the client from their perspective and measure the success of their service by how well it meets the clients needs.
Not by measuring how well they meet their own needs to manage queues within arbitrary target times.
The systems thinking lesson
You cannot parachute the right measures into the sort of environment that hides Fred’s poor service in terrible performance reports.
Targets and the use of binary comparisons between this month and last month to produce a colour or a symbol, these are silly but just getting rid of them does not get rid of the problem.
It is not a measurement problem that has to be solved.
The wrong measures reported the wrong way are a symptom of the wrong thinking.
The terrible measures that hide Fred make sense in the silly command and control world of industrial management.
The task is to help managers see that they don’t make sense in the real world of Fred.