Public Management for the 21st Century · 2019. 3. 5. · Services vs products • Services are characterised by 1) intangibility (it is a process not a product) 2) high levels of

Public Management

for the 21st Century

Benedict Wauters

Vladimír Kváča

Richard Kokeš

BENEDICT WAUTERS

• Expertise in project/programme/strategy/policy development and evaluation

• 20 years+ of experience in the public sector (European Commission – DG EMPL and the Flemish government) as well as the business sector (e.g. manager at Deloitte Consulting)

• Consulted for United Nations, OECD, European Commission (DG Research, DG Employment), NGOs, government departments, cities and regions in the Netherlands, Poland, France, Belgium,…

• lectured at several universities and business schools in various European cities in strategy, risk management, research methodology, impact evaluation…

• Director at the Flemish Ministry of Labour and Social Economy, for innovation, methodology and impact evaluation

• Currently also lecturer at Antwerp Management School and expert for the EU PAG network

VLADIMÍR KVÁČA

I am currently: • Assistant professor at Charles University, Prague, teaching policy design,

public management and evaluation

• Expert and facilitator of Public Administration and Governance Network

• External expert assessing the project proposals for ESF OP at Ministry of

Labour and Social Affairs (Social innovation, Public administration

• Independent evaluator (focused on criminal recidivism prevention)

I was: • Civil servant working for 9 years in area of European Funds management:

• Head of ESF Evaluation Team, Ministry of Labour and Social Affairs

• Director General for European Funds, Ministry of Labour

• Director of Technical Assistance OP Managing Authority,

• Director of Department of Partnership Agreement, Evaluation and

Strategy (National Coordination Authority, Ministry of Regional

Development)

RICHARD KOKEŠ

• Co-founder Gov Lab – evaluation, education and strategic

advisory for public sector

• Supervisor in Strategic Management Academy (Ministry of

Regional Development Czech Republic) • Public Administration enthusiast and futurist

Objectives of the seminar

• Look at interesting examples of public

service provision that…

• …were acknowledged as having delivered

(radical) performance improvement…

• …deviate in how they achieved this from

traditional approaches

• …and reflect together on what this can

mean practically for you (if anything)…

• …making you curious to find out more...

• ...challenging your mental models

1 hour 15 min

• A better foundation for organising the

public sector using organisational theory to

introduce two major, opposing paradigms:

bureaucratic vs flexible, networked

organisations

Policy= sticks, carrots and sermons…

• Sticks = regulations (pre/proscribing) where governee is

obligated

• Carrots = economic dis/incentives where governee is not

obligated…

…but governor makes action easier or more difficult by adduction or

deprivation of material resources (money, time, effort,..)

Financial (e.g. taxes, subsidies…)

Non-financial = mainly “services”

• Sermons= governee is not obligated nor receives material

resources, only data, facts, knowledge, arguments, moral

appeals,…

• In addition*, policy can refer to:

An expressed political will to achieve a broadly defined outcome

Delineation of permitted divergence

Vedung, 2007 *Hill and Huppe, 2011

Policy requires organisation

• “Organisation” of policy-instruments is not itself a

policy… e.g.

Direct delivery of goods and services

Public entreprise

Voluntary organisations

Market creation (auctioning rights)

Privatisation, contracting out, vouchers (introducing

competition for funds)

• …but is a pre-requisite for policy delivery!

All options still require organising contact with citizens in

some way

Vedung, 2007

Hence: an organisational theory perspective!

• “the study of how organizations work and

why they are or are not successful*”

E.g. whether there is “competition” or not, does

not explain how some fail and some are

successful

• =adherence to the “invisible hand” of the market

obscures what (should) happen(s) inside / between

organisations (black box approach)

• having the “whip”, does not mean that you know

how to breed a prize horse!

*http://dictionary.cambridge.org/dictionary/english/organizational-theory

Organisation from an open systems perspective

Activity

Dependence (relation)

People Resources

Mutual adjustment

External hierarchical steering

Anonymous steering with rules and procedures

Support Source: Kuipers, van Amelsvoort, Kramer , 2012, Het nieuwe organiseren-alternatieven voor de bureaucratie / The new

organising-alternatives for bureaucracy

Linked nodes of activity with

people/resources

Organisation from an open systems perspective

Activity

Dependence (relation)

People Resources

Mutual adjustment

External hierarchical steering

Anonymous steering with rules and procedures

Support Source: Kuipers, van Amelsvoort, Kramer , 2012, Het nieuwe organiseren-alternatieven voor de bureaucratie / The new

organising-alternatives for bureaucracy

Boundaries of the organisation exist

where people agree that they exist!

Deming’s depiction

Each element of a process is not important in itself. They are important

only in relation to a goal.

Optimisation of a part usually means sub-optimisation of the whole.

Appreciation for a system

Deming?

E. Deming

T.Ohno

William Edwards Deming was an American statistician, professor,

author, lecturer and consultant. He is perhaps best known for the

"Plan-Do-Check-Act" cycle popularly named after him. In Japan,

from 1950 onwards, he taught top management how to improve

design (and thus service), product quality, testing, and sales (the

last through global markets) through various methods, including

the application of statistical methods. Deming made a significant

contribution to Japan's later reputation for innovative high-quality

products and its economic power. He is regarded as having had

more impact upon Japanese manufacturing and business than

any other individual not of Japanese heritage. Despite being

honored in Japan in 1951 with the establishment of the Deming

Prize, he was only just beginning to win widespread recognition in

the U.S. at the time of his death in 1993. President Ronald

Reagan awarded him the National Medal of Technology in 1987.

The following year, the National Academy of Sciences gave

Deming the Distinguished Career in Science award.

T. Ohno is considered to be the father of the

Toyota Production System, which later became

Lean Manufacturing in the U.S.

Services vs products

• Services are characterised by

1) intangibility (it is a process not a product)

2) high levels of interaction (production and

consumption occur simultaneously)

3) dependence on people (with the “customer co-

producing)

• A useful perspective is to think about services as

“experiences” users are having

Every “touch point” a person has with a service

provider is part of an experience, no matter how

mundane the service is

UK Department of Trade and Industry, 2007,

Innovation in service, Occasional paper nr 9

*S.P. Osborne, Public Management Review ol 12, 1,

2010, Delivering public services: time for a new

theory?

Services vs products

• Performance of a service is a subjective

construct of the user

• Key is to interact positively with the service user

while governing and responding to their

expectations:

Users invariably judge upon the basis of process

issues, while expecting effectiveness

Relationship / trust building are key

By no means one should simply always give the user

what they ask

• In production, the work floor is typically NOT in

direct contact with product users

UK Department of Trade and Industry, 2007,

Innovation in service, Occasional paper nr 9

*S.P. Osborne, Public Management Review ol 12, 1,

2010, Delivering public services: time for a new

theory?

Systems thinking

Ever heard of

“learning

organisations”?

Peter Michael Senge is an American scientist and director of

the Center for Organizational Learning at the MIT Sloan

School of Management. He is known as author of the book

The Fifth Discipline: The art and practice of the learning

organization from 1990 (new edition 2006). He is a senior

lecturer at the System Dynamics Group at MIT Sloan School

of Management, and co-faculty at the New England Complex

Systems Institute. In 1997, Harvard Business Review

identified The Fifth Discipline as one of the seminal

management books of the previous 75 years. For this work,

he was named by Journal of Business Strategy as the

'Strategist of the Century'. They further said that he was one

of a very few people who 'had the greatest impact on the way

we conduct business today'.

“All real change is grounded in new ways

of thinking and perceiving” *

* P. Senge, The necessary revolution, p.10

Vanguard method: lean systems thinking

What is the purpose (in customer terms)? 1

Flow : Value work + Waste (both on core, support or regulating) 4

Capability of response: what is the system achieving predictably? 3

Demand : Type + Frequency What matters?

2

Thinking 6

System Conditions 5 C

U

S

T

O

M

E

R

Seddon, Vanguard

Vanguard method: lean systems thinking





2

Thinking 6


U

S

T

O

M

E

R

Seddon, Vanguard

System conditions = • structure (incl. roles and

authority, external and internal)

• targets • process design • procedures (incl. for

managing absenteeism, appraisal of staff, inspection…)

• incentives • IT…

Everything people assume CANNOT be

changed!





2

Thinking 6


U

S

T

O

M

E

R

Based on Seddon, Vanguard

E.g. Non-citizen facing Ministry influence

Service providing intermediary

Mind your place in the system

Only works if these actors

work systemically!

Role of system stewards

• goals: an overall sense of direction / purpose

rather than targets

• rules: general, limited, enabling

rather than extensive (intricate sets of standards and an intrusive

monitoring regime are likely to be ineffective)

• feedback: focus on how a system is coping, via more informal,

flexible, inquiring approaches, which requires sustained

engagement and good relations with stakeholders

rather than monitoring performance towards pre-established specific

goals

• steering without direct control (rather than direct intervention to

correct “policy drift”) via:

advocacy;

building the capacity of actors to adapt and self-improve;

connecting actors across different networks and policy areas, shifting

incentives towards innovation;

changing rules, resources, incentives where needed.

A new model…

<

<

<

Curre

nt in

put v

aria

tion:

Convers

ion fa

cto

rs +

aspira

tions

Futu

re o

utc

om

e v

aria

tion (=

capability

or

pre

dic

table

varia

tion o

f functio

nin

gs)

Future input

variation

today (weak

signals)

= org. boundary

=system conditions

=network relation

=process = high

systems

thinking

capacity

System ste-

ward

=system

steward

influence

Multi-disciplinary

approach

Multi-disciplinary

approach

Mo

tiva

tio

na

l

psycholo

gy

Four paradigm conflicts

1. Inside out perspective

versus outside in

2. Complex organisations with simple tasks

versus simple organisations with complex tasks

3. Regulating service providers

versus service providers that regulate in interaction

with users?

4. Rolling-out a negotiated way of working

versus allowing everyone to experiment with ‘perfect’

The importance of paradigms

The importance of paradigms

• Reality is reality, right?

• Yes, but the same reality can have a very

different meaning which is a force in itself

Tom Cruise’s character, Jack Harper, has some

doubts, hence he is open to seeing things in a very

different light

This makes previously inconceivable actions possible,

even though nothing in the world “objectively”

changed

Victoria "Vika" Olsen is driven more by fear, hence

closed off from other perspectives, limiting her scope

of action

Issue

Theory

Case

Reflection

Criteria: -well-documented

-externally validated -public domain

45 min

• Paradigm conflict one: inside out vs

outside in?

Case 1: Troubled families in the UK

Case 2: Social housing repairs in the UK

Troubled Families in UK

• English councils given £4,000 for

every family they managed to ‘turn

around’:

£3,200 for every family selected

£800 for every one which was

deemed a success

success is based on a list of

measurements:

• whether people involved had found

jobs

• their children truanted less

• if they committed fewer crimes…

• In the summer of 2015, Cameron

declared victory claiming: ‘I can

announce today that almost all the

117,000 families we started working

with have now been turned around.’

Social housing repair services Tees Valley

• Tees Valley Housing Group (TVHG), based in

Middlesbrough, manages almost 4,000 homes

• Established in 1996 through the merger of two

Teesside housing associations

offers homes to rent, as well as supported housing,

shared ownership properties and market rent homes,

with the majority of properties located in Teesside

operates from a single site in Middlesbrough and its

repairs service is carried out by five in-house

maintenance assistants (MA) and a number of local

contractors

operates with a flat management structure with the

repairs service managed by a Maintenance Manager

reporting to the Head of Housing Management


• traditional targets to complete repairs, which

were closely monitored, were almost 100%

achieved

• also 77.2% "very satisfied" or "satisfied with the

overall service" on customer surveys

emergency = 3

working days)

Normal = 10

working days)

POLL

• What could be problematic?

Troubled Families Programme in UK

• “Across a wide range of outcomes,… we were

unable to find consistent evidence that the

Troubled Families programme had any

significant or systematic impact”

• Families were ‘turned around’ even when

members were still involved in crime, still

addicted to drugs, still playing truant and still

engaging in / suffering from domestic violence

just so long as 1 family member had come off benefits

• Poole council in Dorset figures show it took an

average of 372 days to ‘turn around’…

but this could range from 1,852 days to eight

Troubled Families Programme in UK

• Families were chosen on the flimsiest grounds

(eg a single complaint about noise)

the government had “fixed” the nr of TFs based on a

presumed total nr of 120,000 (an estimate concerning

the number of ‘socially excluded’ families in England,

and not necessarily ones involved in crime, anti-social

behaviour or truancy) divided among the 150 local

authorities, weighted by population and social

deprivation

irrespective of the true number, a council would

happily find the “planned” nr of families


• Deviation of 10% overall when looked at completion from

the point of view of the user

What the tenant considers as "finished" is not the same as what

is considered as such by the service

Repair is not same as a ‘job’ as one repair can consist of many “jobs” (e.g. repair a

window= 1) glazing 2) carpentry 3) plastering 4) painting with glazing and carpentry

urgent but plastering and painting not…): made visible most clearly in priority 1 and 2

(urgent)!

Emergency = 3

working days)

Normal = 10

working days)

outside


"If a job could not be done owing to lack of time, materials or

access, the job was passed back for rebook. This process involved

cancelling the previous job, entering a new one and starting the

whole process again".

job classifications changed to meet deadlines (emergency became

urgent etc.)*

• The average time to complete (from the customer point of

view) for the years 2003-4 was over 28.8 days

with an increase in March and May 2004 to 46 days

due to an increase in misdiagnoses by the call centre, where at that

time new employees were hired

this was not picked up by the traditional "inside-out" targets but it

was by the new method of measuring

*Source: Vanguard consultants

POLL

• What would you suggest?

2h


outside in?



Outside in perspective





2

Thinking 6


U

S

T

O

M

E

R

Seddon, Vanguard


• involves discovering:

who is the client

the reason why the service should exist (purpose)

from their perspective

what they specifically need / demand / ask for

what matters to them (performance criteria)

how good we are at delivering

• requires to go out and step into client’s shoes

(empathise)


• Purpose:

not obvious and a strategic choice whom to serve to what

end e.g. for the police

• client could be victim, suspect, community...

• purpose could be safety, catching criminals, listening and giving

advice to citizens, improving quality of life…

• citizen may ask to file a criminal report but just want/need to sort

out a conflict with a neighbour (demand)

typically, purpose is not well understood on the frontlines

• Everyone has an opinion

• …which is rarely the same across the organisation

hence start out with “working hypothesis” of purpose,

expecting that this may shift during the transformation

process


• demand = the customer hitting the system with a

request / need

Organisations may have various transaction points with

customers e.g. a cable TV operator may

• Send a marketing pack

• Send a sales man

• Install cable

• Transmit TV programmes

• Send invoices

• Provide customer service

Seddon, Vanguard


At any of these “transaction points”, the client will

make demands:

• We need to know what type and how frequent for all of

them

• We need to know what matters for the client for all of

them

• We will need to understand interactions between these

TPs and what matters most overall

• Sometimes the better label is not “demand” but

“contact”

E.g. police need to understand what kinds of crime

and disorder appear in what frequency

• In short, whatever gets the work started

Seddon, Vanguard


Drivers licence

License plates

Birth certificate

ID card

Child benefits

…

Emergency services

(police, hospital,…)

Housing repairs

Acute health care

…

Education

Human services (welfare,

mental health, child protection,

elderly care, chronic care…)

Criminal justice

Social housing

…

What could be the sense in this “grouping”?


Drivers licence

License plates

Birth certificate

ID card

Child benefits

…

Emergency services


Housing repairs

Acute health care

…

Education




Criminal justice

Social housing

…

Ambiguous: what people ask

explicitly (if they ask) may not say

much about their need

Clear: what people ask is

explictly is what people need

Simple = response contextually

independent: people respond

similarly across people’s

characteristics / environment

Complex =response heavily contextually

dependent: people’s characteristics /

environment strongly influence response

to and outcome of intervention

Nature of demand (a need that hits the system)

Outcome pretty certain

(past helps to predict)

Outcome more uncertain

(past does not help so much to predict)

T

R

A

N

S

A

C

T

Volatility? How (un)predictable is the (large) variety of demand?

R

E

L

A

T

E


Drivers licence

License plates

Birth certificate

ID card

Child benefits

…

Emergency services


Housing repairs

Acute health care

…

Education




Criminal justice

Social housing

…

Ambiguous: what people ask

explicitly (if they ask) may not say

much about their need

Clear: what people ask is

explictly is what people need

Simple = response contextually

independent: people respond

similarly across people’s

characteristics / environment

Complex =response heavily contextually

dependent: people’s characteristics /

environment strongly influence response

to and outcome of intervention

Nature of demand (a need that hits the system)

Outcome pretty certain

(past helps to predict)

Outcome more uncertain

(past does not help so much to predict)

T

R

A

N

S

A

C

T

Volatility? How (un)predictable is the (large) variety of demand?

The more VUCA

demand is, the more we need a new paradigm!

R

E

L

A

T

E

Outside in perspective…

TRANSACTIONS

Focus is on the variety of

discrete (one-off)

“questions”

CASES

PERSONAS

PLAYING

FIELD

Focus is on a “journey”, rather than on discrete

demands; this requires a view of typical “travellers”

to whom a service relates


Example: computer maintenance service provider

What matters?

Source: Vanguard

Outside in

perspective

Source: Vanguard

Failure demand!

Outside in perspective…

WAZHMA • 32 years

• 3 kids (7, 5 and 1 years old)

• Dutch level 3

• Bachelor informatics

• 1 year experience in IT in

Afghanistan

• Now at home taking care of the

one year old

• Trouble paying the bills

ABIR • 20 years

• Belgian

• Just completed degree in office

mangement

• Started bachelor orthopedagogy but quiet

after few weeks

• Three sisters

• Wants to be independent, with coercive

mother who holds her back

MOHAMED (& FATMA) • 40 years

• Daughter of 6 months

• No formal qualifications

• Hardly speaks Dutch

• On welfare benefits with his wife

Fatma

• Billiards champion in Syria

ETC, ETC….

Cases…

Outside in perspective • Case based “demand in context”:

“Julia is a 19-year-old girl who was referred via the GP who found the service online.

She stopped school about 1.5 years ago and is at home. She started with different

degree programs (each year something different), but she did not graduate.

On 8 June 2018, she and her mum come to an intake interview with the coach. The

request for help (via the mum) is to find a training as soon as possible, preferably a

course that starts in September, so as not to jeopardize the child support money. She

does not want to go back to the secondary school, but looks at some kind of qualifying

vocational training.

The coach contacts the GP and goes to the GP with Julia. The doctor indicates that she

is depressed and has a lot of stress, but there is no real diagnosis. She lives socially

isolated and does not want to leave her room without her mother. She sometimes

records her own songs there.

She has a lot of anxiety towards new people. Julia is on a waiting list to start therapy. In

the past she had been receiving therapy for several years, but this did not help,

according to Julia. The GP asks the coach whether it is possible to let Julia take a few

steps towards entering a training course somwhere.

The mum cares about Julia, but herself has health problems and little energy. The dad

has an occupational disability, but is getting started in the social economy. There are 7

children in total, of which only the two youngest have no problems. The eldest brother is

also at home, looking for work. The coach refers him to her colleague. Julia helps with

taking care of the youngest children.”

Outside in perspective • Case based “demand in context”:

“Julia is a 19-year-old girl who was referred via the GP who found the service online.

She stopped school about 1.5 years ago and is at home. She started with different

degree programs (each year something different), but she did not graduate.

On 8 June 2018, she and her mum come to an intake interview with the coach. The

request for help (via the mum) is to find a training as soon as possible, preferably a

course that starts in September, so as not to jeopardize the child support money. She

does not want to go back to the secondary school, but looks at some kind of qualifying

vocational training.

The coach contacts the GP and goes to the GP with Julia. The doctor indicates that she

is depressed and has a lot of stress, but there is no real diagnosis. She lives socially

isolated and does not want to leave her room without her mother. She sometimes

records her own songs there.

She has a lot of anxiety towards new people. Julia is on a waiting list to start therapy. In

the past she had been receiving therapy for several years, but this did not help,

according to Julia. The GP asks the coach whether it is possible to let Julia take a few

steps towards entering a training course somwhere.

The mum cares about Julia, but herself has health problems and little energy. The dad

has an occupational disability, but is getting started in the social economy. There are 7

children in total, of which only the two youngest have no problems. The eldest brother is

also at home, looking for work. The coach refers him to her colleague. Julia helps with

taking care of the youngest children.”

Is the presented “demand” the real

“demand”? Is it clear what the real demand

is?


Deciding the nature of the service is a strategic choice:

• E.g. transaction as unit of analysis for a university: each

individual course can be seen as a transaction at a specific

time

• …or if case work: whole relation over time –academic career-

is unit of analysis

• determined to great extent by choice of purpose for targeted

users

e.g. “deliver people ready for society” versus mere “transfer of knowledge”

…for broad diversity of students or for an average student

…but if there are many contacts with same users over

time, indication that customer journey should be unit of

analysis, with an appropriate purpose

choice here will greatly influence the “ideal” process

flow

What type of “observation /

measurement” can we use to

look from the outside in and

understand how good we are at

meeting demand…?


• Permanent systemic measures are typically:

A. Accuracy and value from customer perspective

(need to ask EACH customer what matters first!):

• E.g. number of times work delivered on the time that service

committed to to the particular customer

B. One stop capability:

• how much of the work can be handled at the first point of

contact (transactions)? How much of the relation is dealt with

by the same professional (case work)?

• how much (of the job / relation) is handled right first time?

• single piece flow (transactions) =how many times can we

finish a job before starting another?

Seddon, Freedom from C&C


C. End to end time to do the work and solve the

problem from the customer point of view:

• Variation is normal: in a call centre, the time to deal with a

call in satisfactory way for the client at the level of an

individual worker depends on a) the nature of the call, b) the

clients’ mood, c) design of procedures, d) knowledge of the

worker, e) availability of info, etc.

• This means one day perhaps the same person handles 75

calls and another day 125, yet it IS every day the same

person

• If causes of variation outside natural limits are

not random and within team control, team should act on them

beyond team control then it’s the job of the manager (act on system)

If random then no need to act



Source: Vanguard consultants, anonymous example

Due to variation in process

or in demand?


Source: Vanguard consultants, anonymous example

Due to variation in process

or in demand?

Reducing this can only be done by redesigning the system!

Outside in perspective • End to end time for case based work?

Not just one demand, but typically several, shifting over

time, heavily context dependent

PERSONA 1

0 10

• How did we do concerning

what was needed? • Where did the case start e.g. a

2 (how do you know, why not a

0)?

• Where did it end e.g. a 6 (how

do you know, why not a 10)?

• How long did progress take?

• Was it sufficient to close the

case?

• SPC across cases relative to

typical “milestones”?

0 10

Need A

Need B


• Temporary measures (when engaging in a

redesign):

Failure demand: • demand we do not want

• created by some form of organisation failure - not keeping

customers informed, not getting the delivery correct…

• e.g. progress chasing, repeating demand,…)

Value demand: • demand we DO want

• linked to purpose (from the customer perspective)

• high vs low frequency but still predictable (occurs with some degree

of regularity)

We want to understand the nature of all value and

(most frequent) failure demand


• Understanding cases = asking detailed questions case by case (+/- 2 hours for

a complex case)

Timeline: How many contacts? How long does it take from contact to contact (lead

time)? (“touchpoints” / capability)

How did the participant end up in your care? Where was prior knowledge about the

participant located? Who else is still working with the participant? Are there waiting

lists on which a participant is already present? (context)

How would you rate a person’s severity of need on a scale of 0-10? Why not 10?

Why not 0? What needs does the participant have that have to be addressed? When

/ how do we know what those needs are? (demand)

What does the contact look like from the participant’s perspective? What matters to

them? How does a person give a contact meaning? What (mutual) expectations

arise during contact? What commitments were made towards meeting those?

(purpose)

How do you qualify a trajectory as successful when you look back on it? When do

you really close a trajectory? (purpose)

Was there progress / improvement? How can you tell? Does the participant

recognise this? (capability)

What would have happened if someone could not have used your service? Did

something go wrong that we could have prevented? (failure demand)


• SPC charts naturally raise the question why

there is so much variation for subjects (eg

families / tenants) in achieving their objectives

Why does it take so much more/less time to achieve

the desired progress in one “transaction" compared to

another? For one “case” to another?

Shows little use for averages

• The average person and context does not exist and therefore

cannot serve as a concrete starting point for services

• Better average results that lead to greater variation in

outcomes for citizens are not seen as progress

• The goals is rather to reduce variation of outcomes in

combination with better average results


Variation in outcomes is derived from variation in input

(demand), given a standard response:

• If you give the same response to a different demand, then

you will get a different outcome: “one size does not fit all”

• In service, frontline workers are confronted with

much more input variety than the workfloor in a

factory

Products (temporarily) shield the workfloor from part

of customer demand variety

• e.g. a (large) variety of models, colours, finishes, etc. but all

still “standard” requirements (predefined options)

• when too many customers complain, ask for a different car,

buy elsewhere, … time for a new product !


In service few standard demands exist:

• clients are all different

different abilities, conditions and limitations

different expectations

derived from characteristics of persons (e.g. level of

education,…) and/or their context (e.g. city vs countryside…)

• clients are very much part of the system:

they set the requirements every time

they will co-create the service together with the service provider

• therefore service cannot be mass-produced with standard

times and standard procedures (as can cars)

• a major mistake is to try to turn the service into a (missing

product) so we can operate it like a manufacturing plant

Exception: services with very low variety of demand (e.g.

license plate delivery)




Demand : Type + Frequency / Patterns What matters?

2

Thinking 6


U

S

T

O

M

E

R

Based on Seddon, Vanguard

E.g. Non-citizen facing (central) entity influence

Service providing intermediary

Outside in for “central” organisations

Outside in for “central” organisations

• The described approaches are focused on “service users”,

but what if you are eg a Ministry that does not have any

direct contact with citizens as it works via intermediaries?

• Then it is necessary to study:

what intermediaries are “asking” of the ministry and to understand

what from their point of view is value in there…

…however, this intermediary view of value then MUST be traced

back to citizens and their purpose (from their point of view) = end to

end

WHY?

• what intermediairies consider of value is not necessarily in the citizen’s

interest

• some misalignment between citizens and intermediaries may be due to

thinking/system conditions imposed by the ministry

Outside in perspective in large organisations

• Example:

In a local council dealing with catering businesses:

• E.g. a “planning” department might define its purpose as “say yes to

good development”

• E.g. a food and hygiene inspection service may see it as “help me

run a safe and healthy food business for my customers”

The local council may have a meta-purpose of “help me set up

and run a good business for my customers” that connects both

purposes from the perspective of a business owner (but also

their own users)

NOT more precise as this purpose will be understood somewhat

differently by different business owners

• Key aspect of service delivery is for frontline staff to find out what

this purpose (reasonably) means for each of the business owners

1h 15 minutes


outside in?



Now a Human Centred Design approach

applied to a case work service…

…used by…

Now a Human Centred Design approach

applied to a case work service…

…used by…

Watch…

• https://vimeo.com/album/3420276/video/9

5504481 (about the programme 3 min)

https://vimeo.com/album/3420276/video/95504481


Life programme UK

• In 2008, the need for a new approach to families with

chronic needs was recognised by Swindon Partners

originally Swindon Borough Council, NHS Swindon/Primary Care

Trust (PCT), the police and probation services

• Swindon Partners commissioned Participle, a social

entreprise, to assist with the project

using a wide variety of funding sources

• The whole process to develop Life at Swindon took 18

months

it employed +/-12 staff members on a yearly basis

• Life has continued to evolve through practice and

partnership with Wigan, Lewisham and Colchester

Life programme UK

• At the start, 8 weeks were spent alongside the most

problematic families, experiencing their lived reality

(immersion)

Families also got video cameras to film ‘things we wouldn’t know

about them’

• Visual maps were made with front line workers of the

families’ history with 73 services from 24 departments:

the pattern was for repeated interventions driven by crisis

once managed, hard pressed front-liners would divert their

attention elsewhere

no family had been successfully transitioned out of social services

Life programme UK

Life programme UK

Also, families were quite vocal about this confused

system and its inability to support them

Frontline workers are all too aware of the problems

and many feel demoralised and constrained by the

services and systems they work within

Nevertheless, both sides feel at once judged by, and

judgemental of, the other, without trust, exhausted

and in many cases hopeless, having lost sight that

any change might be possible

Life programme UK

• Automatically, the question arises why the service

exists from the perspective of the citizens:

here it is to “lead ‘flourishing lives’” but what makes life

“flourishing” varies greatly from person to person (only

they can define goals/progress)

It is up to the service to interact with the individual to

materialise these goals and to work in co-creation/ co-

production with the individual

• As the starting point is the real context of a specific citizen it is

not difficult to observe that the individual and their environment

have a lot to offer in the pursuit of his/her goals

E.g. Life included a lot of activities in which contact between the

neighbourhood and the "troubled families" was restored

In this way, the direct environment could play a positive role in

pursuing a better life for these families

Life programme UK

Life programme UK

• Service providers support families to make their

own plans for the next steps

For each family, the plans differ, depending on what is

most meaningful at the time.

Together with the family, the service providers in the

programme plan when they will meet again

Meetings are held to discuss what took place and why

things happened

The service provider then also makes observations on

the spot, which can be discussed

This was derived from the “Warwick-Edinburgh Mental Well-being Scale” and hence provides a

measure of subjective well-being ( see Tennant R, Hiller L, Fishwick R, Platt P, Joseph S, Weich S,

Parkinson J, Secker J, Stewart-Brown S, 2007, The Warwick-Edinburgh Mental Well-being Scale

(WEMWBS): development and UK validation, Health and Quality of Life Outcome; 5:63).

Life programme UK

Life programme UK

Life programme UK

• The subjective well-being tools such as the Life

Star help to get the conversation started

• But service providers should move beyond just

asking “how are you feeling” and move to “what

is happening that makes you feel like that”

• This should reveal the real constraints that

people are encountering (not just their own

perception of these constraints):

They explain why the same “resource” put at the

disposal of different persons does not lead to the

same outcome

Life programme UK

This is because people have:

• different initial internal endowments: physical, mental

abilities, other resources

• different external environment: constraints deriving from

social or family dynamics, formal rules or informal regulations

as well as our physical environment

• Life attempts to help participants tackle the

constraints that limit their effective opportunities

and hence also affect the outcomes they can

achieve

The focus is on tackling what is holding them back,

NOT on becoming different persons

Life programme UK

• On the basis of the interaction, the service

provider generates an opinion concerning four

key “capabilities”

important in enabling most of the families to lead a

worthwhile life

• It is not a standardised (nor standardisable) box-

ticking questionnaire

the citizen is not asked in a direct way e.g. whether his

or her self-esteem has grown

through conversations and direct observation between

citizens and service providers insights are gathered

• These are recorded on the Lifeboard Daily Log

• Based on this, the team member allocates “grades”

Lifeboard

Lifeboard automatically

displays and tracks progress

and set-backs

Team Lifeboard Daily Log:

1. Narrative of key insights

2. Select the applicable

capabilities / indicators

3. Select a level (1-4)

allows progress or decline to be tracked, and at the same

time the reasons for this to be discussed with the user of the

service

Life programme UK

Actionable new measurement

approach

“Living a life that is worthwhile”

Evaluating Life

• Within 12 weeks the team had saved Swindon an

estimated £250k through

the prevention of eviction orders

two children no longer needing protection plans and attending

school

the reduction in anti-social behavior

in one case, a child who was about to be taken into care was

able to stay with their family

• Families who had previously been considered too

recalcitrant to engage with social services were taking

the important steps to change their own lives and were

recommending the Life programme to other families and

to their wider family members

The LIFE programme was described as an

example of good practice in 2012 by

OFSTED, the Office for Standards in

Education, Children's Services and Skills.

Watch…


5508344 Testimonies (5 min)



Watch…


5504479 (view from the professionals 2

min)



• Read also the

stories of

Melvin

Jake

Child A

• http://locality.org.uk/

wp-

content/uploads/Loc

ality-Report-

Diseconomies-web-

version.pdf

Measuring progress

From assessments,

checklists and paperwork

0

2

4

6

8

10

I am listened to and heard

I have more confidence

My financial problems are

sorted

My children can sleep in their

own room

My children have space to

play

I have some space of my

own

I am able to manage my

home better

Our sleeping arrangements do not affect …

Start

29.06.12

24.09.12

To person shaped measures -

based on ‘me, my life and

what’s important to me’ Using better measures

What matters is different for each

person, their rate of progress will

also be different

Measuring progress

Measuring progress

• The individuals co-decide whether there is still a

long way to go and how far

Impossible to aggregate or to generalize

Tool only for the benefit of the citizens themselves

• It is no longer the job of only the service provider

to form an opinion about the level at which an

individual is located

It is up to the individual to explain why he or she feels

there is still a lot or a little work to do

In this way, the service provider looks at the reality

entirely from the perspective of the citizen

• This does not mean that the service provider must agree, but

it does constitute a starting point for dialogue

Watch this for more on “Locality” work

• https://www.youtube.com/watch?v=ujiN37

zz1DA#t=48

• https://www.youtube.com/watch?v=HxC-

fsgb5kE

• https://www.youtube.com/watch?v=f-s-

lc3EoK8

https://www.youtube.com/watch?v=HxC-fsgb5kE



https://www.youtube.com/watch?v=f-s-lc3EoK8





Now an example of “lean thinking” in a more

transactional service…


• Discovering purpose from the customer

point of view

Original purpose:

• “To do repairs within the target time set and

maximise use of the in-house team.”

Revised purpose:

• “To do the repair right, first time and achieve what

matters to the customer.”


New measures


=tenants requesting a (diversity of) repair(s)

for the first time: type and frequency relatively

predictable by geography

progress chasing repair, complaining

repair was not satisfactory, progress

chasing their complaint

Call centre has to locate tradesmen or supervisor to find out what was happening, which takes

time: this time is not available to respond to valued demand hence creating waiting times


Repair is not same as a ‘job’ as one repair can consist of many “jobs”



Here failure demand = calls chasing work that should have been done


• How was the data collected:

The work of call centre and reception staff, as

the initial recipients of customer demand, was

observed to establish the type of demand

made

• Staff need to be reassured that it is the demands

that are being looked at and not them

All customers receive a follow-up satisfaction

call

• Rather than a sample based survey

1h15 min


outside in?



POLL

• Take a particular service that you are

familiar with (you work in it, for it, with it,

…)

• How does if function?

Fully outside in

Mostly outside in

Mostly inside out

Fully inside out

SMALL GROUP WORK: 30 min + 30 min

Pick one of the services you had in mind.

Discuss:

• Are clients and purpose clear?

• What measures do they use now?

• What “measures” would you use to learn if

they are doing a good job for their clients?

• Input questions into the “POLL: what

questions do you have on measures?

POLL

• What are your new, key insights on

measures/observation ?

30 min

• Paradigm conflict two: complex

organisations with simple tasks or complex

tasks with simple organisations?

Case 1: Care at home in the Netherlands


Home care NL

• Home care for eg an ageing person with

dementia:

Persons need to fill in an intake form

Centre for indications decides how many hours of

care of what kind and level they need

Result is sent to a regional care office which contacts

a range of health professionals who can provide that

care

Planners at the health provider then schedule workers

that are specialised in various tasks at various levels

(who, what, when, how long, where)

Workers execute as planned


• Repairing houses:

Call comes into call centre which inputs the job in the

IT system and allocates one hour time slots into

operatives’ diaries

Call centre arranges appointments

• Letter sent with appointment offered on an am or pm basis

POLL

• What could be problematic when

structuring like this?

Home care in NL

• Home care (eg for an ageing person with

dementia):

Actual care split up among many specialists:

• 20-40 different persons come into the house over a short

period of time

They do their task as quickly as possible and move to

the next (when they are pressed for time they do the

task poorly)

They do not take into account what is convenient for

the client

They spend quite a lot of time travelling from one

client to another

As Centre for Indications allocated hours, tendency to

use them even if not needed

Home care in NL

• Home care (eg for an ageing person with

dementia):

Actual care split up among many specialists:

• 20-40 different persons come into the house over a short

period of time

They do their task as quickly as possible and move to

the next (when they are pressed for time they do the

task poorly)

They do not take into account what is convenient for

the client

They spend quite a lot of time travelling from one

client to another

As Centre for Indications allocated hours, tendency to

use them even if not needed

Social Housing repair services Tees Valley D

rivers

Steps

Co

nseq

uen

ces

Social Housing repair services Tees Valley D

rivers

Steps

Co

nseq

uen

ces

Social Housing repair services Tees Valley

• Neither call centre nor tenants can over the phone really

decide what work needs to be done

43% of the time diagnosis needs to be changed at Tees hence:

• arriving at home with wrong materials

• manager checks if respecifying was justified

• call centre needs to reschedule, worker needs to revisit

• Appointments made by call centre fail often- 20% of the

time at Tees:

call centre needs to reschedule, worker needs to revisit

• Maintenance assistants at Tees Valley completed a

timesheet (taking 20 minutes a day to do so) not used for

any meaningful purpose (driven by lack of trust)

Social Housing repair services Tees Valley

• Also typical problems across the UK*:

material allocated according to schedule of rates, not

what was really required (usually less)

every day tradesmen stand in line to collect materials

tradesmen try to get the more “expensive” jobs

according to standard schedule of rates (less travel

time) and try to influence managers

different tradesmen show up at different times for

different parts of the job

*Source: Vanguard consulting

Group work 30 min

• What departments would you create in a

cookie factory?

• List all activities and who would do them

where

• Draw on flip chart

• 20 minutes + 10 minutes discussion

1 hour






Bureaucratic paradigm

Input Process Output

Flour

Chocolate

Water

Sugar…

Make dough – Bake - Package Boxes of

cookies

The cookie factory

Does this make sense?

Unit A Unit B Unit C

A matter of division of labour…

• the extent to which the provision of the service,

its preparation (purchasing, planning, ...) and any

support activities (HR, finance, ...), together

referred to as "operations" are put in separate

units or not;

• the extent to which any of the (types of)

operational activities mentioned above

may or may not be split into several parts, performed

by different people;

may or may not be concentrated in specialised units

based on being operational tasks of the same type

Bureaucratic versus flexible

paradigm…


• maximise the division of operations into

(simple) tasks and put them in separate units

To fulfil an order/demand (a wish of a client), the

interplay of many units is needed

=complex organisational structure

Organisational model



Flour

Chocolate

Water

Sugar…


cookies

• Easy when always same boxes of cookies need to be made

• …AND technology to bake never changes (or there is no

competition that would use it to make better/cheaper

cookies)

• …AND ingredients are always the same

Closed system

The cookie factory

Unit A Unit B Unit C


http://sensesofcinema.com/wp-content/uploads/2011/10/Modern-Times-19.png

http://sensesofcinema.com/wp-content/uploads/2011/10/Modern-Times-6.png

http://lifewithoutbuildings.net/wordpress/wp-content/uploads/2009/09/chaplin_1.jpg

Bureaucratic systems work fine,..

but NOT under VUCA conditions!

• volatility: the nature, speed, volume, and magnitude of change that is not in a

predictable pattern;

• uncertainty: the difficulty in using past issues and events as predictors of future

outcomes;

• complexity: numerous and difficult-to-understand causes and mitigating factors

(both inside and outside the organisation) are involved in a problem;

• ambiguity: lack of clarity about the meaning of an event. (Lawrence, 2013)



Flour

Chocolate

Water

Sugar…


cookies

• Harder when tomorrow people suddenly want strawberry in

cookies, and cookies of different sizes, and day after

tomorrow they want them different again…

• …and technology changes…

• …and ingredients suddenly are hard to come by or become

very expensive…

Open system

The cookie factory

A continuum of services…

Drivers licence

License plates

Birth certificate

ID card

Child benefits

…

Emergency services


Housing repairs

Acute health care

…

Education




Criminal justice

Social housing

…

What: Give what they

want as quickly as

possible (categorise-act)

How: Focus on how to

process demand right first

time and frequency of

errors caused by the

system

Main issue: volitality of

volume/change of demand

How: Focus on understanding type and

frequency of value demand, train

against high frequency demand and

put expertise on frontline; pull in

expertise for low frequency demand

What: Interpret/analyse what comes

into the system and provide correct

response at first point of contact

(sense-act)

Main issues: correct interpretation of

somewhat ambiguous / complex

demand and volatity

What: explore/discover the many

ambiguous demands coming from the

same user(s), over longer term

engagement (act-sense)

How: focus on understanding

patterns of demand (e.g. using

persona’s) and construct

response flexibly

(sequence/combination) with

known elements


highly ambiguous / complex demand,

uncertainty and volatity

T

R

A

N

S

A

C

T

R

E

L

A

T

E

A continuum of services…

Drivers licence

License plates

Birth certificate

ID card

Child benefits

…

Emergency services


Housing repairs

Acute health care

…

Education




Criminal justice

Social housing

…

What: Give what they

want as quickly as

possible (categorise-act)

How: Focus on how to

process demand right first

time and frequency of

errors caused by the

system

Main issue: volitality of

volume of demand

How: Focus on understanding type and

frequency of value demand, train

against high frequency demand and

put expertise on frontline; pull in

expertise for low frequency demand

What: Interpret/analyse what comes

into the system and provide correct

response at first point of contact

(sense-act)


somewhat ambiguous / complex

demand and volatity

What: explore/discover the many

ambiguous demands coming from the

same user(s), over longer term

engagement (act-sense)

How: focus on understanding

patterns of demand (e.g. using

persona’s) and construct

response flexibly

(sequence/combination) with

known elements


highly ambiguous / complex demand,

uncertainty and volatity

T

R

A

N

S

A

C

T

If low volatility of demand (high

predictability), suited for bureaucracy!

Flexible paradigm

• bring together as many operational

tasks as possible in one single team

to fulfil the order/demand in its entirety, only

one organisational unit is necessary

= a simple structure with a complex set of

tasks

Organisational model

Flexible paradigm


The cookie factory

Chocolate cookies

Gluten free cookies

Large sized cookies Lo

w inte

rdependence

be

twe

en t

he

units,

but

hig

h w

ithin

Flexible paradigm


The cookie factory

Chocolate cookies

Gluten free cookies

Large sized cookies Lo

w inte

rdependence

be

twe

en t

he

units,

but

hig

h w

ithin

We try to bundle demands that require similar steps /

approaches together, hence separating those demands that have less in common (in terms

of what needs to be done)

This enables a group to regain the overview (starting with the

user perspective)

Rather than deal with variety through

inventory, variety is put into the line and

production is pulled by a sale (demand).

This is an adaptive system: as demand

changes, people change what they do.

Operators are able to perform many

different operations and make rapid

switches (low change-over times).

Also, they are given the power to

stop the line if something is wrong.

The problem does not appear further

down where many resources are

already consumed.

Because of this, every car coming off

the line can be different (very small

batch) and still unit costs are nearly

the same as when all cars would be

identical. In addition, inventory is low.

This is called economy of “flow”.

Management determines the most efficient way

to produce a car, breaking tasks down into tiny

steps, and focuses on how each person can do

his or her specific series of steps best.

Management then manages inventories, scheduling,

planning, reporting, sets budgets, targets,… All of this

concerns information that is abstracted from work.

Decisions are equally removed from the work.

However, all products produced on one production

line will be identical or very similar, and introducing

variety to satisfy individual needs is not easy (some

variety can be achieved by applying different

finishes at the end of the production line )

These kinds of systems tend to run high

inventories, especially when more than one model

has to be produced (to meet variety in demand) as

it is production efficiency (economy of scale) that

drives them, NOT actual demand.

Clearing the inventory needs to be done frequently by

special sales efforts (push). A focus on production/

activity costs means losing sight of inventory and

management costs (full end to end cost).

In 1988, the number of

man-hours it took to

make a Lexus, was less

than the man-hours it

took to rework a top of

the line German luxury

car at the end of the

production line, after it

had been made.

POLL: What has inherently more

absorptive capacity?

OPTION A: assembly line

OPTION B: team of people

Flexible paradigm





2

Thinking 6


U

S

T

O

M

E

R

Seddon, Vanguard

Flexible paradigm

Flexible paradigm

Julia’s case (ctd…):

The coach gives the mom the assignment to contact the RVA and the Health

Insurance to discuss the financial options. The coach makes an appointment with

Julia at the training career counselors of the City of Antwerp. The student career

counselors question the interests of Julia. It is a difficult process because Julia

says she is not interested in anything. Tests indicate that the interests lie with

sales, a travel agency or reception.

The coach plans a visit to an open house of an adult education provider. There

Julia can follow a half-time program, supplemented with some subjects to obtain

the secondary school diploma. That is too stressful / suffocating for her. Julia

panics and eventually does not start the programme at all.

The coach tries to find something that motivates Julia and finds it in music. She

invites Julia to come to the music studio. The coach receives help from a

volunteer who recognizes herself in the situation of Julia. To date, Julia has

already come to the music studio 2 times and comes without her mom, something

she did not dare do before.

Q: WHAT IS WASTE? WHAT IS VALUE WORK?

Flexible paradigm

Understand type and

frequency of demand Work as single

piece flow

(no hand over,

first time right)

Train against High Freq. Predictable

Value Demand ‘Pull’ expertise for low freq.

predictable value demand

Or put ‘clean’

into flow

Design ONLY for value demand!

Minimise waste!

Source: Jeremy Cox, Vanguard Consulting

Flexible paradigm

• Dealing with waste?

Type 1: absolutely useless, can stop it

immediately

Type 2: needs to be designed out (change

system conditions)

Type 3: does not help but we need to keep

doing it to stay in business, no matter how we

design:

• in the longer term need to do something about it

(influence outside systems)

• short term, put minimal effort (contain):


Flexible paradigm

comply with/ adapt to requirements imposed by other

systems but avoid being run by them (eg report but do

not manage on the targets).

If really problematic you may have to refuse outright but

otherwise be ready to show you are doing a good job in

another way.

So you need to have done enough experiments of the

new way with success

And also “would you like to see sth in the current system

that gives illusion of control but hides “nasty reality”?


End to end

Top to bottom

= governs the end to end

Other systems

Other systems


Flexible paradigm Source(s) of system conditions

that generate waste?

Again we need to measure…

Flexible paradigm

• Temporary process measures (ad hoc for

redesign)

A. Type and frequency of dirt in input eg. incomplete

forms, insufficient info, resource unavailable… (also

from other workers in the system)

B. Type and frequence of waste in the process =

anything that does not add value

• eg handovers, routing, rework, checking, duplication, recording

without use, dealing with errors …

• eg. time lost: idle time waiting for others (e.g. in meetings, for

decisions,…), travel times…

Check cycle time (elapsed) versus value time

• e.g. how often people give up trying to get served -abandon rate


Flexible paradigm

• e.g. for cases, ask questions covering many cases:

What did you do that helped towards achieving progress? (value work)

What did not help? (waste)

What's the next step? Is it different from the previous one? What is the purpose of the

step? (value or waste)

In all of the above, if predictable waste over time, this means

it is a system condition and can be changed

• if unpredictable, then perhaps best to do nothing (some things just go

wrong from time to time)

A very limited nr can be measured permanently, IF predictive

for capability

• For the rest, once cause is removed, measure not needed


1 hour



tasks with simple organisations? (ctd)



Buurtzorg NL

• Buurtzorg is a case of the socio-technical systems

approach applied to “case work”

Started dec 2006

• Fast growing: from 2000 staff end of 2009 to 7000 staff in 2016*

Neigbourhood teams (10-12 people) serve all clients in

a geographical zone

• Market oriented organisation by user characteristics (location),

to whom many treatments offered

Each team member is multifunctional (can do many

tasks of different levels)

Team members serve a limited amount of clients

(always the same) and hence know the client and what

they need as well as how they are evolving

*https://www.beste-werkgevers.nl/beste-werkgevers/2013-plus1000/stichting-buurtzorg-nederland/

Buurtzorg NL

They can decide themselves what to do first and how

much time is needed (for clients and tasks), given the

context and in interaction with the client

They perform the indication together with the clients

who were referred directly to them by local actors (eg

GP)

Preparation (indication, planning) and service delivery

all done by the team

On a monthly basis 15% of the clients see one-two

carers, +/-50% see 3-4 and the rest 5-9

Buurtzorg NL

Organisation in the centre*:

• +/- 2 project workers

Follow care / professional developments

Take care of employee participation activities

Support working on team-crossing issues

Deal with quality and reporting requirements

Support tendering for regional care office contracts, applying for

subsidies,…

• +/-10 regional coaches

not hierarchical

• +/-15 support persons

Personnel and salary admin

Accounting

Collecting and delivering data to care offices

• ICT, training, facilitation, … done with external professionals

*Numbers relate to dec 2009 when there were 209 teams

Buurtzorg NL

KPMG / Plexus (2015):

• Buurtzorg scored as the 6th best healthcare provider from a

total of 360 institutions (adjustments were made concerning

the level of care to ensure that the comparison was not

distorted by a different number of clients that require more

intensive care)

• "Buurtzorg delivers high quality care for slightly less than the

average costs“

Buurtzorg was rated in 2015 for the fifth time in

succession the best employer (non-profit

organisations with more than 1,000 employees). In

2016, it finished second.

Diagnose

Access

Repair

Value work:

Social housing repairs at Tees Valley


• Examples of waste:

Completing unnecessary forms/paperwork/reports

Handling progress chasing requests

Not having access to the right equipment/materials

Working from unreliable or inaccurate information

Dealing with misrouted phone calls or post

Resolving invoice queries

Doing things that you find others are doing/have done

Dealing with problems caused by other departments not doing

their job correctly first time

Fire-fighting - dealing with symptoms rather than causes

Attending unnecessary or poorly managed meetings

Obtaining authorisation

Handling issues that others should have dealt with

…


• Tradesmen teams set up to serve particular areas =

market oriented organisation based on user

characteristics (location)

easier to do different jobs (plumbing, roofs,…) in one

neighborhood than to handle different neighborhoods with

profession based teams (e.g. plumbing vs roofing teams)…

…as they are in the neighborhood, they can stop by and

diagnose the problem, sometimes fix it immediately or schedule

an appointment

…based on the characteristics of the area (type of houses, age,

materials used in them,…) they carry in their vans supplies that

cover typical jobs

• Hence they do not need to stand in line every morning

• Also more likely they can fix a problem immediaterly


• Hence:

Repairs are logged in a streamlined manner (brief

description and contact details at Tees)

Tradesmen get in touch with tenants directly (e.g.

patched through by call centre, provided with contact

details)

• They become owners of the work to be done until finished

from the point of view of the customer (incl. setting up

appointments and arranging materials at Tees)

Useless actions (e.g. time registration at Tees)

dropped


• End to end time improved

(from 46 days to 5,9)

• Customer satisfaction went

up from 77.2% to 94.4%

being "very satisfied" or

"satisfied with the overall

service" (score 7 out of 10 or

higher)

• There are also substantial

cost reductions

• ODPM concludes that “the

systems thinking pilot

appears to have worked well

at Tees Valley" (p. 54).

1h 15 minutes






POLL



…)

• How does if function in terms of structure?

Very complex

Somewhat complex

Somewhat simple

Very simple

SMALL GROUP WORK 30 min+ 30 min


Discuss:

• What is the operational flow from demand

to satisfaction?

• Is it cut into different units? Does this

create problems?


questions do you have on structure?

POLL


structuring?

1 hour

• Paradigm conflict three: regulating service

providers or service providers that regulate

in interaction with users?

Case 1: Youth protection in Amsterdam, the

Netherlands


Jeugdzorg Amsterdam

• Looked after 10000 children at risk of abuse or neglect,

with about 600 staff (yearly) up to 2008

Children – minors between the ages 0 to 18 – were usually

referred to the agency by teachers, police officers, doctors or

other professionals who judged they may be at risk

Three possibilities / departments:

• 1 Parents could choose to accept the help of the agency voluntarily

• 2 If the case was referred to the child investigation council it could

seek a court order to place the child under care of the state

• 3 Other children, such as those with a suspended sentence

imposed for an offence, were referred to the agency as part of their

parole program

In each situation, a range of welfare organisations could then be

mobilised to care for the children and support the families,

including foster homes, parental support groups and mental

health services

Jeugdzorg Amsterdam

• Management gets quarterly reports containing:

number of measures

number of requests

length of (safety) measures

number of kids in special care

kids flowing in and out

number of cases per worker

number of complaints

number of plans

number of indications delivered during a period

absences due to sickness

number of side activities…

Jeugdzorg Amsterdam

• managing focused on the size of the case load,

which differs for the three departments:

social worker: around 60 children (voluntary)

guardian: 18 children (when kid taken under state

custody)

parole officer: 22 children (eg with a suspended

sentence imposed for an offence)

• the IT system defines what steps should be taken

for each child in a family, for each of the three

departments

• targets (within the IT system) are in place e.g. see

a family in 5 days, have a plan signed in six

weeks,…

Home care NL

• Home care staff schedules are tightly

planned:

Planners define exactly what they should do,

where, when and how long it should take

• Need to log with a chip card every minute

they spend with each client

Care moment 1, 2, etc.

POLL

• What could be problematic about

regulating like this?

Jeugdzorg Amsterdam

• in practice, workers focus on the highest risk

children and only passively monitor the others:

often, as a consequence, the situation of the ‘lower-

risk’ children deteriorated over time

• some families were confronted with a variety of

different case workers from the three different

departments and each time the case worker

started from scratch, guided by ICT;

however when only one child in the system no

attention to others until also in trouble

Jeugdzorg Amsterdam

• CYA (“cover your ass”)

extensive case reports (more than a hundred pages,

spending up to sixteen hours per week on it) but not

used if client hand-over

• I think it [the report] gave me a feeling of security, and the

feeling that I have done my job well’

copying everyone into emails (even when no one was

reading them)

having many meetings by staff about families (but

very little WITH families)

• e.g. to show a letter was sent, as well as a reminder (even

though knowing full well these families do not open these

letters)

Jeugdzorg Amsterdam

• all clients to be treated in same way

e.g. even if mental disability then still asking

agreements via formal letters

• formalism related to the targets

e.g. having a plan signed did not mean anything was

actually in the plan, let alone that the family was going

to stick to this plan

but a special function to “chase” people on these

targets existed

• In essence, operational managers did not have

much information that helped them to form an

image of the work their team members are doing

with the families

Jeugdzorg Amsterdam

• In 2008 the government bodies overseeing the

organisation -notably the inspection services and the

Amsterdam alderman in charge- placed it under

heightened supervision and the CEO was asked to

resign

• 2009-11 saw a new CEO, mission statement,

development of new working methods, learning and

development opportunities, professional work

environment, competence management,…

• while this helped to change existing staff mind-set,

reconnecting them with why they were there, as well as

ensure that new hires had the right profile, after two

years, most service and financial indicators had still

improved only modestly

Home care NL

• Home care staff do exactly what is

foreseen

ignore what matters to the client

ignore what the previous care worker did (not

do)

do often too little or too much or simply not

what is needed at that time

• Extreme pressure to stick to the target:

Absorb delays (e.g. due to traffic, unforeseen

problems,…) into private time

• Boston Consulting Group “index of complicatedness,” based on

surveys of more than 100 U.S. and European listed companies

• The survey results show that over the past 15 years, the amount of

procedures, vertical layers, interface structures, coordination

bodies, and decision approvals needed in each of those firms

has increased by anywhere from 50% to 350%.

• Over a longer time horizon, complicatedness increased by 6.7% a

year, on average, over the past five decades.

• In the 20% of organizations that are the most complicated,

managers spend 40% of their time writing reports and 30% to 60%

of it in coordination meetings.

• That doesn’t leave much time for them to work with their teams. As a

result, employees are often misdirected and expend a lot of effort in

vain

• Employees of these organizations are three times as likely to be

disengaged as employees of the rest of the group

Burn-out

Bore-out

See also: Häusser, Jan & Mojzisch, Andreas & Niesel, Miriam & Schulz-Hardt, Stefan. (2010).

Ten years on: A review of recent research on the Job Demand–Control (-Support) model and

psychological well-being. Work and Stress. 24. 1-35.

POLL

• What would you suggest in terms of

regulating?

1h 15 min





Netherlands


Division of labour: steering / regulating





2

Thinking 6


U

S

T

O

M

E

R

Seddon, Vanguard

Knowledge is power, we are more special than you are

We don’t trust each other or citizens

We worry about risk!!!

Needs are complex

Protect our budgets/ income

We focus on activities and

targets!!!

Thanks but that does not help me

My problem is getting worse

No-ones taking responsibility for

helping me solve my problem

There are real barriers to sharing

data

We focus on doing our bit

and then pass it on

We close the case if

other agencies

are involved

We use standard risk assessments to decide whether this

one is for us or if we can pass it on

We pass info to other agencies even when we

don’t expect them to do anything

T

S

P

Referrals lead to more

referrals

Referrals between agencies are the way to get things

done

We process issues rather

than fix them

We record everything

Everyone's got a bit of knowledge but no-

one’s doing anything even when its getting

worse

There are multiple assessments by multiple

agencies We only do what we have to

We notice and record when people aren’t coping but

don’t do anything about it

B. Wrighton , Vanguard

Observe (new)

situation Interpret

issues (deviation

from norm) Decide how to

deal with issues

Execution of

decisions

Division of labour: steering / regulating

-many aspects

taken together

(cost, quality, staff,

time,…)

- based on

“objective” external

norm OR normative

judgement by

expertise

(professionals)

when more

situational (depends

on context)

Norms are always in the background:

assumptions about what should be

observed and why (e.g. UCL in social

housing because of specific nature of

demand and our service process).

Select actions

based on “if…then”

rules (mechanical OR

using professional

expertise)

Regulating is solving problems (error correction) eg burnt cookies due to wrong mix,

then correct mix

Learning is getting better at solving problems eg get better at mixing

Division of labour: steering/regulating

• Decisions are to be made about…

the extent to which regulatory tasks are

• separated from the execution of operations

• put into other (management) units (levels)

the extent to which different types of regulation are

assigned to different units (levels):

• Operational (task execution = eg mixing ingredients) vs

• Tactical (internal structure of production/regulating = eg mixing

and baking unit or strawberry vs chocolate cookies) vs

• Strategic (purpose for whom, partners, scale/location = eg only

fruit cookies)


Double loop

Is a spike on a SPC / or wider

variation / poorer averages due

to a change in (size / type of)

demand? Then question

strategy. Observe (new)

situation

Interpret

issues (deviation)

Decide how to

deal with

issues

Execution of

decisions

Single loop

Strategic

What does the external environment

“require”? Is it as expected? Or, if an issue,

then: What is the purpose for which clients?

What the desired scale / location? What

partners do we need for what demand?

(“what”; transformation; external structure)?

Tactical (Re-)

norming Observe (new)

situation

Interpret

issues (deviation)

Decide how to

deal with

issues

Execution of

decisions

Single loop

SPC variation / averages? Failure demand? Waste? As expected?

Or, if an issue, then: How do we change structure? (design of “how”

we respond; set-up; internal structure* of production and regulation).

*rules, procedures, processes,

functions, departments…

Double loop

Is a spike on a end to end

SPC or a frequent type of

failure demand due to a

design flaw? Then question

structure.

Observe (new)

situation

Interpret

issues (deviation)

Decide how to

deal with

issues

Execution of

decisions

(Re-) norming

Single loop

Operational

Do we do the tasks right (the first time)? Are there no SPC

spikes due to poor execution? Do we have low failure demand

due to poor execution? Or, if an issue, then correct by

learning how to do the task better / assign a more competent

person, reassign staff to handle unexpected volume…

(Re-) norming

Double loop

Division of labour: steering/regulating • Example:

Operational regulating:

• If someone forgets a bank card in an ATM (observation/issue), we

send them a replacement (decision/action)

• If it happens a lot, we may add some bleeps and warning signs to

prevent this (better “task execution”)

However, if we pick this up as frequent failure demand due to a poorly

designed process, then we may move into a tactical regulating cycle:

• We may reflect on the issue an realise that the expectation (norm) that

people are forgetful (hence the bleeps to remond them) is not helpful

• If we realise that the reason many people come to the ATM is to get

money and hence they leave if they have it…

• We could redesign the structure of execution by giving back the card

first, and then the money


the extent to which the various parts (observation, interpretation,

decision and implementation, norming) of the regulating cycle

are separated as subtasks and assigned to separate units

• E.g. strategic planning most observation done by planners

the extent to which 'systems' (collections of standardised,

formalised procedures that fix activities into routines)

• specify maximally what should happen

• …or provide minimal critical specification

Bureaucratic versus flexible

paradigm…

Bureaucratic paradigm • separate regulation from execution…

• …maximally specify the work based on systems

(specifications embodied in planning, budgeting,

quality, appraisal, ICT systems …)

• = direct consequence of division of labour in

operations

great number of complex interdependencies between

these units require a lot of interaction (transfers)

between units that do not have the overview of the

entire operational process anymore (mixing vs baking)

managers at a higher level, who still possess the

overview, therefore need to regulate, and they normally

try to accomplish it through detailed procedures,

standards and planning (max spec on baking)

Flexible paradigm

• Regulation via self-steering=

Operational teams fully responsible for operational

regulating cycle (tasks)

• problems that cannot be resolved (absorbed) operationally

require change in structure hence tactical regulation

Operational teams ideally also fully responsible for

tactical regulation (structure)

• may require cooperation of other units e.g. central

procurement unit (eg buying ingredients)

does not imply that regulation then also moves to these other units e.g.

central procurement unit can be steered by the operational teams

• tactical learning can also be fully decentralised

but coordination and judging of results of experiments should be central

to pool knowledge at system level (eg change baking process)

• problems that cannot be resolved tactically require strategic

regulation

Flexible paradigm

Strategic regulation

• In principle possible to be fully decentralised

E.g. developing and launching own new services, defining own

purpose,…

Then organisational level oriented towards maintaining common image,

supporting common culture, supporting an internal labour market,

stimulating innovation…

But usually strategic regulation is only partially decentralised

• strategic learning hence can also be fully decentralised, but

again, coordination and judging of results of experiments

should be central

Both at tactical and strategic level, double loop

learning via experiments does not first require a

disturbance/issue

• Organisations can decide to stimulate trying something new,

even if there is no problem yet

Flexible paradigm

• Self-steering requires minimum specification

by systems

There are (minimal) rules but

decisions for action are made

by judgement (specifications

supportive of action)

E.g. involve stakeholders appropriately

Rules fully steer action

(maximum specification)

E.g. have a meeting of half a

day every 6 months with a list

of stakeholders

http://www.alifewewant.com/ Example:

Life team

competencies

Flexible paradigm

this also relates to the difference between “standard work”

and “work standards”

• Work standard = bureaucratic

Typically set by staff groups in bureaucracies

Managers manage incidents / check compliance

• Standard work = flexible

Routines are seen as useful (save time and attention for decision-

making) but when they freeze become a hindrance

Hence, every time a disturbance happens this is an opportunity to

question routines

• standard way of working is seen as contributor to the problem and

hence in need of revision

• in flexible organisations that makes flows visible again,

disturbance is revealed much faster + creates sense of urgency

Critical review done by the same teams that need to use the routines

Managers check if teams are being critical (and if not, why not)

“To manage

one must lead.

To lead, one

must

understand the

work that he

and his people

are responsible

for.” P. 76

“Support of top

management is not

sufficient. It is not enough

that top management

commit themselves for

life to quality and

productivity. They must

know what it is that they

are committed to…” P. 21

“Management by numerical goal is an

attempt to manage without knowledge of

what to do, and in fact is usually

management by fear.” p. 76

Key role is to ensure that front-line workers

can do the best possible job for the client, by changing system conditions

when needed

1h 30 min





Netherlands


An example of “lean thinking” applied to

“case work” …

Jeugdzorg Amsterdam

• Family as “case”:

not individual children, avoiding multiple case workers

(from different silos) in one family

• Purpose = “bed, bath, bread” and the absence of

abuse or being witness to violence

• Multi-functional area based teams now have full

operational autonomy over families

High frequency predictable demand dealt with by a

team of 6 to 8 counsellors, supported by a team

leader (who coaches 2-3 teams), a specialist in

behavioural and child development and by a senior

counsellor (who deals with fewer cases)

Jeugdzorg Amsterdam

if there is a need for more specific support (low

frequency predictable demand), specialists are

available at headquarters to be consulted

one person in charge for each family

makes sure whole system is in the room (other

service providers, grand parents, neighbours,…)

• to other service providers “clean” transfer by being in the

room

if not possible, personal conversation with caseworker or a very good

report

• once a family is secure again for the children, these are

handed over in person (once again a clean transfer) to:

another service

left to themselves with the assistance of their informal network

Jeugdzorg Amsterdam

• FFPS* as (evidence based) process:

Not “telling” what family should do

• but influencing whole family to come to a joint judgement of

what is (not) OK

• increasing the families’ insight in the harm that children are

exposed to

• Clarifying what help is needed/to be expected

need to be IN the family to do this

*Functional family parole systems

Jeugdzorg Amsterdam

• Value work:

1. Making contact

2. Understanding the situation

3. Making a plan together with the family

4. Taking the journey together with the network

partners

5. Ensuring that things continue to go well

• Everything else is “waste”

How do they regulate?

Jeugdzorg Amsterdam

• Measures

End of case satisfaction rating

Focus on child safety after every interaction with family

• Safety line

• Central line: when family can be released

score of 0 to 10

where a five is

insufficient and a 6

just OK (based on 8

questions)

Jeugdzorg Amsterdam

Three phases:

• 1) engage and motivate: in the first 6-12 weeks, meetings are held

with the family as often as necessary: assume noble intent, build on

strengths but face safety issues

• 2) support and monitor

• 3) generalization and clean transfer to other providers

Statistical process chart for months until phase achieved (by

order of entry)

Jeugdzorg Amsterdam

• weekly team meetings (+/-4 hours) focus on the “why” of

safety evolution of 8-20 specific cases

No more extensive contact journal but single, actual,

report written together with family

• detailing relevant events, facts, how causes are being

addressed with emphasis on those where little progress /

key decisions needed

if a case really gets stuck, it gets escalated with

weekly meetings with the CEO, knowledge manager,

extra psychologists etc. to find the way forward

• new cases get taken in a team as capacity

becomes available (no targets):

average number of households per counsellor now 14

• but they believe this should be more like 10

Jeugdzorg Amsterdam

Jeugdzorg Amsterdam

• FFPS supervision (quarterly):

Observation during contact with family

Reviewing case notes

• Yearly internal audit:

dig deep: asking “why” five times is a standard

practice

observation, interviews and checks (e.g. do the

numbers really make sense?)

shared across the teams (visiting teams is common

practice)

• External ISO audits (mandatory):

Focus on checking if feed-back loops function

Jeugdzorg Amsterdam

• when a team concludes that a structurally

blocking factor has arisen, which everybody

agrees cannot be solved at the level of the team

itself…

this is then immediately reported to a higher level

without considering formal reporting rules

the core task of the management is to tackle

structural problems for which the team itself does not

have the resources

management will always challenge the team to

determine whether it really has tried everything

possible at team level and whether the same problem

is also recognised by other teams.

Jeugdzorg Amsterdam

if really a case for management, it intends to find a

structural, rather than a short-term solution

• = regulating cycle at a tactical level start within the teams,

and if necessary moves to the strategic level

• always done pragmatically, from a real and well-understood

demand from the work floor

• to be urgently addressed by higher level management

• typical examples are structural problems in collaborating with

other organisations

when intensive networking between the Jeugdzorg teams and

members of these organisations is not resulting in preventing

the same problems from arising repeatedly

Jeugdzorg Amsterdam

• ICT supportive now (vs maximal specification)

From assumption that staff spend 80% at desk they

moved to being 80% in the field

• HQ mainly for meetings!

• No personal desks with desktop PCs anymore (incl. for

management)

• Staff got laptops, smartphones with mobile data connections,

public transport cards, access to shared/public car parks

• Offices were closed down and transformed (see next slides)

ICT system reconfigured to suit family orientation

Jeugdzorg in Amsterdam case

• HR, legal, secretariat,… all supportive

HR:

• recruitment takes into account IQ and personality, based on

an evidence based psychological assessment, focused on

youth care

police officers and people with interesting life experience have

particularly well suited profiles, more so than traditional social workers

social workers tend to take over, but the case workers need to be

coaches of others, empowering them

also a high capacity for-reflection is required concerning one’s own

learning as well as that of colleagues, asking each other open

questions without judging

this capacity is also needed to avoid that one starts to behave like the

families one is meant to coach.


• Rather typical annual planning and evaluation questioned

now

too much looking backward rather than forward and think it may have a

demotivating effect and cycle too long

now looking for ways to have a future oriented focusing on talent and

strength where people can grow

• Link with renumeration is very limited:

performance graded from A to D where B means that the automatic

pay upgrades are maintained, while A means that these can come a

year faster

in case of a D, the pay upgrade can be delayed a year


Secretariat (small pool of secretaries)

• also study the demand they get from inside the organisation

and ask constructive questions (e.g. is it really useful to take

minutes of meetings)

• soon clear that there is less work for them, but pleased to

see much is improving for the kids

Legal

• Realise that a lot of the questions they get derive from

insufficient knowledge of case workers

• develop training that enables case workers to retain and use

the knowledge.

Jeugdzorg Amsterdam

• Achievements?

the costs of taking care of an entire family in 2014

were only marginally higher than taking care of just

one child in 2011

Client satisfaction rose from 5.8 to 7.5 (on

0 tot 10 scale)

Jeugdzorg Amsterdam

The changes resulted in cost-savings of around 30

million EUR annually:

• within the agency, by eliminating unnecessary internal

processes and reducing the number of court measures.

The total budget was reduced from 53 to 34 million EURO (19 million).

• A further 11 million EUR (at least) was saved for the child

protection system as a whole, as the agency was able to

decrease the number of clients it had to refer to specialist

services.

• While other child protection agencies across the country

struggled with budget cuts, they delivered a balanced budget

Sick leave amongst case workers was also reduced

from 8-9% in 2009 to 6% in 2013

• Yet, the agency now only employs 410 as opposed to 600

• The organisation is now growing again as 10 more

municipalities outside Amsterdam have contracted for 2016

Jeugdzorg Amsterdam

They now take care of 3200 multi problem families

with more than 7000 children

• down from the 10.000 children who where engaged before

the transformation as half of those cases were voluntary

where there were only mild problems and their case

management could be closed during the transformation

process

it was awarded Best Public Sector Organisation of the

Netherlands by a select committee of government

experts in 2014

this was confirmed at EU level by winning the

European Public Sector Award for the category of

local government in 2015

case was taken up by OECD OPSI in 2017

Back to Buurtzorg, STS approach applied to

“case work” …

Buurtzorg NL

• neigborhood teams have full autonomy

regulating the work for their clients in their

neighborhood

do job interviews / decide on new staff (with support

of central office where open inquiries for jobs are

gathered)

plan and schedule colleagues to provide care

no registration of minutes spent on a product via

electronic registration at the client site

• Do what is needed (register that in Buurtzorg system), not

what is indicated

• Central office makes agreements concerning prices, volumes

and product mixes with each regional care office

this creates an average hourly price for use by teams

Buurtzorg NL

• Central support office converts to the indicated hours /

products and then bills the regional care office (each of which

has different formats)

audits are conducted regularly by regional care

offices (material control)

• care as described in the Buurtzorg client files corresponds to

the care products that were declared

• no substantial irregularity nor lack of appropriateness

detected

Buurtzorg NL

• if a team encounters an issue it cannot resolve

itself, this can be shared in the “web community”

other teams can then react if they already have

solutions

if no one has a solution and other teams recognize

the problem as relevant for them, a working group is

formed

the web is also used to incite people to participate in

pilot projects, expertise groups etc…

• Regional team coaches (about 1 per 30 teams)

can be called to help teams sort out their issues

NOT hierarchical positions!

• Focus on helping teams figure things out themselves

Buurtzorg NL

Meet every 2 months with CEO and the project

workers at central level

• Not a management team!

• Discuss issues that are common across teams but that

cannot be handled by these teams themselves

eg how to deal with colleagues that are sick for a long time: requires by

law that employer runs certain procedures; decision is that coaches will

act as employer

eg to cover unplanned night duty, some teams buy in independent care

workers, but this is very expensive and not always of high quality;

decision for coach to set up an experiment with a regional pool of

Buurtzorg colleagues

eg abolishing the function of a team coordinator (who had a higher

salary)

• Solutions are to be put to judgement of teams first (see later)

Buurtzorg NL

• teams analyse their own markets, get their own

clients, make contacts with other actors in the

neighborhood…

• teams make their own budgets

Based on projection of work x hourly price (from

central office)

+ average cost per FTE (based on mix of staff in

team, also provided by central office)

• what is decided at central level?

1) (implicit) vision on care and behavioral rules that

result from it (principles)

2) some other common operating rules

• Eg on productivity (50% after 1 y, 55-60% when stable)

Buurtzorg NL

• Buurtzorg’s implicit vision on care:

Holistic

• A person has physical, mental, social and emotional aspects

that influence each other

Relational

• People are part of a social context and cannot be seen

disconnect from this

Autonomy and self-worth

• Each person is unique (needs, experiences), can make their

own choices and craves for dignity

Trust

• People are in principle disposed to do the right thing

Buurtzorg NL

• Buurtzorg’s behavioural rules relating to care:

1) Context oriented work:

• Network around client:

Informal: family, friends,…

Formal: professional carers

Neighbourhood and its facilities

• Carers build personal relations with formal and informal

network

What can client / informal network cope with?

What can doctor do? (Buurtzorg knows all doctors in a

neighbourhood) What is offered by other facilities (e.g. for

lonelyness, dementia,…)?

• Office in main shopping street of a neighboorhood

facilitates contacts

Buurtzorg NL

2) Relation oriented work

• Strive for low number of carers to support building a relation

• Each client (as well as doctors and other carers) has mobile nr of

team and can contact carer directly

• Night duty arranged within team

3) Start from needs and experience of clients

• Do what is needed (eg call a plumber) incl. sometimes not providing

the indicated care as a neighbour can do it

• Take into account clients wishes

Balancing act with own professional / personal judgement of what is

best

4) Strive for resilience and independence of care

• Add only added value (on top of what people / network can still do)

• Take into account root causes of care need (requires knowledge of

sickness and recovery e.g. stroke requires stimulating brain)

Buurtzorg NL

• Other rules (not strict norms but goals to strive

for)

Team competence: +/-half “verzorgenden” and half

“verpleegkundigen” with +/-12 people

40-60 clients on 15-20 thousand inhabitants with

more than 17% aged 65+

responsible from intake to end of care

• Team 24 hours per day reachable

• Close contact with doctors, hospitals, other referring actors in

the neighbourhood

• Coordination is responsibility of whole team (but this can

mean that only a few people take a coordinating role)

Teams contribute to start up costs of new teams

Buurtzorg NL

team functioning

• Regular team meeting to discuss clients

• Intervision concering difficult situations and their own role in it

• Year plan where they describe what actions will be taken

concerning client and quality, training, organising care and

dealing with problems from practice

3% of wage mass can be spent on training (of which 1% on training

provided by the central office)

• Team members discuss functioning with each other once a year

• Productivity must be 55-60 % (for a mature team, 50% after 1 y)

• Decision-making is based on consensus

not everyone “yes”, but no one “no”

temporary: let’s try for x months, then reevaluate

• Team members are jointly responsible for results

• Salary based on education and experience (NOT on taking up

coordinating / managerial roles)

Buurtzorg NL

3) Strategic decisions:

• Examples:

Starting/stopping new teams

Cooperation between Buurtzorg and other organisations across the whole

organisation

Starting new businesses (other forms of care, services)

Making investments

Financial policy

• E.g. starting new teams is financed from income of existing

teams

Higher start up rate requires higher productivity to stay break-even

Break even means that internal capital is not boosted and means cannot

be invested in increasing expertise of staff

• Made by CEO, supported by internal experts, controller,

external advisors, and others whose opinion he values

No management team

But there is a Board composed of people that value the principles of

Buurtzorg and have relevant expertise

Buurtzorg NL

• However, participation of all teams is stimulated

Via web discussions (CEO regularly starts discussions but all

employees can also do so)

Bi-annual conference of the CEO

• CEO gives overview of state of Buurtzorg and policy

• Themes of common interest can be put on agenda (if need be

more meetings are organised

For topics that require consent or advice of “ondernemingsraad” by law)

• Meeting set up on the topic open to all, where it can be decided

to…

• …set up an ad hoc advisory group / working group

• Referendum

Managed by the project workers at central level

Key insight!

• Self-steering CANNOT be introduced as

such to a bureaucratic structure

Frontline does not have overview over

complete process…

…nor does it understand purpose from the

user point of view

Endless discussions and conflicts would arise

that require intervention from the hierarchy

…creating the self-fulfilling prophecy that the

workplace is not ready for more autonomy

1h15 min



in interaction with users? (ctd)


Netherlands


POLL



…)

• How does if function?

Front-line staff is heavily regulated (e.g. by

maximum specification, management)

Front-line staff is rather regulated

Front-line staff is rather autonomous

Front-line staff is highly autonomous

SMALL GROUP WORK 30min+30min


Discuss:

• How much of what people do is defined by

systems?

• Where does tactical regulation/learning

take place?

• Where does strategic regulation/learning

take place?


questions do you have on regulating?

POLL


regulating?

30 min

• Paradigm conflict four: allowing everyone

to experiment with ‘perfect’ or rolling-out a

negotiated way of working?


Netherlands


Wow,…

… but how did they make this switch?

Easy on a “greenfield”: get it

right first time in a new

organisation (e.g. Buurtzorg,

Life)

Harder on a brownfield (e.g.

Jeugdzorg, Social housing

repairs,…) where the organisation

needs to shift

Typical strategic change management

• First phase = blueprint

Define a vision, mission and strategy (goals and ways

to achieve them) at management level

• Reassert the “what” of the organization

Consult the rest of the organisation

Delegate a group of people from different parts of the

organisation to think about redesigning the

organization

• Reassert the “how” of the organization

• Second phase = roll-out

implement this new design across the organisation

POLL

• What could be problematic about this kind

of change management?

Why this typical approach?

• Assumed that strategic regulation cannot primarily

be done by the work floor

management must provide the "framework“ as in a

bureaucracy, the work floor would not have the “big

picture” overview to answer strategic questions

…but then again, management is too far removed from

the frontline, used to working with abstract, general and

simplified information

• Hence management works with frontline to design?

but both are in poor position to engage in tactical double

loop learning… so typically only single loop incremental

improvement (e.g. cutting out useless process steps)

representatives from all levels and units does not equal

having the entire organisation “involved”

POLL

• What would you suggest in terms of

change management?

30 min





Netherlands


A better approach

• Phase 1: use the three principles that need to

underpin the future flexible organisation:

Find people with all the expertise that is necessary to

serve customers

• incl. support and regulatory tasks, hence with someone from

each management level all the way up to CEO

• =“simple organization with complex set of tasks”

• of course, the team does not yet know what these tasks will

involve, because these must still be designed by the team

itself

• use volunteers first

Reconstruct the big picture at the granular level by

taking an outside in perspective

• "who" the customers are and "why" the team exists, from the

perspective of these customers =“empathy”

A better approach

• Phase 2: experiment with the “what”, reasoning

from the perspective of the diversity of

customers

Redesign core flow

• 1) holding off system conditions (clean stream) or

• 2) plan direct action

Predict consequences of actions and how you will

measure these

Make changes and measure: now you understand the

system better which helps to…

build a plan to make it normal

Adapted from J. Cox, Vanguard

A better approach

The two options for phase 2:

• 1) Clean stream (redesign core flow, holding off

system conditions): Big change in small part of the system: stick to new

principles, first small volume, then grow volume

Learn how to do ONLY value work: what does it take?

You can use prototyping (eg story boards how it would like look

to be showed to those involved = first iteration)

• Can take lots of iterations before stable

Once confident: put enough work through to stress test to learn

what capacity is needed and to take constraints into account:

• Which can be addressed immediately, which need more

time and hence a work-around?


A better approach

For case work: clean stream a relationship rather than a set of

transactions!

• Ring fence a case and work with them

• 2) Alternative to clean stream is direct action: Small incremental changes (vs big ones) in big part of the system

Stick to new principles in old context (vs create new context based

on principles)

Solve issue one by one, more and more using predictions /

measures

Use three types of waste as starting point

• Phase 3: allow everyone their own process transfer only data, NOT the design

changes meaningful to everyone + everyone will have

learned how to self-(re)organise from the very beginning


A better approach

• CRUCIAL for management (all levels) to

participate in a multifunctional “vanguard” team

(with all relevant expertise, incl. support and

preparation)

• …to conducts analysis and redesign

themselves!

• Only if they see the waste in the system,

understand it is a systemic problem and NOT a

people problem

• … can there be “double loop” learning that

questions the ruling assumptions

A better approach

• Leader always needs to lead within a reality

They can use a new paradigm within boundaries

which requires also to contain:

• comply with/ adapt to requirements imposed by other

systems but avoid being run by them (eg report but do not

manage on the targets).

• If really problematic you may have to refuse outright but

otherwise be ready to show you are doing a good job in

another way

So you need to have done enough experiments of the new way

with success

And also “would you like to see sth in the current system that

gives illusion of control but “nasty reality”, which brings you to…

influence over time the other systems (eg look for

common purpose)

45 min





Netherlands


Jeugdzorg in Amsterdam

A “brownfield” case…


• Experiment with “being perfect” (phase 1+2):

Out of the entire organization 1 volunteer cross-functional

team with two managers and the CEO worked full time

on a project to look outside-in (analysis)

• what happens to the client from the start of contact to the end of

the engagement; normally, with “live” cases but as here this can

take months/years, they decided to dig up 60 recently closed

cases

• purpose was settled on: “Keep every child safe, forever”

• went through the extensive case reports and marked in red when

case workers were doing things that did not contribute to the

purpose

there was a lot of activity (people did work hard), but very little of it

was noticed by the families

indeed, 60% got worse, 30% stayed stable and only 10% got

(slightly) better


clear signals existed that kids were not safe and parents unfit

but nothing was done with these signals as case workers

simply did not know how to act on these

• they then designed a service that is perfect (ignoring existing

conditions) based on new principles (contrasted with old

ones) and using outside-in measures

the team then worked out from April-July 2011 (3

months) how to deliver the new way of working in

practice (experiment)

• incl. adapting ICT…

• …and integrating requirements that are not useful but that

cannot be avoided (e.g. upward reporting to the city council)

• using the new measures

as entire hierarchy represented IN the exercise,

automatic endorsement of the new approach


• “Roll-in” instead of “roll-out” (phase 3):

The rest of the organization was NOT told about the

new design, only about the process the team had

gone through

• otherwise, communication only creates resistance as other

teams have not gone through a process yet that enables

them to understand why, for example, contact journals have

been abandoned

In December 2011 three new volunteer teams were

given time off and got all the data that had been

collected and analysed

• They were asked to redesign the process themselves and to

try it exactly as the first team had done

• This process of “learning to learn” took three months


week 1 = analysis and planning for perfect

week 2-3 transfer of files to the new (family based) ICT system

in the 10 weeks that followed they went through “doing”

Next 40 more teams were rolled in in the next year

• all getting time off with work taken over temporarily by others

to make this possible an overall planning was made

• it took a full year, until June 2013, for the entire organisation

to take all 40 teams through the process of “rolling in” and

have them experience their own process

Rolling in focused on volunteers first

• Staff were given up to two years to figure out if they could

function in the new way of working

• If not, they were helped to find jobs elsewhere: 40% opted

out of the new way of working, however, there were no more

lay-offs than usual


Team managers were crucial

• had to reapply for their jobs via a process with external

experts that knew the organization very well

• About 25 % of the former team managers left the

organization based on this process (no need any more for so

many managers so this attrition was not problematic)

• needed to be able to reflect on how the rolling in was going,

hence, came together weekly, coached by the present CEO

(at the time director of innovation) and, initially, a Vanguard

consultant

• It was key for senior management not to take over and

propose solutions but rather to coach the team managers

into doing their own thinking

Social housing repairs Tees Valley

• Similar process at Tees Valley

Systems Team introduced to systems thinking

over two days

First phase (analysis): six weeks, 3 days/week

• Call centre and reception staff observed to classify

demand

• Capability charts (SPC): time-consuming process as

the information required was not always available

directly from the IT systems and had to be collated

manually from the base data that was available

• Mapping the flow involved working with maintenance

staff and contractors

Social housing repairs Tees Valley

• Presentation to sponsor, management teams,

boards, councillors and tenant conferences and

representatives’ groups

Second phase (experiment) (6 more weeks)

• proposed changes were tested by using different

maintenance assistants, staff and contractors to

differentiate

• teams shadowed the person doing the work to

discuss issues arising, both with them and with

customers

Third phase (roll-in)

• redesigns were introduced gradually

1h15min





Netherlands


POLL

• Take a particular change process that you

are familiar with (you conducted it,

planned it, participated…)

• How does change happen?

Fully roll in

Mostly roll in

Mostly roll out

Fully roll out

SMALL GROUP WORK 30+30 min

Pick one of the change processes and

discuss:

• How did change happen?

Did it go as planned?

Was there a lot of resistance?

Does it last, is it sustainable?


questions do you have on change

management?

POLL


change management?

Documents

Public Management for the 21st Century · 2019. 3. 5. · Services vs products • Services are characterised by 1) intangibility (it is a process not a product) 2) high levels of