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From Home Adaptations to Accessible Homes
- redesigning services using business processes
31st May 2012
Tom Gilchrist
• Rapidly growing city – 430,000 • Fastest growing 0 – 10 age group in England• Economically successful• City of contrasts – greater income range and
pockets of significant deprivation• Housing profile; social static (19%); owner-
occupation in decline; rapid rise in social/Private renting
Background to Bristol
• 40% increase in service demand since 2008, will rise further
• 20% forecast increase in 85+ population by 2021
• 60% increase in disabled children over 40 years
Older and Disabled People
• Multi-tenure service (from 2006)• Unit costs competitive• Fast-tracking (within adaptations team)• Demand-led• Budget increases – waiting lists still increasing
lagging behind demand• New RP protocol in place (2010)• Top-up funding available for DFG’s• 2 delivery agencies – in-house and HIA
Background to the Home Adaptation Service
• High satisfaction: Large no. of complaints!• Long waiting times and growing waiting lists• Service split between 3 directorates and 2
organisations (very disjointed)• Inconsistency in waiting times between
tenures
Drivers for Change - Organisational
Drivers for Change - external
• Increasing demand• Political pressure to reduce waiting times• Policy issues:
• hospital discharge• community care
• Falling resources (PSRG) removal 2011• Threat of Audit Commission ‘red flag’ due to
waiting times:• Private sector 15 months (standard
priority)• Landlord sector 18 months (standard
priority)
Approach
• LEAN systems/BPR• Learn from customer experiences (journey
mapping)• Learn from staff• Manage as a project with board• Use business analysis techniques• External Project Manager; Process Maps
• 2 completely separate services (assessment and delivery) and 4 different processes
• Little understanding of customer types• Professional and organisational barriers• Focus on product, not on need• Needs assessment/specification divorced from
budget decisions
What Did We Discover?
What Else Did We Discover?
• Only 20% of staff time was spent with customers• Separate queues• Too many home visits (surveyors and OT’s)• Poor management reporting• 4 different IT systems; no interfaces• Average length of process too long
And More……
• Professional silos• Day-to-day focus• No understanding or ownership of whole
process• Inward looking• Not outcome focussed; waiting list driven• Heavy reliance on public funding• Lack of customer involvement• Tendered contractors - profit driven
Changes
• Re-design and simplification of whole process, eliminating organisational and professional boundaries
• Process designed around customer journeys• Outcome-based performance measures• Strong emphasis on diagnostics and triage at
beginning – better training• Greater efficiency by reducing home visits and
less hands-on contract management
How We Are Doing It Now• Case-workers are at the centre of the new process• Strong diagnostic, based on need, by OT/OTA• Diagnostic carried out at ‘assessment centre’ which is
co-located with WOE Home Improvement Agency• Emphasis on meeting needs with simpler/cheaper
solutions• Reconfiguring IT systems (little cost saving: improved
reporting)• More emphasis on self-funding and re-housing• Standing customer-focus panel• Demand management - new assessment criteria
and better information to customer
Initial Assessment
Resolve at SWIFT
Resolve at ILS
Provide Equipment
Provide Minor
Adaptation
Install adaptation
Produce Specification
Arrange Re-housing
Equipment
Major Adaptation
Minor Adaptation
End to End Process
Care Direct ILS SWIFT ILS Accessible Homes
Contractor
Assess Need
Re-housing
HIA
- Direct phone call- Hospital discharge
Review and Triage
Consequences
• Average ‘end-to-end’ times reduced (new cases) 71 to 30 weeks (7.5 months), many resolved within days. Will reduce further as new process becomes ‘the norm’
• Different processes used for backlog/new cases• One manager with an integrated team of caseworkers,
surveyors and OT’s• Capacity increased (assessment centre seeing 6
cases/day)• Lower cost solutions increasingly used – budget
stretched• Net revenue savings over 6 years of £609k• Mobile working by OT’s and surveyors• Savings re-invested in IT improvements, more
caseworkers and specialist re-housing OT
What Does ThisMean for Real People? – Mrs. K• Diagnosis at Assessment Centre• Small number of aids (bath board & toilet frame) met her
needs and were issued• Interested in self-funding a new shower; she tried out
various options at the centre• 4 months later she returned aids having had shower
installed at her expense
Outcome:• Quick resolution to immediate needs• More choice• Avoided long wait during which time her condition
would have deteriorated• Deflected from taking DFG
Mrs. C
• Seen at assessment centre within 8 weeks (over Christmas period)
• Assessed for bath lift and step. Provided bed and armchair raisers, toilet grab rail and lever taps
• All equipment was demonstrated to her• Equipment delivered within a few days of assessment.
Outcome:• Able to take a bath unaided for first time in years• High risk of fall avoided• Mrs C very pleased
Mrs C• Client suffers from Inflammatory arthritis, bowl disease, falls, social isolation and
anxiety and depression.
• Property accessed via steps to front door and up 18 steps to first floor
• Client unable to use bath and perching stool unusable.
• Family unable to provide support. Homecare costs incurred.
• Projected costs for adaptation £7K (access improvements and intercom) plus monthly pendant alarm.
• Support provided to bid for house and handholding/support throughout move.
• Minor adaptations installed and small incentive towards move costs (total cost £1,250)
• Better outcome achieved: more usable property found (level access, equipped shower room which can be used independently) no further homecare costs.
• Client closer to family who call in daily to call daily to provide support
• Time from initial enquiry to move: 16 weeks
• Unable to manage stairs to first floor RP flat• Applied for re-housing but placed in lowest band• HIA assisted them to have health assessment• Banding increased and successfully bid for 1 bed
sheltered RP bungalow• Now very happy; able to go out more, able to hang out
washing, reduced risk of trips
Mr. & Mrs. J
Top Tips• Take a customer-centred view: not all customers are the
same!• Senior managers/directors need to own the change• Take an end-to-end view of all processes• Get objectives agreed; measure progress against them• Spend time understanding what’s going (As Is)• Be forensically analytical• If possible capture system-wide costs and benefits• Engage all key stakeholders• If possible test out new processes by piloting • Implementing’s not the end of the story, use ‘process
ownership’ and benefits realisation to ensure its working
What Next?
• Process Ownership Board: multi-agency– change management– benefits realisation– outcome tracking
• Re-commissioning of HIA– sub-regional– integration of Assessment Centre with HIA
• Introduce IT integration• Continuation of process mapping – re-housing
