max moullin - “realising the potential benefits of ci”
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Continuous Improvement: Change for the Better
Manchester Conference Centre, May 2015
Creating a quality culture
Max Moullin, Public Sector Scorecard Research Centre www.publicsectorscorecard.co.uk
Quality - have we lost the plot?
What definition of quality do most organisations use in practice ?
Conforming to the specifications of head office (or central government)
A.
Q.
So what is Quality in the public sector ...
“Meeting the requirements and expectations of service users and other stakeholders while keeping costs to a minimum”
Moullin, 2002
Insurance Claims Example
• Insurance company has an average call waiting time of 12 minutes in its claims department - up to 25 minutes at busy times. Many complaints.
• The manager is considering four options: A. employ 2 extra staff
B. reduce average call time by 25% C. divert most enquiries to the internet or
D. share services with another company.
What would you recommend?
"Don't just do something, stand there"
The White Rabbit (Disney's Alice in
Wonderland movie, 1951)
… and do some systems thinking
Systems Thinking: Insurance Claims
Reason for phone call % How to address Chasing up due to non-‐response
22 Process claims on 6me
Don't understand claim form
16 Produce clearer form. Help on web site.
Disagree with decision 20 Give clear reasons Mistake in processing claim
12 BeFer training to prevent errors
Informing company about details of claim
25 Adds value. But check that all stages needed.
Other 5 Inves6gate further
Two stages: analyse data. Take action!
In addi'on you are told that 28% of calls have to be re-‐directed as they come through to the wrong person, while 5% of calls are re-‐directed twice.
18:58
Developing a quality culture - some pointers …
©Max Moullin 9
Pointer 1: Focus on outcomes, not activity
"Effective commissioning must focus on outcomes. Only then will we achieve the high quality, value for money public services
that people deserve"
Sir Stuart Etherington, Chief Executive, UK National Council for Voluntary Organisations
Pointer 2. Manage performance across organisational boundaries
• For example, research on teenage pregnancy
showed that 71% of young women between 16 and 18 who were NEET* for > 6 months were parents by 21
• Therefore if you run a team aimed at addressing teenage pregnancy, working together with local colleges and employers is absolutely vital.
* Not in education, employment or training
Moullin, 2006
©Max Moullin 11
Pointer 3: Integrate risk management
'identifying and addressing key risks are essential for any high-performing
organisation and therefore any evaluation of performance without
considering risk is incomplete'
4. Take account of the cost of measurement
"Public sector organisations spend up to 20% of time on form-filling, auditing, measuring and reporting performance but only a fraction of this is ever used to gain relevant and new insights or lead to performance improvements."
Professor John Baillie
Chair of Audit Scotland
5. Develop a performance management culture focussed on continuous improvement, innovation, and learning - and not a top-down blame culture …
©Max Moullin 13
Pointer 5: Focus on CI
"All performance targets are flawed, some are useful"
Max Moullin, "What's the Score",
Public Finance, 22 May 2009
with due acknowledgment to the quality management guru Deming who said:
"all models are flawed, some are useful"
COMPLACENCY
TUNNEL VISION
DATA MIS-REPRESENTATION
MEASURE FIXATION
GAMING
MYOPIA Concentrating on short-term
Emphasis on 5 A-C GCSEs. Schools focus on those on C-D margin
13 week target for planning applications
'led to more rejections'
% of offences brought to justice target led to more efforts on easy to solve
crimes
Follow-up appts for ophthalmology delayed to meet targets for new ones
3.5 hour wait for A&E is OK
Based on Brooks (2007), Ch 3.
UNINTENDED
EFFECTS
Auditors found 12 NHS Trusts had adjusted
waiting lists ‘inappropriately’
© Max Moullin,
Performance management culture
“Once we accept that all targets are flawed, it is clear that the priority is to
develop a culture focussed on continuous improvement, innovation and learning - and not a top-down
blame culture”
... but targets can be useful too
Max Moullin, 2009, What’s the Score, Public Finance
Hospital waiting times in England–thousands of people waiting a number of months
©Max Moullin 17 Source: Dept of Health
0
50
100
150
200
250
300
350
400
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Thou
sand
s
>6 months
> 9 months
Pointers for creating a quality culture …
6. Use the Public Sector Scorecard to help you ...
©Max Moullin 19
The Public Sector Scorecard
OUTCOMES
PROCESSES
CAPABILITY
The Public Sector Scorecard is an integrated performance
management framework for the public and third sectors
“The Public Sector
Scorecard is groundbreaking”
Bob Penna, former Director of Research and Communications, New York Senate
©Max Moullin 20
The Public Sector Scorecard
What are the outcomes we really want to achieve for our service users and stakeholders?
How effective are our processes in achieving these outcomes? How can we improve them?
How can we best support our people and processes to achieve the outcomes required?
OUTCOMES
PROCESSES
CAPABILITY
©Max Moullin 21
SERVICE USER/ STAKEHOLDER
FINANCIAL
OPERATIONAL EXCELLENCE
INNOVATION & LEARNING
STRATEGIC key performance
outcomes
The Public Sector Scorecard
OUTCOMES
LEADERSHIP
PEOPLE, PARTNERSHIPS & RESOURCES
PROCESSES
CAPABILITY
Clarifying outcomes
Identifying process & capability outputs
Strategy mapping
Integrating risk management
Re-designing processes
Addressing capability
Developing performance
measures
Learning from performance
measures
How the Public Sector Scorecard works
©Max Moullin 23
Strategy maps • Kaplan and Norton (2001) say a strategy
map ‘describes how shareholder value is created from intangible assets’
• However with the PSS, it can be defined more simply as showing the relationships between capability, process and outcome elements
• They are the vital link between strategy and performance measurement
Health & Wellbeing of
people with LTCs
Effec=ve use of resources
Reduced unnecessary
acute bed days
In control of their health
Reduced isola=on & anxiety Reduced cost of
unscheduled care. Sustainability Effec=ve personal
& self-‐care Improved
mental health
Reduced A&E admissions for
non-‐A&E pa=ents
Integrated LTC & mental health care
Reduced admissions to care homes
Consistent good quality care in care
homes Accessible shared records
Reduced delays
Carers’ needs met
Removal of non-‐VA ac=vi=es
Re-‐design flow
systems
Reduce unwarranted treatment varia=on
Focus on resource -‐intensive pa=ents
BeNer sharing of informa=on
Emphasis on preven=on & early diagnosis
More joined up working in H&SC.
Change public percep=on re hospital care
Simpler financial
flows & risk sharing
Less duplica=on of assessments Integrated
H&SC teams More independence
Reduced hospital admissions, length of stay & outpa=ent aNendances O
UTC
OM
ES
PR
OC
ESSE
S C
AP
AB
ILIT
Y
Feedback on the PSS
'The strategy map is really useful as it simplifies a complex issue with a complex response into an orderly understandable approach'
Executive Director for Children, Young People, and Families, Sheffield City Council
.
©Max Moullin 25
'The SLC4L Strategy Map visually told the story of SLC4L, what we were trying
to achieve and how.
It helped all those involved understand the outcome and process measures the programme was trying to achieve, and
therefore being evaluated against.'
Programme director Sheffield Let’s Change4Life
.
©Max Moullin 26
How the PSS reduces the impact of perverse incentives
• Measures user satisfaction • Focus on outcomes, not activity • Works across organisational boundaries • Involves staff, users and other
stakeholders in developing measures • Much more selective approach to targets,
not top down • No blame culture – appraisal model
©Max Moullin 27
Key features of the PSS • Focuses on outcomes and evidence-based
drivers of outcomes • Provides a link between strategy, service
improvement and performance measurement • Incorporates service re-design, organisational
culture and resource issues • Ideal for use across organisational
boundaries • Integrates risk management • Culture of improvement, innovation &
learning, not a blame culture
Creating a quality culture: Recommendations
1. Make sure you focus on the outcomes that matter to users and other key stakeholders
2. What about your processes? Can they be more effective in delivering these outcomes
3. How can your organisation improve its capability to support its people and processes in meeting the outcomes required
4. Develop your performance measures around desired outcomes, processes and capability
5. Develop a culture of innovation and continuous improvement and not a blame culture
6. Use the Public Sector Scorecard to help you
Recommendations (continued) 7. Performance measures and targets, where
appropriate, should be developed jointly with the organisations that are being held to account.
8. If measures are not directly related to outcomes or evidence-based drivers of those outcomes, then they should be scrapped.
9. If performance is below a target, then organisations or departments should be able to offer an explanation of any exceptional circumstances that have affected performance.
10. Public and third sector organisations need to develop their own integrated service improvement and performance measurement frameworks.
MAIN REFERENCES 1. Moullin, M and Copeland, R (2013) Implementing and
evaluating behaviour change programmes with the Public Sector Scorecard. National Health Executive, Jul-Aug 2013, pp.16-18
2. Moullin, M. and Copeland, R. (2012) Strategy Mapping for Behaviour Change with the Public Sector Scorecard. British Academy of Management Annual Conference Winner of 'best paper' prize.
3. Moullin, M. (2009) What's the score? Feature Article, Public Finance, 21 May Chartered Institute of Public Finance and Accountancy, London.
4. Moullin, M. (2009) Lean and Six Sigma – Can they really be applied to the public sector? Public Sector Executive, May / Jun 2009
5. Moullin, M. (2004) Eight essentials of performance measurement International Journal of Health Care Quality Assurance. 17:3. Winner of International Literati Prize
Contact details:
Max Moullin, BSc (Soc.Sc.), MSc, FORS, FCQI, CQP Director, Public Sector Scorecard
Research Centre Visiting Fellow, Sheffield Business School e-mail: max@publicsectorscorecard.co.uk
Web site: www.publicsectorscorecard.co.uk
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