Gillian Xie
My first priority coming into this project was to clearly process map the user journey from their first entry to hospital through to receiving their final package of care. This revealed not only confusion amongst staff as to the exact process, but also a complete lack of communication between different teams. This meant that as a service user moved through the system, they would have to repeatedly describe their situation to different health and social care staff. I found that decisions were made with incomplete information about service users which led to both delays and reduced levels of independence and quality of life.
I found that on average, service users were waiting for over two weeks to receive occupational or physical therapy assessments. Furthermore, even when service users had completed their rehab, they were waiting for up to a week for assessments to receive their final packages of home care. There was a lack of multi-disciplinary working as well as inefficient resource allocation. For example, some staff were scheduled to visit service users on opposite sides of the borough and whilst other staff sitting in other teams were waiting for work to be allocated.
Through direct working with senior members of staff and shadowing their daily work, I discovered that senior staff lacked oversight over the current status of their services. They didn't have high-level visibility into delays or issues or even their current overall workload. I found that there was a lack of data used in their day-to-day operations and particularly found that instead of focussing on service improvements, senior staff often ended up being pulled into singular cases that prevented them from stepping back and viewing their service from a holistic lens.
There were two key staffing changes that needed to happen in order to improve service design—multi-disciplinary working to ensure accurate deceisions about service user needs were made as well as resource reallocation to reduce delays. Through hosting design workshops with representatives from different teams, we were able to identify key requirements for a weekly multi-disciplinary team meetings that would allow members of different teams to discuss service users and how best to assist in their rehab, as well as request assistance or support from other teams to achieve this. This also facilitated the reallocation of resource as delays were identified near the end of the user journey which allowed staff to be moved between teams to support the teams involved in assessing user's final packages of care. This led to a 20% reduction in delays, allowing service users to move quickly through the service and freeing up staff time to see other service users in need.
In order to provide senior staff with better visibility over the status of their service, I collaborated with them alongside other members of my team to design a dashboard that could provide insights into information such as the current number of service users or the effectiveness of their service. As the clients were the experts on the service, this design was based heavily on what they considered to be the key metrics for effective decision-making. This dashboard was also tested among frontline staff with iterations including changes to layout and designin order to better suit the workflow of staff members. I also spent several weeks sitting together with senior staff to coach them on using data to drive their decision-making as well as using the information to drive service improvements.
The final outcome was a much more connected service that was more comfortable in using data to drive their decision-making. We were able to save £4m annualised spend for the council which was key for them to continue providing valuable social care services to their citizens. Critically, different team members were able to develop a more positive and productive working relationship with each other and I observed an increase in interactions between different teams. Surveys for service users also noted a decrease in complaints and an increased level of satisfaction with the service.
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