Multi-agency improvements: serving several masters
The problem with silos
Managing processes across different teams in an organisation is difficult. Ad Esse has conducted many diagnostics in many different types of organisation, and one common issue that we find is the existence of silos between different teams. These silos can have a dramatic impact on the performance of processes that cross functional boundaries, with extra delays, animosity between teams and poor levels of customer service frequently occurring as a result. Often teams are working to different targets and objectives, leading to a situation where improvement in one team just creates more problems for other teams and for customers. Pay and bonuses may be linked to targets that create some of these issues, and the organisational design may mean that staff are in the wrong place or team to deliver the end-to-end process successfully.
Improving these cross-functional services involves work to identify the end-to-end process and to agree what success for each process looks like for the organisation and for the customer. Improvement almost always includes changing teams measures and targets and ensuring that the overall efficiency and effectiveness of the process is measured and reported, rather than teams having arbitrary targets that do not relate to customer experience or organisational effectiveness.
Changing all of this means addressing many complex issues that can impact directly upon team and management structure, job descriptions, pay and bonuses and the sense of worth that individuals may have. If it is done well, however, performance can improve, relations between teams can change out of all recognition and customer service can be transformed.
Improving multi-agency processes
Given all of the above, imagine how much more difficult it is to deliver efficient, customer-focused services when these services cut across organisational boundaries and not just team boundaries. Ad Esse has worked on a number of multi-agency improvement projects, where leaders in different establishments have realised that the only way to improve performance is through a coordinated transformation programme. These have ranged across health, social services and criminal justice, with the most complex involving over twenty organisations from the public and not-for-profit sectors.
Delivering successful multi-agency improvement is dependent upon a number of key principles:
Be clear about the project objectives and keep them realistic
Map and review as much of the end-to-end process as you can, and be honest about all the failings identified
Work together on solutions and improvements and accept the need to compromise
Develop common measures of success that all participants agree to
Be facilitated by someone who does not have an element of self-interest in the outcomes of the project
1. Objectives
Having assisted with the set up of many multi-agency projects, we have found that the first step needs to be to agree what ‘better’ will look like. In one criminal justice project we found that different participants had completely opposing measures of success for the service, and so were looking for contradictory outcomes for the project. These issues have to be addressed before any improvement work can commence. Making sure that you have an executive level group of sponsors that you can go to for clarification is essential if the rest of the work is to be useful.
Secondly, it is not possible to resolve every issue in a project. Ensure that you agree what are the main issues that need to be tackled (and some partners may have to accept that their individual bugbear is not a priority in the end-to-end process) and agree that for some issues, mitigation or some improvement will be acceptable, rather than expecting every problem to be completely eliminated.
2. Mapping and reviewing the process and problems
Although every partner and individual in a large, multi-agency service will have their own tale to tell about what they do and the problems they encounter, it is only through the production of an end-to-end value stream map and customer journey map that it is possible to understand the interactions between the different agencies, and between them and the service users. It is vital that these maps are based upon what does happen, not what should happen, and that all teams are honest about what works and does not work, and why.
For example, working with a project team (made up of voluntary agencies, social services and primary and secondary healthcare staff) aiming to reduce avoidable A&E admissions for elderly patients, it was when mapping the nightmare journey of an individual woman through six hospital admissions and discharges over seven weeks that it became clear that although each partner organisation was trying to do the right thing, the net result was terrible suffering and high levels of inefficiencies.
Another example was working on an offender management process we discovered that up to four different voluntary agencies might be trying to house the same offender leaving prison (depending upon their personal circumstances), leading to duplication of effort and overburden of the teams who might provide the housing. This was not evident to them before the mapping session.
Exposing all the problems in a multi-agency service is usually a real eye-opener and can become quite cathartic, if a bit depressing, so long as all issues are treated with a no-blame attitude. None of the issues are usually anyone’s fault, more a combination of poor communication, differing priorities and poor processes. Having a shared understanding of the problems, and the root causes of the problems, is essential before true improvement and transformation can begin.
3. Designing solutions with consensus
There is always a danger in a multi-agency improvement project that the largest organisations will dominate both the mapping and process redesign activities. Whether it is the police services in criminal justice, or acute trusts in health and social services, they may see the project about resolving their issues rather than the end-to-end service user issues. It is vital at the redesign stage to be clear on what is of most benefit for the complete customer journey, and for the effectiveness of all organisations, rather than focusing on just one or two. The value stream map is extremely useful in that respect as it shows all the negative impacts of problems and their likely causes.
When working together to improve processes, recognising the ‘art of the possible’ is essential. There is no point missing real improvement in the pursuit of perfection. It is likely that at the end of the redesign workshop all participants will still have issues with the new process, and it may be that there are longer-term changes that would be beneficial, but cannot be implemented at the moment (often based around systems and the sharing of data), but these should not stand in the way of more immediate process and behaviourally-based changes.
The creation of a very clear action plan is essential. This may well need sign-off from different partners, but it should be developed with as many of the agencies in the room as possible. Names and end-dates should be inked-in to avoid slippage.
4. Common measures for the new process
Although most partner agencies will have their own key performance indicators with regards to the service being redesigned, it is useful to create a common basket or dashboard of measures to check that all parts of the new end-to-end process are working as planned. Creating a single Information Centre for the redesigned service can make it easier for each partner to see how they are contributing to the overall process and to spot any issues more quickly. Weekly meetings or conference calls will help ensure that progress on the agreed actions is being made by all parties and that the expected outcomes are being achieved.
Some of these measures may need to be agreed by the senior teams of the different agencies involved in the project, as they may focus on areas that are not currently being measured, but the use of the as-is value-stream map and future-state redesigned process will help to explain why these new measures are important.
To avoid stagnation, it is a good idea to build-in a review with the senior sponsors and representatives from other agencies after two to three months. This is usually long enough to see if things are progressing as planned, but not too late to catch up and ensure that the ultimate outcomes are achieved.
5. External Facilitation
From experience, we all know that it is hard to both be a participant in a workshop and to facilitate the workshop. It is usually easier and better to use someone else who can focus on the process for the workshop/meeting and on achieving the outcomes, rather than getting involved in the detail of the topic being discussed. Also, with a multi-agency project, there may be suspicions that a facilitator who is not independent will be more sympathetic to some agencies’ issues than others.
Working with an external facilitator like Ad Esse also means that you get a tried and tested set of tools and someone who is experienced in managing large change events. We have often run mapping workshops with over 30 people in a room and have also run redesign workshops with over 20 different organisations represented. In these cases, it is vital the facilitator uses techniques that allow all participants to feel genuinely involved, and to ensure that all the information and ideas that are in people’s heads is captured and evaluated by the rest of the team. Given the cost of other people’s time for a one-day or multi-day project, the extra cost of an external facilitator is usually marginal, and generally well worth the money.
Conclusion
Although getting a multi-agency improvement project off the ground can be difficult, the benefits can be enormous. The prevention of wasted time in each of the partner organisations can be very large, and the benefits for service users (which is usually why all the agencies exist) can be equally transformative. Following a few simple rules can ensure that the project delivers swiftly and effectively.
