2. 2
What do people say they need and The Voice of the customer?
• UNDERSTAND ME – listen to me, understand me and help me to understand
• ENABLE ME TO HAVE CONTROL – offer me choices, work with me to develop my care
• BE COORDINATED – make it easy for me to have my needs met, ask me only once
• BE CONSISTENT IN QUALITY – make my care feel the same, whomever I see
“Help me understand why I have to be fed via a tube”
Conceptual Design Team
3. 3
Some key issues for both customers and staff
A clear ‘cause and effect’ relationship
Customers said: Staff said:
“Performance is managed by length of stay,
not customer outcomes."
“We are completely driven by the process
and rules.”
“[You don’t] Assess me according to my
needs – I just fit in with what suits you.”
“Every day we reinvent the wheel… because
we don't talk to one another.”
“Departments don’t coordinate with each
other who are dealing with the same thing.”
“I just want someone to listen….but they
ignore me.”
“There is not enough time to listen to crying
people."
“My late husband was discharged from
hospital and no-one was at home when he
arrived.”
“Even though they have all the information
we don't get told about the discharges."
“[You don’t] Help me continue to do the
things I am interested in ”
Conceptual Design Team
4. The Process;-
The Stages
• Design
• Paper Testing
• Live Testing
Not New But……
• Inter Agency
• Over a long of period time
• 300 years of different
background experience of
front line working in public
services.
7. Value Add Assessment - ‘Pat’
Full
Value
Part
Value
No
Value
Tot
3 25 14 42
Full
Value
Part
Value
No
Value
Tot
16 7 0 23
‘As Is’ Process ‘To be’ Process
16
7
03
25
14
23 Process steps42 Process steps
Conceptual Design Team 7
8. Pat
Home with
support of
APA and
Care
Exchange
Home event
999 – with
information
Care Exchange ie
Hosp referral
(GOD)
Care Exchange
Direct admission
to appropriate
ward (only
setting)
Bringing Home
Team & Care
Exchange
Home Care ‘APA’
Rapid Response
Social work GP
Care Exchange
Stay at home
(with my care
plan)
Key
Understand/Plan/Do
Conceptual Design Team 8
9. Stories Summary
Story Steps Capabilities Cost* Value Add
Betty
90 year
old
woman
4 months in hospital (acute and Community) delay in
discharge. Sectioned under the Mental Health Act
because of medication and food. In reality cancer
was the cause of her weight loss.
As-Is 72 12 £40,000
To-Be 15 8 £10,000
Norman
83 year
old man
Admitted to hospital, medication reviewed and
stopped, condition deteriorated - multiple further
hospital admissions
As-Is 32 17 £13,100
To-Be 20 5 £7,980
Jeremy
83 year
old man
Lives in a poor environment. Range of health issues
including Type 2 diabetes, high blood pressure and a
history of falls. Had home assessment by Staywell
following series of falls.
As-Is 28 18 £755
To-Be 12 10 £725
William
18 year
old man
Has Asperger’s syndrome. Is reclusive and nocturnal.
Going through transition from Children’s to Adult
Services. Recurrent suicide attempts of increasing
regularity and intensity
As-Is 17 5 High
To-Be 9 6 Initially high
Susan
lady in her
80’s
An older, adult Type 1 diabetic in-patient. Considered
medically fit for discharge. Referral to Staywell to
organise micro environment. Discharged although
several delays
As-Is 18 9 £2,700
To-Be 7 8 £200
Thomas
63 vear
old man
Thomas has Motor Neurone Disease. The home
environment is cluttered and potentially hazardous.
Whilst waiting for a review he had a fall and was
admitted to hospital
As-Is 22 8 £7,937
To-Be 7 3 £8,020
*Costs under discussion with Commissioner
Conceptual Design Team 9
10. Non traditional capabilities for development
• A range of Advanced Personal Assistant capabilities
A professional care giver in the community – building
on existing home care capabilities through an
additional set of health and social care skills
• Homecare/Substance abuse/Mental
Health/Dementia/Professional Befriending
• COPD/Cardiology
• Core Nursing skills eg catheter, insulin
• Community branches – Settings in key community
locations aimed at keeping people well through
prevention. These should be developed directly from
customer needs Conceptual Design Team 10
11. • A ‘Home Options Team’ supporting return home
from hospital
• A single OT service – Health & Social Care
• ‘Acute Community Care’ Team – avoiding
hospitalisation
– Nurse Practitioners/General Practitioners/
Hospital Specialist of the Day/Advanced
Personal Assistants
• Supporting people in residential settings
Non traditional capabilities for development
Conceptual Design Team 11
12. What is the Care Exchange and what makes it different?
Much of what the Design Team has seen shows that whilst care
delivery is usually very good, its co-ordination is not and that individual
customer journeys are often obstacle courses rather than simple steps.
The conceptual model of care is based on a simple methodology of
‘Understand, ‘Plan, and Do’.
The strength and simplicity of this model is underpinned by;
• its coordinated and consistent approach
• Its person centric focus
• its access to all the information systems across the Borough in one
place
• its ability where applicable to come up with different and innovative
solutions
Conceptual Design Team 12
13. Conceptual Design
Care
Exchange
Referral
Shared
spaceHomeRest/Nursing
HomeClinics Homeless
persons unit
Acute/community
hospital
1. Understanding of immediate risk. Make a contact with the Care Exchange
2. Planning and Creating a whole system response – intelligent decision making
3. Doing - Settings - a range of options to meet peoples’ needs (shown examples but
not exclusive)
1
2
3
Conceptual Design Team 13
14. Care Exchange Acceptance Criteria
• All stories considered
• Final Acceptance Criteria – will determine stories going
forward
1. No Health Emergencies
2. Referrers capability has been reached
3. A basic level of info/age/d.o.b etc
4. The customer agrees to the Care Exchange involvement
• Care Exchange capability has been reached
Exit Criterion
Conceptual Design Team 14
15. Measurement & Evaluation are key.
• Measurement will play an important role in
answering the questions which we need the Live
Testing to answer
• There will be some questions which will be
impossible to measure. It’s important that we collect
evidence for a narrative answer to these questions,
rather than ignoring the unmeasurable
• By focussing on the questions we need to answer, we
can ensure that we’re measuring the right things
Conceptual Design Team 15
16. Recording and Monitoring
The Care Exchange will aim not to artificially influence the
range and type of cases in scope but let a representative
sample naturally develop. This is the only way the recorded
data can be extrapolated to the wider Kingston person base.
We need to rigorously record:
• Time against stories
• Activity
• Retrospectively mapping the journey the person would
otherwise have taken
• The additional activity arising from the artificial nature of
the live testing
• New solutions and the time/activity implications
Conceptual Design Team 16
17. What do we need from you during the
‘live testing’ phase:-
• Your ideas of what would make a difference that
we could test out.
• A link person.
• Referrals.
• You to tell the community what is going on &
feed back their replies – good & bad!
18.
19. Key Messages – just to emphasise…..
• Evidence from the paper based testing shows
that the person’s experience was improved
• The project is emergent and continues to
evolve
Conceptual Design Team 19
