The final installment: Question 5

Q: In Scotland in the addictions field we are all facing a huge shift in emphasis from a treatment modality (i.e. Methadone prescriptions) to Recovery (i.e. focussing on the holistic person - improving quality of life).  This is significant in terms of service redesign and a system overhaul.

I just wondered what kind of support you could offer - we want to change how we deliver services and the biggest problem we have is that our current system is under so much pressure we have no room to make that turning space.  How do you create turning space when the front end of your system is under so much pressure - the mid end is at capacity and there is little throughput at the backend.  Existing systems are convoluted and confusing for clients to negotiate and we are facing targets from the Scottish Government that have no bearing on whether or not the service we provide is of quality and what people want.

Stuart’s A: The question needs to be answered in two parts.  The first is how to create capacity and the second is how do you start to improve the wider system around addiction?  Let me try to deal with each separately.

1. Creating capacity in the current system
   1. Without being glib, to create capacity requires knowledge of how the current system works today.  And in your system you have to know two things.  The first is the type and frequency of demand into the system, i.e. who wants help, how often and what help do they want. When you get this data you might find that there are some people who would be better served elsewhere, or some who are having to make multiple demands on the system to get what they need, hence destroying capacity.
   2. The second piece of information you need to get is your capability to serve those that need your help.  I.e. how often do they get what they want and how easy does the system make it for you to deliver what they need?

Let me give you an example.  A few years ago we did some work in cancer care.  They had similar problems to the ones you describe.  As you can imagine it was tough but very satisfying work.  We worked with the medical staff and hospital administrators to teach them how to study their system. They soon found that the nature of demand was predictable in terms of frequency.

But what they also found was that there were a percentage of the clients referred from doctors that should not have been referred and they made plans to work with doctors who needed additional help in the pre-diagnosis stage.  Additionally there were some patients that had been given the all the clear many years before and therefore had no higher likely hood of contracting cancer than someone who had no history of cancer. There were obvious opportunities to reduce the demand into the system.

Whilst I can’t and wouldn’t say that the same would be true of your system, gathering data on the type and frequency of demand would be my first port of call, it’s likely to provide useful data if not about how to reduce demand, then to prove the true levels of funding and staff you might need in your system.

Additionally when we studied the flow of a patient through the cancer diagnosis system, it was obvious that the process was cumbersome, slow and filled with red tape. And when systems are slow to respond to what matters to customers, they (the customer) tend to place more demand on the system to find out what’s happening.

Hence it’s likely that you would get some benefit studying what’s involved in your service provision. You may find that there is unnecessary bureaucracy and policies that would be better removed for those afflicted with the addiction and would reduce the cost of running the service.

Having created capacity by doing this I would suggest that it’s incumbent on you to make the wider system better and actually do things to help remove the addiction (yes a statement of the obvious I know).  But the question is by what method. I will deal with this in the second part of my answer.

2. Optimising the larger system and improving care throughout the system
   1. As in my first response the answer to actually improving the whole system lies in understanding the points of failure in the system.  It may be that those points give the clues to what happens when a methadone dependant citizen reaches out for help and is let down, thus further exacerbating their addiction.
   2. To provide insight would require, in my opinion, a slightly different approach.  Rather than working forward, you work back.  Take 20-30 people who are in the system currently and work back though their typical journeys.  You may have to involve many different agencies: benefits, housing, the criminal justice system, accident and emergency, the local GP practice, and of course your own system.  As you study a typical journey you will no-doubt find predictable points at which help might have been effective and welcomed, or points at which help was wanted but there was no method for its provision.

Though this might prove a difficult task I’m sure it would be a worthy one.  My experience in multi-agency work with the criminal justice system and local authorities is that with the right leadership much can be changed.

This entry was posted on Wednesday, December 16th, 2009 at 10:03 am and is filed under Change Management, Public Sector, Measures . You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.