Organisation Services offered Methodist Mission Southern Community Social Services support and advocacy services The Hub Early Years Hub supporting families / whānau Next Step foundation learning opportunities for young people and adult learners Arahina family support centre (in Mosgiel) providing front door community services Little Citizens early learning centre Community Research projects - Take10 Streets Storybook Dads Organisation s size Staff 100+ staff (50 FTE) Clients 516 social services clients increasing between 10%-15% per annum. For all service delivery areas, contact with 3,342 individuals in 2014. Client / case management system Exess 1 Introduction Methodist Mission Southern is a charitable organisation providing a range of community services supporting Otago and Southland. They provide front door services using a distinct model of engagement that enables clients to access the resources they need and to develop skills that enable them to become independent. Their physical sites are connected via secure VPN links, so they can share data and resources across the distributed team. Laura Black became Director at Methodist Mission Southern in 2005; since then she has undertaken a series of reviews that lead to a refocus of its goals and key objectives. A new strategy gave the Mission clarity about making fundamental changes to the services they offered and how they would be delivered. By moving to a strengths-based approach, the client rather than the social worker was placed at the centre of decision making. Methodist Mission Southern also had a strong desire to improve monitoring of its workforce and decided to implement systems to monitor accountabilities of individual staff. Implementing a client management system that provided greater transparency encouraged staff to change behaviour. More importantly, it brought a huge shift in culture, which Laura emphasises as being key to their success. infoxchange.org 1
Methodist Mission Southern has undertaken significant organisational change to achieve its current position of connected business systems, high quality data and reporting, and a quality management framework that underpins delivery of their services. This case study is looking at Methodist Mission s adoption of Exess for social services; they are also using it for some event bookings and questionnaires. The organisation also uses Puk-e Data and APT as systems for other services it provides: those are not discussed in this case study. 2 The issues There were two main issues with the organisation s client management approach. The first was a lack of measurable process and systems. The second was a culture that was not always focused on client needs or quality of services. Before the organisation implemented a central client / case management system, client records were kept on paper, making it difficult to monitor services. Social workers did not have defined processes for electronic access to client information, so there was heavy reliance on manual tracking. This led to inconsistencies across the client management process. Lack of timely access to client data resulted in often inconsistent practice. This was inefficient use of social worker time, and didn t support Methodist Mission s long-term strategy to encourage client independence. Methodist Mission also needed tools to monitor staff performance and ensure they complied with service standards. A key driver for a client management system was to put quality assurance in place for Methodist Mission services so the organisation could be confident they were doing all they could for their clients in a consistently measurable way. As part of the organisational change process, Methodist Mission recognised it needed a quality management system comprising a client / case management system, a well-defined model for client engagement (measurable against organisational standards), a change in staff culture and a robust performance management framework. In 2008, Laura employed Dave Eggers as the organisation s ICT Co-ordinator to review infrastructure and lead technology improvements, including selecting and implementing a new client / case management system and supporting systems. Issues at a glance» Inconsistent service delivery processes make it harder for the Mission to support its clients.» There is no effective mechanism for managing staff performance or service quality.» Business systems to support day-to-day operations are limited.» Paper-based client records mean there is no readily available intelligence to inform good decision making high quality, accurate data was required. infoxchange.org 2
3 Selection and implementation As part of its move to a strengths-based / evidence-based approach, Methodist Mission adopted an engagement tool called Partners for Change Outcome Management System (PCOMS). PCOMS is an evidence-based practice for improving the quality and outcome of health services. For Methodist Mission, it underpinned the organisation s primary focus of empowering its clients. Case management system requirements were developed by Dave Eggers on the premise that Methodist Mission Southern s services would include a strengths-based approach using PCOMS as its standard. Functional and non-functional requirements were identified. There were no formal selection criteria or documented requirements, but the key priorities based on the service model (PCOMS) and Dave s extensive knowledge of IT systems were written on a whiteboard and used to review and guide the evaluation and selection process. Some of the non-functional considerations were:» technical management of system upgrades, change management processes, backups, and disaster recovery» vendor support and capability» financial viability of the vendor» ability to add or modify processes within the software. Dave undertook the selection process, looking at a range of client management systems. He recommended the Exess system because the vendor was willing to be flexible and to undertake new developments to accommodate Methodist Mission s needs. This enabled Methodist Mission to have PCOMS developed as a new module in Exess, providing the necessary intelligence to set clear service standards and monitor staff compliance and performance. Dave was the project manager and estimates he did about 95% of the planning and co-ordination himself. This included post-implementation support, such as configuration changes to fit with business workflow, end user issues and support, communication of bug fixes and general vendor co-ordination. Implementation planning was informal, with close interaction between Dave and the Exess team. Transition to Exess was simplified because there was no data migration. Having Dave full-time on site as the main support limited the impact on front-line staff. Dave got administrator training and access to the test environment early on so he had oversight of the environment that was to be used by staff. Expectations were managed through constant liaison with the Exess team who were very helpful and engaging. Methodist Mission undertook a post implementation review after six months to fine tune their approach to services and ensure Exess was configured optimally to support their needs. 4 The solution The Methodist Mission solution is a combination of Exess and an internally developed browserbased reporting facility. Exess is used for capturing all client information for the Mission s community and social services. By March 2015 there will be 23 users of Exess; Dave (as administrator), managers, supervisors and front-line delivery staff. infoxchange.org 3
The reporting facility has been developed using a combination of Joomla (an open source web content management tool) and Plotalot (a Joomla extension for visual display). Exess data is extracted three times a day so that performance information is readily available and up-to-date for management and staff. All social workers are required to use Exess and have information up to date at all times. The PCOMS methodology outlines the service process and standards to be met, which in turn are monitored through the browser-based reporting facility. The standards are measured against individual staff KPIs. A PCOMS module was developed by Exess in partnership with the owner of the PCOMS methodology. A combination of Exess and Joomla reports are used for individual case management, and practice oversight. Exess is also used more broadly across other service areas as a booking system (for events) and for questionnaires (assessments for various programmes). 5 Benefits Making clients more self-sufficient was a significant change in Methodist Mission s service model. This was a challenge both for the clients and for the support workers who were accustomed to providing hands-on support. The combination of PCOMS and Exess facilitates that process and gives management and staff critical information to achieve those outcomes. Embedding a PCOMs module within Exess makes it easier to set and monitor standards for the way that staff engage with clients. The client / case management system combined with Methodist Mission s own reporting tool enables Methodist Mission to measure and improve service performance, monitor individual KPIs, perform contract reporting and easily access information for management decision making. Staff see their progress (through KPIs) from the internal reporting tool; this encourages them and makes them more proactive. Methodist Mission has leveraged its client management and reporting systems by implementing a quality management system (QualityWorks). The quality programme underpins Methodist Mission s service model, enabling them to proactively monitor organisational performance. Benefits at a glance» Staff have tools they can use to support their clients to develop independence.» Management are able to proactively monitor quality and performance of their services.» Staff are accountable they have real-time access to KPI information.» A quality management programme ensures services are consistent.» Client information is easy to access and can be used as a historical reference.» Timely identification of any services falling outside of key performance indicators enables remedial action to be taken early. infoxchange.org 4
6 Challenges A major challenge for Methodist Mission was not so much the technology but the change management aspects of the project. There were many barriers to getting staff to use the client management system and to understand and embrace the new approach to services. Staff were required to take personal responsibility for their role and performance in the process. This change contributed to some staff leaving the organisation. While this was painful and challenging at the time, in the long run it was beneficial for the organisation. The refresh of staff and change in behaviour was (and has continued to be) key to the ongoing success of the service. Social workers needed to have input into the setup of the client management system: they are the key users and have in-depth knowledge of day-to-day activities. The first attempt at involving staff in determining configurations such as service categories was not successful. This was because the team became too involved in the detail and struggled to come to a consensus. Dave then developed an overview for general feedback / input from the team to move it along. In hindsight, a facilitated group approach may have been more successful. Challenges at a glance» Achieving the necessary staff culture change was difficult.» It took a while to find an effective way to engage with staff and get their input into how the system should work. 7 The future Methodist Mission is constantly feeding back ideas for innovation to the Exess team to improve the system. Methodist Mission believes it is probably using Exess to its maximum and is continuing to push the boundaries of its capability. Methodist Mission is also talking with Exess about developing workflow capability to enhance service performance tracking and to further support its workforce through the client management process. Exess have proven to be extremely co-operative and willing to listen to new ideas to improve their product. Dave continues to develop the internal browser-based reporting system that provides the valuable performance reporting which is integral to the Mission s quality management programme. 8 If we knew then what we knew now Methodist Mission were pleased about how well implementation of Exess went and subsequently how it has been embedded into their quality framework. These were some lessons learned from their experience:» The organisation needs to decide what its values are, and what internal and external outcomes are important to it. This will drive its service priorities and its model. This informs what systems are needed to support the things it is trying to achieve. infoxchange.org 5
» Defining a set of key performance indicators (KPIs) makes it easier for everyone in the organisation to discuss and measure what the organisation values and aspires to.» It is important to quickly identify and respond to any concerns in an organisation from a client s wellbeing to a systemic issue within the organisation. Setting KPIs and developing technology to measure them and deliver results to responsible staff helps solve problems more quickly.» The PCOMS engagement tool helps achieve a standard for workflow and a basis for performance. This sets the priorities for system selection.» Careful attention to culture change is critical to successful system implementation. Staff need to understand and buy into the new approaches and to using the system.» Document any configuration requirements (for example service classifications why staff engage with clients) and ask for input from staff. The Mission s first attempt led to an elongated process and confusion as staff were trying to do this from scratch. In hindsight, asking for review of a suggested set of categories would have been better.» Engaging a couple of staff members as power users early on in implementation would have helped lessen the support burden on Dave. They would also be a valuable resource for implementing change at the frontline.» The full day group training for staff by Exess was not effective. Too much information was presented in a short time-frame to a workforce that was not committed to the change process and/or was not ready to apply new knowledge. Using power users to undertake internal training would have been more effective. This would make sure that training was targeted at a practical day-to-day operational level. The vendor training was a little daunting and didn t really focus on individual staff responsibilities. Exess now delivery training tailored to each organisation s way of working.» Formalising the process for selection of a client management system would have provided valuable information to support implementation planning. For example, the Mission would have known what impact the client management system would have on other existing systems.» When looking at implementing a client / case management system, make sure you consider the broader issues as part the overall plan. Examples are: what data is to be collected and what is it to be used for, change in culture (and staff mindset), and what are your service workflows and standards. This broader view is key to achieving a high quality service.» Front line staff delivering the services are the subject matter experts and need to have input into the configuration of the client management system. However, care should be taken to ensure they have support to work through the process as they may not have the necessary skills to do this alone. infoxchange.org 6