As Chief Executive of Here, some of my time is spent working directly with our teams and services in order to support my understanding of what matters to the people we serve. By doing this I hope to work out how we can deliver more of what matters, more reliably, more of the time. Here has been using an approach and methodology called “System Thinking Design” which I want to share, along with some of my learning.

Focusing on what matters

In the last six months I have been privileged to work with some of the team from our Memory Assessment Service. The purpose of this service has been to assess, diagnose and offer advice and support to those with memory problems. Collectively we wanted to understand what really matters to the citizens we serve and how our service design could better support that.

We began by studying the way that we were already helping people. There were countless stories of people whom we had offered a series of tests in order to reach a diagnosis and then provided them with a pathway to support them in that diagnosis – without it being clear, in retrospect, if we had understood what mattered. We discovered that of the people who came to us asking for help only 30% of them were requesting a diagnosis, and the other 70% were requesting practical help and support with living with either memory problems or dementia. This was a big surprise to us as our service had been designed to assess, diagnosis, and then offer practical support and help. In many cases, in following our specification we were not identifying what mattered to people. In our study, of over 10% of our case load, we could see a pathway to dependency, which is so typical for this group of people. We began to wonder if this was predictable, and therefore changeable.

Reimagining our purpose and rewriting the rules

There were also stories which showed that sometimes when we understood what mattered to the person and their family we were able to be so much more helpful. It became clear to us that our purpose could better serve that way of working, so we changed it. We want a person accessing the Memory Assessment Service to understand that we are here to:

“Help me and my loved ones to get the support and information we need to live our lives well.”

Our studies showed us also that the rules, both explicit and implicit, that were underpinning our current service design were not helping us to deliver on that new purpose. So, we changed those too. The old rule of “You have to have a diagnosis to get practical help” has now been replaced with:

“You have the right to have help as you enter the service. We will help those who care for you to support you.”

The implicit rule that “Assessment is harmless” we have changed to:

“We will only offer you an assessment if we or you can see a benefit. We will use the assessments and views of other professionals to help you.”

The beginnings of meaningful change

We also began to realise that if we understood what mattered to the people who were asking for our help, and we actually helped them first time, we could use our time and skills in a better way. We subsequently began to wonder if we could then halt the currently inevitable pathway to dependency and reduce cost to the whole system.

Already in small ways the team have changed the process of understanding. They are speaking to people as we receive their referral and are being more flexible in their approach. We have also recruited another dementia advisor with the support of our wonderful partners from the Alzheimer’s Society and we are on a journey to discover the true difference we can make by delivering what matters, first time.

Our ambition with this work is to make this normal in all our services and all our interactions. We will gather the data that will challenge the prevailing thought process that delivering what matters is expensive, inefficient, or too overwhelming. We are learning that delivering what matters costs less, is more efficient and helps people stay well for longer.