Using behaviour change to better manage demand for adult social care services at the ‘front door’

Behaviour change in adult social services

25%

increase in calls signposted to local community services by front door provider

120%

increase in telephone calls resolved by front door provider

32%

decrease in social work support conversations which result in ‘no further action’

“IMPOWER’s work identified key interventions for managing demand at the front door, and when this work was handed over to an internal project team we were able to hit the ground running. IMPOWER brought a strong evidence-based approach to managing demand at the front door which generated buy-in from front line staff and confidence in delivery.”

Nikki Davey (Front Door Project Manager, Bristol City Council)

Task

Reframing the problem

Key insights

Change at the frontline

What was IMPOWER tasked to do?

As a part of Bristol City Council’s Better Lives programme we were tasked with designing and implementing a number of small but impactful interventions to better manage ‘front door’ demand (handled by Care Direct, the adult social care team within the Council’s contact centre).

The interventions focused on behavioural change within the front door team to:

Strengthen feedback loops with the rest of the service
Improve the quality of strengths-based conversations with members of the public and professionals, facilitated by a coach embedded within the team
Improve all website forms and communications with the public to better manage expectations in order to prevent, reduce, delay demand where appropriate.

How did we help the client to reframe the original problem?

Bristol City Council reframed the problem of unsustainable demand for adult social care services by looking at the sources of demand and at making changes to the way the front door team handles contacts.

Were there any key pieces of information, analysis or insights that changed the course of the project or which our recommendations relied upon?

After the first phase of implementation, we called for a ‘stocktake’ evaluation session to consider some new insights related to how demand was being managed at the front door in Bristol. Data analysis had demonstrated that 59% of contacts passed to safeguarding senior practitioners from the Care Direct team were quickly screened out rather than being investigated. A second additional finding was around the poor quality of online referrals the Care Direct received, and the large number of different online channels involved. This resulted in an unnecessarily time-consuming email triage process to determine the priority of (and actions needed for) each case. Following the stock take, two larger interventions based on the new findings were designed and implemented.

How did we help the client to deliver change at the frontline?

The front door interventions were co-designed through a series of workshops with operational stakeholders and frontline staff from across the service, based upon evidence we gathered through our avoidable demand analysis. We used feedback sessions and surveyed Care Direct team members to monitor the impact of the changes on the team, in order to make sure that they could respond to any concerns and to the training needs of advisors. Embedding a coach within the team enabled the team to improve the quality of strengths-based conversations at the frontline. The coach was a former advisor, so had a deep understanding of the type of demand the Care Direct team manage.

How did we help the client to apply behavioural science, and what did this achieve

Using applied behavioural science we redesigned the web forms that members of the public and professionals use to submit online referrals to the service. We included strengths- based language and improved the quality of information capture, in order to enable more effective call backs and to reduce referrals. We also applied behavioural science techniques to the redesign of the adult social care website to make it easier to navigate, provide clearer information and referral pathways, and signpost Tier 1 services and resources (such as the council information directory Well Aware).

How did we help the client to manage trajectory?

Working with the Front Door project group, we designed a set of Primed Metrics to measure the impact of the interventions, as well as their impact on the public and professionals contacting the service. These Primed Metrics feed into the Trajectory Management process designed by IMPOWER that is being used to direct operational decision making and measure the impact of the Better Lives programme on the service user’s outcomes, as well as the council’s financial benefits.

What impacts did our work have?

Early indications of the impact of the front door demand management interventions are very positive:

25% increase in calls signposted to local community services by Care Direct
120% increase in telephone calls resolved by Care Direct, with calls requiring ‘no further action’ more than doubling to 20% between October 2017 and March 2018
32% decrease in social work support conversations which result in ‘no further action’ (falling from 60% of support conversations in October 2017 to 41% in March 2018).

What was good about this project? What was the key to its success?

“Key to the success of the project was making small incremental changes. This approach meant that we could quickly evidence success to the teams, which encouraged them to work with us to make further changes.”

Nikki Davey (Front Door Project Manager, Bristol City Council)