THE EFFICIENCY IMPROVEMENT NETWORKS

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1 THE EFFICIENCY IMPROVEMENT NETWORKS Norwegian Municipalities' largest reorganization project Improved user satisfaction and quality through better resource utilisation - Experience from 300 municipalities

2 Improved user satisfaction and quality through better resource utilisation - Experience from 300 municipalities The Efficiency Improvement Networks Norwegian Municipalities largest reorganization project What is our results? What can we learn from de others? Which targets? Input Results Results 0 Cost pr pupil Cost education material pr. pupil Teacher pr. pupil "Reading level" 2. Class "Reading level" 7. Class Average score 10. Class Veste Toten Average Highest score % Teachers with edecation Score evaluation pupils Score evaluation parents

3 Largest reorganisation project ever Around 300 municipalities and boroughs in participated in The Efficiency Improvement Networks. The municipalities mapped and analysed productivity, availability, measured quality (professional quality) and user evaluations of services. The municipalities have then evaluated their own improvement areas, planned and carried out measures within schools, nursing and care, kindergartens, social services, child care and building issues. 300 The number municipals signed-up during and the services they have chosen Care and nursing sevices School Child welfare Day care facilities Social sevices Executive work for the building trade municipals New municipals 2003 New municipals 2004 The main focus throughout the process has been result efficiency, meaning the relationship between resource usage and results achieved measured in terms of user satisfaction and quality. The goal is that municipalities, with an unchanged or lower resource usage, should; provide services to at least as many users and/or provide better service quality

4 The project has experienced good and constructive cooperation with the relevant departments, county governors and other governmental authorities. Binding cooperative agreements have been entered into between the government and The Norwegian Association of Local and Regional Authorities (KS) and between The Directorate for Primary and Secondary Education and KS, to further develop quality within nursing, care and schools. The municipalities themselves are focussed on strengthening internal controls and carrying out local quality work rather than that the state carries out detail management and control. From 2005, The Efficiency Improvement Networks will be extended to run in regions, with a dedicated supervisor who operates the networks for the members in each area. Operational responsibility includes arranging conventions, continuous contact with the participant municipalities and providing advice and guidance. KS will also manage and carry out strategic development of the work, development and maintenance of tools, advanced analysis work and contact with central authorities and professional environments. Municipalities that want to participate in networks pay a fixed, annual subscription. KS also can provide individual municipalities with special development, analysis and training assignments and consultancy services.

5 The Efficiency Improvement Networks give correct resource allocation The municipalities financial frameworks are becoming increasingly tighter and there are many challenges waiting to be solved. However, it is possible to achieve better result efficiency and better user satisfaction. This is the main conclusion of the final report from The Efficiency Improvement Networks. Some areas are easier to improve than others. However, mapping shows that municipalities that take on the challenges make progress. Through The Efficiency Improvement Networks, participants work actively to improve their service provision. The goal is that reductions in service volume and quality are less than the reductions that would be necessary where these are adjusted to tighter financial frameworks. The work has given clear results. Participating municipalities develop a more active user dialogue and user focus in service provision has increased significantly. The municipalities have also developed increased competences in managing their own activities, so that they are able to get more out of the resources. The municipalities have shown great courage in publishing both good and bad results. Participation in the network has led to a culture change in openness with respect to own results and the municipalities have had a positive attitude towards being measured, evaluated and compared with other municipalities. Openness, active communication with users and a critical evaluation of a municipality s own results strengthen confidence in municipal services. The results from mapping are used in the municipality s management dialogue, both between the chief administrative officer and the individual activity and with public elected representatives. Managers and elected representatives have received a better basis for making decisions on quality goal setting and results reporting before services are remapped.

6 The method is the key The Efficiency Improvement Networks have worked with what is called best practices. The focus has been on what individual municipalities have succeeded with and what other municipalities can learn from their success. This opens for the exchange of experience between municipalities and between activities within individual municipalities. Comparisons, analysis and discussions between network municipalities have increased awareness around efficiency and improved management competence. At the same time, a long list of efficiency increasing measures have been developed. The working method is bench learning, which combines mapping and analysis with a focus on learning and improvement. Mapping and analysis in the networks has given the municipalities an improved basis on which to make decisions relating to increasing prioritisation and goal efficiency. In other words, decisions that relate to the correct allocation of resources and services. This applies both to resource allocation between services, internally within services and changes in contribution margin and resource/person years per user for example in home based and institution based services. Mapping has in addition given municipalities an increased insight into their own productivity. This insight has made it possible for the municipalities to utilise the room in which they have to manoeuvre to improve productivity. Local politicians have received a better basis on which to make decisions. They can continuously see how the municipality performs in relation to neighbouring municipalities and they can compare different service areas, such compare schools internally within the municipality. Service quality Summery of the mapping - nursing homes Single bedded room Single bedded room with a private bath Part of staff with social service education Part of users on short term premises

7 Key figures for municipality activities KOSTRA is a national information system which provides information on municipal and county municipal activities. The figure data includes most of the activities in municipalities and county municipalities, including finance, schools, health, culture, environment, social services, housing, technical services and transport. The figures illustrate prioritisations, contribution margins and productivity using a large number of key figures. Using KOSTRA places a focus on the quality and knowledge of registrations. Through using this data for comparisons, municipality incentive to register correct figures increases. Input of of resources Cost Cost pr pr produced produced services services Measured quality Amount Amount of of time time spend spend doing doing executive executive work, work, user user results. results. ect ect Contribution rates rates Network What is our results? What can we learn from others? Which targets? Availability of of services Experienced quality; Users Users evaluations evaluations of of the the services. Key figures from account and services/public statistics Data from the municipals 5-10 pr service Surveys, questions pr services

8 Better performing municipalities In their feedback, users show that they are satisfied with services. However, the work in The Efficiency Improvement Networks has led to municipalities wanting to further improve user satisfaction. The Efficiency Improvement Networks have examined the quality and efficiency developments which have taken place in the municipal sector in the project period. The results of this mapping show that participation in The Efficiency Improvement Networks has resulted in: 65 per cent of municipalities increased user focus in services provision 85 per cent of municipalities increased their management and follow up competence within service provision and resource usage 70 per cent of the municipalities developed management and follow up systems Investigations also show that few municipalities have goals linked to productivity improvement. The Efficiency Improvement Networks will therefore increase the focus on productivity in future work. Satisfied users User surveys show that those who use nursing and care services, schools and kindergartens are satisfied with the services provided. User participation is however the area in which users are least satisfied. The results show that an increased focus on users, on the interplay between users and the service provider and on increasing user participation are important factors in achieving more satisfied users and services which are better adapted to users. There is a high level of satisfaction with personnel performance within all service areas. Resource usage alone appears have only a lesser effect on users experience and their evaluation of individual services. It is however important to point out that it is the citizens who receive services which are requested, and not the citizens who would really like to a have offer to receive a service from the municipality. At the same time it is important to take into consideration that there are many quality aspects that are not measured. Index user satisfaction answers. School, parents 65 School, pupils 70 Institution care services, relatives 74 Day care facilities 79 Institution care services, users 79 Home care services

9 Success factors The Efficiency Improvement Network success is built on a combination of many elements. The project was started at the right point in time and is supported by KS, the municipal sector s own member organisation. The network arena is adapted to all municipalities and the tools are developed in consultation with members. These tools have high utility values, which give quick results and short steps from measurement to action. The networks in addition have been well suited and well adapted organisations with competent employees recruited from the members. Improvement opportunities Correct focus and prioritisation, solid support within the administrative and political leadership and a dedicated local project manager with the required time and authority have been very important conditions. Municipalities which have been less successful would have achieved greater success if there was better leadership support, strengthened communication with the public elected representatives and a stronger focus on a transition from analysis and mapping to change and development. More demanding requirements and clearer expectations, greater motivation, assistance with goal formulation and a reduction in the number of projects running at the same time can increase the opportunity for success. Focus on users A number of municipalities have participated in child care and social services specific networks. Results have also been achieved here and many point to the cooperation and comparisons between municipalities as the factor that has improved the basis on which decision are made. Standardised analysis and documentation provide comparable data, which can be used in the management of individual cases and in the municipality s strategy work. 26 municipalities and boroughs in Oslo participated in five social service specific networks in The KOSTRA analyses showed large variations in client rates, benefit periods and resource usage. This is partly due to differences in living standards and expense requirements, but also is due to differences in management, organisation and practices. One example is that analysis of developments over time showed different patterns in comparable boroughs. This provided a good basis for identifying good practices and critical success factors for increasing the efficiency of social services. Several municipalities have also seen that a more goal orientated initiatives work can provide better results for users and lower total resource usages in social services. The municipalities had not previously carried out user surveys. The results from these surveys were therefore used to set goals for improving service quality. Several municipalities have seen that developing service statements is a good tool for communicating goals and service levels to users. Many municipalities have at the same time focussed on improving resource utilisation. The municipalities in the networks have exchanged experiences on good ways to realize the intentions of the Social Services Act and learning between the municipalities has been a central factor.

10 Better child care 44 municipalities and boroughs in Oslo have taken part in seven child care service specific networks. None of the municipalities had previously carried out user surveys within child care services. All the municipalities have set goals for the improvement of user experienced quality and evaluated resource usage, availability/client rates and general quality. Large differences were recorded for each indicator in isolation and in the relationship between resource usage and quality. In all networks, practice variations were shown to be one of the causes of the differences. KOSTRA analysis is systematically used to discuss the similarities and differences in client rates and the use of the initiative chain in child care services. This has led to more municipalities implementing measures to redirect resources from the use of institutional places to an increased use of initiatives in families. Many municipalities have set up goals and measures to improve user participation. Key measures are interviews with children (both at the investigative stage and after implementation of measures), parents participation in the design of initiative plans and written feedback from next of kin. Several municipalities are also focussed on method development, such as in intervention in families to strengthen parents ability to function and the way employees in the child care service interact and communicate with families. The user surveys have also shown that several municipalities need to strengthen cooperation between units within the municipality (family centres, clinics, schools, kindergartens and others). The work carried out in the network has focussed on openness within child care and this is an important element in building confidence. Improved tools for the public good The Efficiency Improvement Networks have developed several common tools which the municipalities find to be user friendly and which focus on action. Productivity, availability and quality in the services are mapped. This is carried out using indicators of measured quality and own user surveys which can be used by all municipalities. The municipalities carry out user surveys themselves. This increases local analysis and method competence and provides greater knowledge on user opinions. This also means that changes are carried out quickly. The tools are continuously improved and governmental authorities are worked with to further develop national indicators within measured/professional quality. KS has set up the portal All municipalities can here map and compare their performance at the activity level, and compare their productivity, measured quality and user satisfaction with other municipalities over time. The portal was expanded in the autumn of 2004 so that the municipalities could map employee satisfaction in the services.

11 The portal will probably be used as a joint tool for carrying out user surveys and employee mapping in the municipal sector. This places demands on KS to cooperate with professional bodies and to adapt the tools to the municipality needs. Continuity is also important, so that the municipalities can compare themselves over time. The mapping of network municipalities also shows increased competence in the use of KOSTRA. The majority of the municipalities will use key figures in management documents and in the general management and follow up of activities. KOSTRA is therefore an even more valuable tool in the work on correct resource allocation and will be available and can be used in the municipalities own management systems and in individual activities such as nursing homes and schools. KS and several municipalities have taken the initiative to propose that KRD further develops KOSTRA. It is important to develop KOSTRA data for individual activities, to separate reporting for the mentally impaired in nursing and care and to receive better data quality on person years used in nursing and care. Tools will be improved the municipalities can enter own questions based on local requirements offer tools which make it possible for the municipalities to analyse own data better, with cross linking and statistical analysis to clarify which areas are the most important for user satisfaction Participation in The Efficiency Improvement Networks has given good results Better management information Improved analysis competence Useful exchange of experience, learning from best practice, resulting developments in efficiency and quality

12 Important conditions Solid support within administrative and political leadership Commitment, involvement and participation from top management One internal project manager in the municipality with the required commitment, time and authority Would you like more information on this work? Contact Michael Kaurin at KS on or by at KS PO Box 1378 Vika 0114 Oslo, Norway Tel.:

13 KS Headquarters: Box 1378 Vika, 0114 Oslo, Norway THE EFFICIENCY IMPROVEMENT NETWORKS Tel Fax Norwegian Municipalities' largest reorganization project Improved user satisfaction and quality through better resource utilisation - Experience from 300 municipalities