4.4 Work with your board to address problems

Problem

Solution (to avoid or address problem)

Delays to recruit well-qualified staff

• Recruited the entire frontline team in advance of contract signature (at investor’s own risk) so that they would be ready to deliver at full speed from day one

• Adjusted the pay scale and terms of contract to be better able to attract well-qualified staff

Variable management of staff performance, resulting in sub-optimal delivery

• Implemented a bonus scheme to reward high performing teams for excellent performance

• Implemented an active performance management scheme to train or replace staff who were not delivering the highest quality services

• Paid for and recruited a ‘programme manager’ after the first year to oversee the service and drive improved management.  This role was not in the original specification or budget

• Recruited a ‘trainee’ frontline staff member, ready to step into a role as soon as it became vacant, to mitigate against the effects of staff turnover

• Fast-tracked team members to training courses, paying transport costs, to ensure that staff were trained rapidly and could commence delivering services immediately

• Offered to carry on delivering the service after the contract cap had been hit, to drive more outcomes and better value for money

Failure to keep the team fully functioning right up to the end of the programme

• Implemented a retention scheme to reward high performing frontline staff who continued delivering right up until the contract end date

Problem

Solution (to avoid or address problem)

Failure to market the programme to those responsible for referrals (e.g. social workers)

• Ran a marketing campaign to pitch the programme to social workers, e.g. workshops, visits, videos and case studies to explain the benefits for families, along with clear referral pathways and instructions for eligibility

• Offered incentives in return for participation levels e.g. guaranteeing rent arrears for certain clients – to clear logistical and perceived barriers to engagement

Inadequate IT system for referral of participants

• Built, paid for and implemented a new IT system for all GP practices, which flags up suitable patients and encourages GPs to refer them to the service

Insufficient resources within the referring authority to manage the essential tasks required

• Paid for ‘care experienced mentors’ to help young people make the transition out of residential care.   These mentors were not in the original budget

• Paid for a formal medical and psychological assessment of all children referred to the service for adoption, from the country’s leading child mental health assessment team

• Paid for and seconded an additional social worker into the referring authority, to ensure that all referral tasks are completed effectively

• Paid for a full academic evaluation to identify the benefits and recommend improvements mid-programme

Problem

Solution (to avoid or address problem)

Poorly-defined contractual outcomes lead to lack of clarity in claims

• Brought delivery staff to contract review meetings to avoid a back-and-forth situation and bring a dose of reality to contract discussions

• Set up a working group including commissioner and provider, during which particularly thorny hypothetical ‘test cases’ were probed and tested to their limits

• Signed contract amendments to redefine or add parameters to outcomes when all variations and permutations have been explored

Administrative or teething problems with claims process

• Took each site administrator out for lunch or coffee to ask about particularities of their site and gain buy-in for a monthly process. Used this information to map the different systems and processes used across all sites

• Developed a two-step claim validation process where a manager dip tests a handful of claims each month, tracing the paperwork back to ensure validity

• Reverted to Excel when our system confused or lengthened the process. Data can always be bulk-uploaded at a later date