SENIOR MANAGEMENT SERVICE DELIVERY CHALLENGE: PROJECT KHAEDU 4th Annual Service Delivery Learning Ac

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SENIOR MANAGEMENT SERVICE DELIVERY CHALLENGE
PROJECT KHAEDU4th Annual Service Delivery
Learning AcademyBY LAWRENCE TSIPANE
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ISSUES

• What is Khaedu?
• Progress to date
• Examples of Deployment reports
• Outpatients waiting time in hospitals
• Organisational and process barriers to capacity
  management in Home Affairs
• Right people in the right jobs? Organisation in
  Mpumalanga hospitals
• Summary and roll-out for 2005/6

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What is Khaedu?

• In August 2004, Cabinet mandated that all SMS
  members should, during each performance review
  cycle, spend time observing and solving service
  delivery issues at the coal face
• The DPSA has developed and piloted Khaedu as a
  process to facilitate and ensure successful
  deployments to the coal face
• Khaedu has 3 components
• 4.5 day core skills development programme where
  participants are exposed to techniques for
  problem solving
• A supervised 5-day deployment to the Coal Face
  where participants analyse service delivery
  problems and write a short report
• A further deployment during PSW (preferably to
  the same site)

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The core skills development programme is based on
practical exercises and problem solving
Day 1
Day 2
Day 3
Day 4
Day 5

• Introduction and case methodology
• Process problem solving and business maths
• Problem solving exercise 1
• Observations at the coal face in your company
• Measuring cycle times volumes
• Process exercise 2
• Simple solutions to big problems
• Process case-study

• Process case discussion
• Modern organisation design
• Effective decision-making
• Organisation exercise
• The Wisdom of Teams
• Overcoming human capacity bottlenecks thinking
  laterally
• Organisation case-study

• Organisation case discussion
• The People Plan and managing performance
• Dismissals the LRA
• People management exercises
• Organised labour from foe to friend
• Communicating for results constructing a
  logical argument and packaging it effectively
• People case-study

• People case discussion
• Budgeting effectively
• Budget exercise 1
• Budgeting dynamically in the real world
• Budget exercise 2
• Expenditure control tell-tale signs of loss of
  control
• Final integrated case-study

• Work on integrated case-study
• Presentations of integrated case
• By syndicate
• Discussion of final integrated case
• Prize-giving

Based on the Harvard Business School model
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The core skills development programme is based on
practical exercises and problem solving
Syndicate groups working on an evening case study
in KZN
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with a supervised 5-day deployment to practise
the skills developed
Monday
Tuesday
Wednesday
Thursday
Friday

• 8am Introduction at provincial legislature
• 10am Move to service delivery site
• Introduce syndicate to site management
• Tour of facility
• Detailed work-planning
• Data requests
• Interviews

• Interviews
• Management
• Staff
• Customers
• Data collection
• Diagnostic

• Diagnostic
• Analysis

• Analysis and consolidation
• Presentation of high-level findings to management
  of the host site

• Meet at provincial legislature to consolidate
  findings and start writing report

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Participants develop their problem solving and
analytic skills in the following areas

• Process Design Basic introduction to process
  design concepts such as process mapping, time and
  value analysis, capacity analysis and Best
  Demonstrated Practice development.

• Organisation Effectiveness Modern organisation
  structures, teaming concepts, decision making and
  authority levels, overcoming human capacity
  bottlenecks and creating a learning-culture
  organisation

• People Management Core skills in hiring,
  performance management, discipline and grievance
  procedures, dismissal and the Labour Relations
  Act, working with organised labour and
  understanding the change management issues within
  a typical civil service unit

• Budget and Controls Developing effective
  budgets, understanding when a unit is unable to
  effectively control expenditure, preventing fraud
  and unauthorised expenditure

• Communicating for Results How to present
  problems and their solutions effectively

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Syndicates work together and learn from each other
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Agenda

• What is Khaedu?
• Progress to date
• Examples of Deployment reports
• Outpatients waiting time in hospitals
• Organisational and process barriers to capacity
  management in Home Affairs
• Right people in the right jobs? Organisation in
  Mpumalanga hospitals
• Summary and roll-out for 2005/6

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Progress to date
May 05

• gt56 SMS members have completed the supervised
  deployment phase
• Rob Ferreira, Themba and Witbank Hospitals
• Addington and Greys Hospitals, KZN
• Home Affairs Nelspruit
• Home Affiars Scottburgh and eThekwini
• KaNyamazane Police Station
• Lebombo and Oshoek border posts

• 67 SMS members have completed the core skills
  development week, 23 from Mpumalanga and 22 from
  KZN and the rest from National depts.

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The programme has been well-received by
participants
Best programme yet on what Batho Pele is
supposed to deliver.
The programme is tough but I have learned a lot
about how to solve real problems
Skills I have from these sessions, I can use
immediately.
All SMS managers, starting from the top, should
attend this programme
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and the deployment reports are also viewed as
useful
We must ensure that this report (Rob Ferreira)
is seen by the relevant HoD and Senior
management. DG in OTP Mpumalanga
Finally, people understand why we cant do our
jobs better. Senior officer at KaNyamazane SAPS
as to amount of time spent in management meetings
and workshops instead of operations
Analysis like this is what we need to solve
problems not more long lists of what is wrongwe
know that we have lots of problems, but are not
empowered to solve them. Senior manager Themba
Hospital
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Agenda

• What is Khaedu?
• Progress to date
• Examples of Deployment reports
• Outpatients waiting time in hospitals
• Organisational and process barriers to capacity
  management in Home Affairs
• Right people in the right jobs? Organisation in
  Mpumalanga hospitals
• Summary and roll-out for 2005/6

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There appears to be a persistently severe
shortage of staff at Rob Ferreira Hospital
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and outpatient activities have been steadily
rising
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with a large proportion of patients being
primary healthcare patients from out of the area
Target patient for Rob Ferreira
Could be seen at local clinic
Source Note that this data is based on estimates
of interviewed doctors
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leading to bottlenecks and long wait times
Outpatients at Rob Ferreira Hospital
Outpatients at Rob Ferreira Hospital
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and patients are unhappy with the waiting time,
overall process and cleanliness of the facilities
Happy
Unhappy
Source PSW questionnaires, Nov 2004
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The outpatients process at Rob Ferreira is
cumbersome and slow
Join queue 2 Records Clerk take details of
patient on dummy
Send dummy to filing room
Retrieve file and replace with dummy
Send file to clerk who calls patient hands over
file
Send file to clerk who calls patient hands over
file
Yes
A
Patient arrives at hospital and goes to OPD
Previous patient?
Join queue 1 Records Clerk registers new patient
and creates file
No
Go to pay clerk and pay
Yes
Need to pay?
A
Consult with doctor
Take file to dispensary and queue to wait for
medicine
Collect medicine
Walk to Outpatients and queue for doctor
No
Total process 3-10 hrs
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particularly compared to Witbank, which appears
to be more efficient and
Checks vital signs
Case presented to doctor
Doctor decides to see patient or refer
Assisted by a queue helper
No
Patient arrives at hospital and goes to OPD
Has an appoint-ment?
Joins the queue for screening
Yes
A electronic Number system used
Issued with admin and colour
Receives file at clerks desk and pays
Checks vital signs
Consult with doctor
Take file to dispensary and queue to wait for
medicine
Collect medicine and return file
Total process 2-4 hrs
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well supported
Queue helper
Numbered queuing system
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And the broken filing systems at R Ferreira
result in long delays and lost information
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versus Medical Records at Addington, who have
developed a number of best practices

• All O/patients have to have an appointment before
  they are seen at Outpatients
• All files logged out on the computer as soon as
  they are drawn
• All appointment patient files drawn 2 days prior
  to appointment
• Moved to respective clinics 1 day prior to
  appointment
• Colour coding system to prevent mis-filing
• Repeat prescriptions separated out and filed in
  separate area for rapid retrieval

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e.g. all files are logged out out on the
computer as soon as they are drawn
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All appointment patient files drawn 2 days prior
to appointment
Photo taken on 18/5/05 Files ready to go to
Medical Outpatients clinic
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All files are colour coded
to enable quick identification of misplaced files
Mis-placed files
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But, critically, the patients all arrive en masse
in the morning!
Source Direct observation on site, 7-11 Feb 2005
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Therefore, solving the OPD challenge requires us
to

• Reduce the volume of primary healthcare patients
  flooding the facility
• Spread the volume of patients more evenly
  throughout the day to avoid bottlenecks

OPD Outpatients department
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The Khaedu deployment team developed some ideas
to help solve the Outpatients problem
Reduce Volume
Spread volume
Short-term

• Introduce Help-desk at reception point to inform
  patients of procedures (as per Witbank)

• Improve management of file archives
• Improve queue management
• E.g. give patients numbers when they arrive to
  enable fair tracking

Medium long-term

• Reinforce provincial communication campaign
• Introduce pre-screening at process start (as at
  Witbank)
• Expand the chronic (repeat) medicines model to
  move drugs to clinics (can also be used for ARVs)

• Appointment system
• 0800 number to book times with Doctor
  (Switchboard will have to be properly staffed)
• Appointment desk at reception for repeat patients
• Those who do not book have to wait
• Investigate use of a WIP (work in progress)
  system to track location of files

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Agenda

• What is Khaedu?
• Progress to date
• Examples of Deployment reports
• Outpatients waiting time in hospitals
• Organisational and process barriers to capacity
  management in Home Affairs
• Right people in the right jobs? Organisation in
  Mpumalanga hospitals
• Summary and roll-out for 2005/6

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Similarly in the Nelspruit office of Home
Affairs, the plea is for more people, but

Workloads vary widely across the year, e.g. IDs
and time of day
NB Significant amount of training scheduled in
Jan and Feb!

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The organisation model is both top-heavy and very
silod into small sections
Head of Office Nelspruit
13 total staff in civic affairs unit
Civic Affairs Section Head
Civil Affairs Supervisor
Amend-ments Unit Head
Counter staff (2)
Births amend-ments to addresses Unit Head
Marriages Deaths Unit Head
ID Documents Unit Head
Passport Unit Head
Cashier (1)
Finger prints
Clerk
Clerk
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and the processes hinder efficiency
At a local office level, provision of printers
and cash boxes at each counter would eliminate
significant queuing (at low relative investment
cost)
Fingerprints
Enquiries and forms
Collect
Counter clerk
Cashier
Queue for collection
Queue for fingerprints
Queue for acknowledgement
Queue for cashier
External assistance to fill out forms
Fill out forms
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which is the main issue with citizens
Happy
Unhappy
Source PSW Report back
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Customers are very unhappy with the waiting times
at Home Affairs (all offices).
Home Affairs Office (KZN)

• Ive applied for an ID document four times, but
  the department fails to issue one
• Passport application in June 2004No response.
  Moved around Staff not sure of service points
• Applied three times for an IDsuggest that ID s
  be posted

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and the overall time to process e.g. ID book
ID replacement process
Wait for Pretoria to respond
Pick up documents
Receive and check application
Load application
Ship to Pretoria
2-6 months average
Longer cases
1-6 weeks
10 mins
24 hrs
12 hrs
Error / loss / issue in Pretoria start at
beginning
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46 come to Home Affairs more than twice on the
same matter

I have been here 4 times for my ID and it is
still not here.

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Not knowing when a document is ready for
collection is a major frustration which could be
partially solved using a simple SMS message

• Majority of customers have cell phone access even
  in rural areas
• Over 6,000 IDs uncollected in Port Shepstone
  region
• Over 60 of IDs cannot be linked to a postal
  address in Scottburgh
• Why cant they tell me it is lost and stop
  wasting my time

Very low cost (26c) way to sharply reduce current
communications frustrations
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Some ideas to improve queue times at Home Affairs

Process
Short-term

• Invest in cashier boxes printers for abridged
  documents
• Eliminate queue at cashier and for abridged
  documents
• Client to fill out acknowledgement form detail
• Improve signage

Medium-term

• Overhaul central processes for document
  production
• All under one roof
• Eliminate batch production
• Target 2 weeks not 2 months
• Provide SMS messaging for clients

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The team suggested a revised provincial and
regional structure for Home Affairs
DDG Civic Affairs
5-6 Regional Managers
Regional Manager MP
Service Delivery Manager
Administration Manager
Processing Manager
HR (2)
Call Centre (6)
20 Service Points and satellites (60)
Finance / Accounts (2)
Processing Centre (20)
Procurement (1)
Logistics (1)
Total potential staff in MP 97 101 (similar
to what they have now!
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Agenda

• What is Khaedu?
• Progress to date
• Examples of Deployment reports
• Outpatients waiting time in hospitals
• Organisational and process barriers to capacity
  management in Home Affairs
• Right people in the right jobs? Organisation in
  Mpumalanga hospitals
• Summary and roll-out for 2005/6

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In Mpumalanga, the decision-making processes in
hospitals appears complex and time consuming

e.g. Recruitment process
Hospital
Provincial Head Office
Identify requirement for porter
Motivate and write requisition
Review requisition and approve
Develop job advert
Approve and place job advert
Receive applications
Shortlist with Unions
Receive and sort applications
Develop short-listing criteria with Unions
Review shortlist and approve
No
Appoint
Interview (with Unions)
Recommend candidate
Review recommendation
Yes
Average cycle time 8 months, but often
completely stalled

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but decentralisation is risky with the current
management structure

818 people organisation, budget of R115M
CEO (of 3 hospitals)
Director
Senior Medical Superintendent
Hospital Secretary
Nursing Service Manager (Senior Matron)

Dep. Director
Ass. Director (R133K pa)
Management vacuum
Level 8/ Snr Admin Officer (R89K pa)
Finance Provisioning
Patient Admin
Auxiliary Services (acting)
HRM (acting for 6 years)
Level 6 (R67K pa)
3 HR clerks
Level 4 below

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The team suggested that grades, job requirements
and decision processes must be overhauled at both
province and hospital level

• Overhaul decision process between province,
  district and hospital for all HR and budget
  decisions
• Re-evaluate the grades and job requirements of
  the top 8 positions in the hospitals to ensure
  management capacity in key functions
• New top level organisation structure is proposed
  to ensure focus on key strategic issues

CEO (of Themba hospital only)
Senior Medical Superinten-dent
Infrastructure and Maintenance
Nursing Service Manager (Senior Matron)
Administra-tion Director
Finance Director
HR Director
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Agenda

• What is Khaedu?
• Progress to date
• Examples of Deployment reports
• Outpatients waiting time in hospitals
• Organisational and process barriers to capacity
  management in Home Affairs
• Right people in the right jobs? Organisation in
  Mpumalanga hospitals
• Summary and roll-out for 2005/6

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Programme roll-out
Costs
Location
Who

• Approx R10,500 per manager, which includes
• 5-day core skills week
• 1-week supervised field-based study
• Excludes
• Travel accommodation expenses for those
  attending courses
• Printing
• VAT

• Each province to have a local venue
• To keep revenues in province and promote SME
  development

• Ideally, all SMS managers at National
  Provincial level over the next 2-3 years

Less than 1 per annum of average SMS package and
can be partly recovered via SETAs
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CHALLENGES

• Lack of conducive environment
• Poor People Management
• Centralisation v/s decentralisation esp. HR and
  Procurement issues
• Follow-up on Reccommendations
• Issues of Sustainability

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Summary

• Khaedu is a successful model for operationalising
  coal face deployments
• It develops the core skills necessary for solving
  problems of service delivery and the Managers
  skills to deal with the day-to-day works
  functions.
• It produces useful output for the host
  departments, and
• It enables managers to have a sense of the
  realities at the coalface of service delivery
  points.

It remains Cabinets goal to ensure that all SMS
members are exposed to the Coal Face as part of
their performance cycle and we are investigating
ways to tie this into the PMDS
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• THANK YOU