Part 4: Case management capability and capacity in Work and Income

Ministry of Social Development: Using a case management approach to service delivery.

In this Part, we discuss our findings on the Ministry’s case management capability and capacity – that is, its people and systems.

Capability refers to the right people with the right skills and behaviours, equipped with suitable tools and knowledge. We discuss:

  • staff aptitude and the changing role of the case manager;
  • the Ministry’s progress on developing its practice standards for case management and the skills, coaching, and training required to support those standards;
  • whether the way case managers’ performance is appraised has changed, given the new ways of working;
  • what guidance case managers can access to help them do their jobs; and
  • how well IT applications support the delivery of case management tasks.

Capacity refers to having enough of the right capability in the right place at the right time. We discuss:

  • the Ministry’s plans to simplify some transactions and move some online or to centralised teams; and
  • how the Ministry is managing the supply and demand for case managers, including:
    • day-to-day deployment in service centres and covering for absences; and
    • whether the streaming of clients and the allocation of staff to service centres are aligned.

Summary of our findings

We met some excellent front-line staff. Their values, beliefs, and outlook are in line with what the Ministry and clients need as a foundation for effective case management. The Ministry knows what further skills its staff need and has started to develop its practice standards for case managers. This means that staff will need further training on their new roles.

The way that case managers’ performance is supported has not caught up with the change in role and is too focused on aspects that are easy to measure.

The Ministry has some good resources to support case managers to do their jobs. The roles are complicated and busy, and there are some barriers to staff being fully effective and efficient. For example, guidance is extensive, and IT is clunky. Because of this, it can take two years for a case manager to become effective.

The Ministry has identified significant opportunities to gain further administrative efficiencies so staff can spend more time with clients who need more help.

It is difficult to cover staff absences and stay true to the service delivery model. There is significant variation in the use of staff on a day-to-day basis. The Ministry has more to do to match staff resources to demand.

Putting staff into new roles

Most staff are enthusiastic about the new case management approach. Some additional support is required to enable staff to become fully effective in their roles.

The case managers we chose to speak with displayed good aptitude for their roles. They were enthusiastic about the introduction of work-focused case management, used appropriate language with and about clients, and showed empathy. Many spoke passionately about why they did the job. However, aptitude and enthusiasm alone are not enough to make the new approach a success.

“I regularly work through my lunch break to see clients who need to start work the next day.”
Case manager

Many staff had been employed by the Ministry since before the welfare reforms, when their jobs were more focused on transactions. Staff moved into new roles based on expressions of interest, subject to management approval. Some of those staff need more support to be fully effective in their new roles.

Staff need this support because the new work-focused case management model is about engagement, problem-solving, and support, rather than service co-ordination and transacting benefit payments. Work-focused case management staff have ongoing relationships with clients to get them ready for employment.

Effective engagement underpins all stages of the model. It is intended to build positive client relationships. Staff are expected to demonstrate that they are open, are respectful, actively listen, and acknowledge the client’s point of view. The model (see Figure 2) has several stages:

  • information gathering and analysing;
  • planning and problem solving;
  • facilitation, reviewing, and planning; and
  • exit planning and support.20

Some staff in the Ministry worked in case management roles before, so for them the change is not as great. However, even those staff are working with new groups of clients in new ways. Overall, we recognise the extent of the change this has meant for many Work and Income staff, and it is still early days in building capability. We also recognise that the shift to working intensively with clients who already depend long term on a benefit is a challenge.

The rest of this Part describes some of the barriers to front-line case management staff being more efficient and effective. Mostly, the Ministry has plans to address the problems we found, and we include details of those plans where relevant.

Building case management capability through coaching and training

The Ministry knows what new skills its staff need and has started to develop its practice standards for case managers.

“Right date, right rate, right client, and right benefit.”
Work and Income staff on paying beneficiaries

The Ministry trains its staff well in technical matters, and there are many layers of support and checking of calculations. This is to try to ensure that payments are correct – no more and no less than the beneficiaries’ entitlements. Our work21 raised no concerns about the capability of case management staff in processing beneficiaries’ payments.

Unsurprisingly, because it is newer, we found significant, unintentional variations in case management practice. This variability occurs because the Ministry has not yet made clear what it considers appropriate practice. We, and the Ministry, could see the effect in the data the Ministry collects about client outcomes.

Guidance on practice matters because, as we described in paragraph 4.11, the Ministry’s new approach to case management requires front-line staff to be good at identifying barriers to employment and then helping clients work through them. This approach needs different skills, such as knowing how to appropriately discuss disability, mental health, and cultural matters, or how to work with resistant clients. The lack of guidance could lead to variable practice, because staff either draw from their own life experience or ask colleagues what to do. This could undermine the ability of the Ministry to measure the effect of case management.

For example, work-focused case managers have clients with health conditions (including mental health conditions), injuries, or disabilities. The Ministry would like these staff to be specialists in their streams – for example, by having a greater knowledge of tailored services available for this group of clients and understanding their needs better. However, the Ministry has not yet aligned its staff training and guidance to support specialisation. Many staff had received basic mental health awareness training, but not all.

We met some enthusiastic staff who tried hard to motivate clients in these groups, including some clients who had not worked for some time. Advocates told us they sometimes worried that over-enthusiasm was counter-productive for some clients and could make matters worse. We also met other staff who were so empathetic to these clients that they did not feel able to push the clients too hard towards employment.

The Ministry recognises that the lack of guidance on case management practice is having an effect on client outcomes and the client experience, and it has started to make changes.

In May 2013, the Ministry produced some practice guides for case managers that will provide a good base for development, when supported by training. These guides were quite new when we started our audit, and not many staff knew about them. The guides have since been rewritten and extended, and further training is planned, including a new module on mental health matters and a refresher on managing clients subject to drug testing. A new case management competency model is also in development, which will guide future investment in case manager capability.

The Ministry continues to prepare tools to support staff and encourage consistent practice. For example, it launched a trial of an “engagement application” in October 2014. Several staff working with younger people who receive a supported living payment will be testing the application from late 2015.

The Ministry has also put together a small practice review team, who observe case managers’ practice and “soft” skills. The team has identified that a coaching approach is more effective than training on practice matters. The team will advise the national office on practice development. Regional directors and trainers and service centre trainers will then train others in best practice in their regions. The Ministry told us that it intends to expand this team in the future. However, there were no firm plans in place at the time of our audit, and the practice review team had not yet submitted proposals to the National Commissioner on the next stages.

During our audit, we saw little evidence of the coaching culture that senior managers aspire to. Local trainers focus more on compliance matters. Coaching on case management practice is not a priority for service centre managers or trainers because of their workloads.

In 2012, Cabinet noted that the Ministry was working on a future workforce strategy. The strategy identified that the new service delivery model might require new roles. The Ministry initially focused on the changes needed to the front-line case manager and work-broker roles.

The Ministry has now started to look at other service centre roles as the new service delivery model evolves. For example, many service centre managers are good operations managers, with good technical knowledge. However, in future, front-line staff will need more coaching and support on case management practice and “soft” skills. Job descriptions for service centre managers do not reflect this responsibility.

In 2014, the Ministry set up a leadership programme for service centre managers to enable them to meet the new demands placed on them. The Ministry also needs to consider how the roles of service centre trainer, service quality officers, and the new practice review team complement each other.

Using performance management to increase staff capability

The way that the Ministry supports case manager performance has not caught up with the change in role and is too focused on aspects that are easy to measure.

Work and Income has clear standards for tasks related to processing benefits – for example, the accuracy of calculations. The Ministry measures and checks staff against these standards, and staff get regular feedback to help them improve.

Staff spoke positively about the discussions they had with their managers about performance. However, they felt that the assessment had not changed since the welfare reforms. Managers agreed that there were not enough measures to assess how well case managers used “soft” skills. Therefore, discussions focused on aspects that were easier to measure, such as the number of clients leaving a case manager’s caseload because they were no longer claiming a benefit.

In the past, there has been inconsistent scrutiny by senior managers of certain factors that can affect the client experience. For example, the Ministry’s “queue manager” system records how long clients wait to see case managers, but only once reception staff book them in for their appointments. Queue manager displays the results on screens that staff know senior managers pay close attention to.

If there is a queue to book in at reception, case managers in some locations collect their clients from the queue and book them in themselves. Despite this, queues to book in can form during busy periods, especially if reception staff are scanning client documents. There is no measurement of time spent in this queue.

There are other less visible queues, such as work in progress. Work in progress can include applications waiting for action and work waiting for checking. The Ministry measures the quantity of work in progress, but senior managers do not give this information as much attention.

Senior staff agree that the current performance measures might not support the right behaviours needed to deliver the new service delivery model effectively. For example, some offices and regions have found that, when they follow the new service delivery model rigidly, other key performance indicators fell.

Staff in one regional office told us that they watched closely whether clients were going to “tip over” into the next benefit duration category (that is, the length of time from their first receipt of a benefit). They would then focus extra attention on those clients to prevent that happening. Although that might be good for that client, and the relevant performance indicator, we consider that this behaviour could compromise the results of trials and control groups.

The Ministry told us that there had been a culture of competition between the regions, fuelled by ranking performance indicators. The Ministry is trying to keep the positive benefits of this motivation. At the same time, it is changing how it assesses regional performance. Work and Income’s senior leaders are encouraging the regions to support each other in improving performance.

We have no reason to consider that this competitiveness has a detrimental effect on clients. In our interviews with clients, some said that they thought the Ministry’s staff were on a performance bonus based on how little money they paid to beneficiaries. We concluded that there are no measures in place to encourage such behaviour. In fact, not paying people the “full and correct” entitlement is likely to have an adverse effect on a case manager’s performance rating.

In our view, the Ministry needs to reconsider how it looks at case managers’ performance. For example, the Ministry could explore ways to assess the content and quality of interactions with clients, such as interviews and planning, alongside other measures, such as how many clients stopped receiving benefits.

This would help to address an issue evident in some of the data the Ministry holds. The issue is that, by focusing on the numbers of clients no longer claiming a benefit, staff were less likely to want to work with difficult clients. This is because difficult clients can take a lot of case management time and might not have a successful outcome. These are the clients who the Ministry designed the new service delivery model to help.

Recommendation 2
We recommend that the Ministry of Social Development develop an approach to assessing and supporting case manager performance that reflects the importance of soft skills, such as effective client engagement, as well as the technical skills that case managers need to have.

Supporting staff with guidance

Guidance for case managers is extensive, and it takes a long time for staff to become fully proficient.

Complicated benefit rules stem from the law and ministerial direction. Most experienced case managers we spoke with were happy with the online guidance in the Ministry’s Manuals and Procedures (MAP) system. A few told us they relied on the practice guides. Other case managers told us that they found MAP difficult to navigate when they were under pressure, especially when they were with a client.

There is a lot of guidance. We copied the “Jobseeker Support” table of contents from MAP and pasted it into a separate document. The headings ran to 26 A4 pages. The case manager “desk file” contains links to resources that case managers might use regularly. There are more than 130 further links to other pages organised under 21 sections. This represents just a fraction of the guidance in MAP.

Many case managers said they would ask a colleague rather than attempt to find the relevant information in MAP. MAP is searchable. However, it is not a true “knowledge base”, and it is not intuitive. Finding something requires a reasonably good understanding of where to look.

Along with the clunky IT applications we discuss in paragraphs 4.44-4.50, this contributes to the time it takes for a case manager to become proficient in the role. The consensus of the staff we spoke to was that it takes about two years. This might explain why the Ministry’s turnover rate is greater for people with fewer than two years in the job.

“The complex guidance is our biggest challenge in trying to help clients.”
Client advocates

Client advocates singled out the complexity of the guidance as one of their biggest challenges. The Ministry makes its MAP guidance freely available on its website, which is good practice. Advocates told us that the Ministry’s policy guidance sometimes did not accurately reflect the legislation. They suggested that staff needed more training in how the relevant legislation works as a whole. Advocates said that MAP deals with each benefit by itself and not how benefits might work together for a client.

Increasing capability and capacity by providing effective IT applications

The Ministry’s IT applications are clunky, can be slow to navigate, and require entering the same information more than once. However, there are plans to reduce the number of systems in use in the short term, and the Ministry is considering further long-term improvements.

We talked to staff about, or sat alongside staff as they used, the IT applications needed for their jobs. We also tested the applications ourselves. The Ministry’s IT team has done a good job at putting a “home screen” together from which case managers can get client records. However, case managers need to use many separate platforms and applications to get client records.

There are many issues with the current applications, all of which mean case managers are less effective in their roles than they could be. For example:

  • Many of the applications require separate passwords, and constantly logging back in to each is frustrating.
  • There is a delay for some of the applications to load, and a case manager might need to open about eight applications during one appointment.
  • It is hard to get an overall picture of a client’s information because it is split between applications.
  • Many staff have two computer screens to reduce the amount of switching back and forth between applications. This introduces the risk of incorrectly entering data because it is possible to have two different client records open.
  • Staff have to enter the same information in more than one place.
  • Staff cannot add to client “engagement logs” after three months, so they have to start a new one. This means that getting access to a client’s history is time consuming.
  • The main client management application does not help case managers manage their workflow – for example, by prompting them for the next step or reminding them they have an action to take.

SWIFTT22 is the oldest system the Ministry has. It is used mainly to process payments to around one and a half million beneficiaries, superannuitants, and students each week. Staff like SWIFTT because it is stable and reliable.

The Ministry will begin planning for a replacement in about five years, but will be reducing what SWIFTT is used for until it is used only to make payments. Other functions will be transferred to the Ministry’s main client system. The estimated replacement cost is about $150 million. We found some problems with the client letters that SWIFTT produces. We discuss those problems in Part 5.

The Ministry has had a relatively incremental approach to IT development. Until recently, it did not have a longer-term IT strategy. It has now stated its plans and targets for 2013 to 2016. These include:

  • reducing the number of systems that front-line staff use and getting rid of redundant processes;
  • reducing the number of manual transactions; and
  • developing online and mobile services, and encouraging more clients to use self-service options.

We reviewed the Ministry’s IT strategy and consider it good at a high level. It outlines where the Ministry is now and where it needs to be. We could see that it brings together all of the aspects of IT provision within Work and Income we identified as being problematic. The strategy is clearly in line with the Ministry’s approach to service development, and a cross-Ministry group governs the delivery of the strategy.

The main IT projects for Work and Income are allowed for in the Ministry’s capital plan. The plan includes retiring two computer applications and transferring their functions into another existing computer system during 2014/15. This investment should make future changes easier to achieve. The Ministry had not yet agreed funding for some further projects, and the plan notes some reprioritisation might be needed once the costs of a simplification project are known (see paragraph 4.53).

Using capacity better by simplifying administration and online services

The Ministry’s simplification project presents significant opportunities to gain further administrative efficiencies so staff can spend more time with clients who need more help. The Ministry has already made some changes and is planning for more.

Processing transactions takes up about 60% of case managers’ time and equates to more than 2250 full-time case management and other staff.

Key fact
The time the Ministry spends processing transactions is equal to 2250 full-time staff.

During our visits to regional offices and service centres, we noted that general case managers in particular were under the most pressure. General case managers usually have half an hour with a client, and the call centres book most of their appointments for them. General case managers can see 10 or 11 clients on a busy day, so they have to keep to the appointment times to prevent long waits for other clients. They also look after “walk-ins” – people who arrive without an appointment. General case managers can have a significant amount of work to do in a half-hour appointment. If they have back-to-back appointments, it can be hard to catch up on administration.

The Ministry is designing a simplification project to:

  • simplify transactional services by removing unnecessary and costly work and administration tasks for front-line staff by processing some transactions online;
  • contribute to better client experiences, increased accuracy, an improved reputation, and staff satisfaction; and
  • allow front-line staff to focus on achieving return-to-work outcomes for clients.

The Ministry’s initial business case for the simplification project has been agreed. Work on some aspects of the simplification project is under way, such as some batch processing of transactions and removing authentication requirements on some benefit resumptions. A detailed business case is due in early 2015, which will set out the capital requirements to deliver the remainder of the project.

The Ministry has stated that it will face a funding shortfall in four years if the simplification project does not deliver the intended benefits.

The Ministry has had some success with other centralisation projects, which sped up processing times and made more time available to case managers, so the prospects are promising. For example, the Ministry now carries out authentication work (checking applications, confirming client identity, and other tasks) from two Work and Income locations: Mangere and Lower Hutt. The Ministry has plans for more centralisation before the simplification project begins.

The Ministry offers a number of online services, including “My Account”, where clients can view their information and make changes. The Ministry knows it has a way to go to gain the potential efficiencies of online services. For example, if a client fills in an online application form, a staff member prints out that form and then enters the information into the client management application.

This is partly because the Ministry does not yet have a system that can do automatic verification or authentication for most clients. Also, the complicated nature of the Ministry’s current systems makes end-to-end automatic processing difficult. However, the simplification project does have plans to implement “straight through” processing for many financial payments and reassessments. This means that clients will eventually be able to input their own information and have a “receipt” returned that shows the calculations and effect on future payments.

Working out where staff are needed

It is difficult to cover staff absences and stay true to the service delivery model. There is significant variation in the use of staff on a day-to-day basis.

During our audit, we saw significant differences in the use of case managers. For example, the Ministry expects work-focused case managers’ time to be protected, so they do only work-focused client activities. However, in some places, work-focused case managers also worked on reception or worked on general case management during busy periods.

“It can be hard to keep track of my caseload.”
Case manager

This meant work-focused case managers spent differing amounts of time on their client caseloads. Those who had their time protected spent more time with clients, following up client actions, and rebooking missed appointments. They had more time to work with those clients who were showing some resistance to engaging with job-focused activities. Case managers who can manage their caseloads are more likely to achieve better outcomes for their clients.

Overall, the Ministry’s rates of staff turnover are low. However, some centres have much higher rates. Service centre managers can spend much time rebooking appointments because of staff absences. The overriding priority in the centres we visited was to ensure that clients saw a case manager and did not have to wait in queues for too long. This often meant compromising the model for staff use, such as by not protecting work-focused case manager time or cancelling staff training sessions.

Staff in service centres where turnover is high are likely to have been employed by the Ministry for shorter durations and have less experience. The Ministry is aware that the turnover rate for staff with fewer than two years’ service is much higher than it is throughout the Work and Income workforce as a whole.

Matching the streaming rules and staffing allocations

The Ministry has more to do to match staff resources to demand.

When we started our audit, the Ministry told us that it was still working on getting its caseloads and streaming rules right. The Ministry’s streaming tool allocates clients to staff based on a complicated set of rules. During our audit, we noted some teething problems and unintentional effects. For example:

  • The streaming tool did not work effectively for small sites.
  • In some locations, clients who needed and qualified for intensive case management received a less intensive service because there was no room for them.
  • Conversely, in some locations, clients with lesser needs received higher intensity services because work-focused case managers had the capacity to work with them.
  • The streaming tool assigns clients in the control group to any of the other available services, which might not be a significantly different service. For example, a person with a health condition selected for the control group could end up in general work-focused case management instead of the appropriate work-focused case management stream (health conditions, injury, or disability). There is little difference between the services offered in those two streams.

The Ministry has more work to do to match staff resources to demand. The complicated rules that stream clients to case managers do not inform the calculations that work out how many case managers should be in a particular service centre. This is leading to unequal access to services in some locations.

The Ministry has started to work on an approach that looks at the geographical catchment of its smaller service centres, taking into consideration local labour market conditions. It will then decide which streams of case management to put in place. One case manager might work across the streams.

We can see the logic in the approach, and it will help the Ministry set priorities for its resources. However, the Ministry would need to train and support staff to be specialists in more than one stream, given the differing needs of clients. If staff are not trained in this way, the service can only be a general one.

20: Some clients will move to a different benefit or choose not to receive income support from Work and Income.

21: Transaction sampling at eight service centres in 2014.

22: SWIFTT is short for “Social Welfare Information for Tomorrow Today”.

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