We are all individuals, especially as we age

When you think of a person who needs support as they grow older, what do you think of? Is it an image of someone in a bed, or a wheelchair? Is it your grandmother? Your neighbour?

Do you think of a group of people? Or an individual person?

The many and varied needs, wants, desires of people in our communities – from football supporters, to those with wanderlust, from cat lovers, to bird watchers, loners to socialites – these and all of the infinite flavours of our humanness only become more important to savour as we grow older. When we reach the stage when support is necessary, who we are remains, however our needs are exacerbated by health difficulties. When we need support, we want those around us to have a deep understanding of who we are.

Transitions in ageing are not consistent and systematic as they are described by our ageing systems. Sometimes they are incremental, sometimes accidental, sometimes monumental, and they are always personal.

Grant Thornton 2020

Imagine the needs of a woman of Italian heritage, who loves red dresses and her 10 grandchildren, cooked her entire life, and now suffers from dementia. Compared with a 90-year-old ex-athlete who broke his hip last year, is struggling to walk again, mostly deaf, and whose only daughter lives in New York and can’t visit. Both have very different personalities, connection needs, family support and financial support. However they will both be met with a basic one-size-fits-all offer from most aged care organisations.

Carl Rogers, a humanistic psychologist, introduced a “person-centered” approach to support [1], with the view that acceptance, caring, empathy, sensitivity, and active listening, promotes optimal human growth. He believed that in order to actualize human growth in late life, individuals should have access to, and opportunities for, ongoing learning, personal challenges, and close and intimate relationships. Furthermore, he argued that human capacity and need for growth does not diminish with age. The emphasis of person-centered support is on the well-being and quality of life as defined by the individual. The research [1] that applies this philosophy to ageing has shown positive influences on staff outcomes (satisfaction and capacity to provide individualized care); improvement in the psychological status of residents (lower rates of boredom and feelings of helplessness); and reduced levels of agitation in residents with dementia. However COVID-19 has added to the complexity of delivering aged services that support the individual rather than the mass.

So why is aged care vanilla?

What do we mean by vanilla? We are talking about the basic, one-size-fits-all support that most organisations offer to clients. It is designed for the mass, not for individual tastes. It is good, and for many people, it’s what is needed. However there is a large segment of the aged care market that want, and can afford, a more tailored offer. Some people would prefer - and go out of their way for - a locally made pistachio praline gelato, with chocolate sprinkles.

In many countries, aged care policies and services were designed as a democratic way to support an entire population. Residential aged-care facilities and support services were viewed as places of long-term treatment and therapy, dominated by a healthcare model that values efficiency, consistency, and hierarchical decision-making [1] However older people (particularly baby-boomers) have expressed a strong preference for alternative forms of aged support and accommodation, and a greater ability to exercise control over where they live and the nature and quality of services they will receive. The majority of aged care organisations have not yet adapted to this need. There are historic and cultural reasons for this.

Aged care policy and funding is changing

Globally, aged care policy and funding is adapting to an aging population with new needs. According to a 2017 report by KPMG [3], disrupted aged-care markets bring opportunities for new challengers and incumbency may not be an advantage. To put the risk and opportunity into perspective, when the United Kingdom shifted to market-based provision more than 50 percent of consumers moved from a not-for-profit to a for-profit provider. In New Zealand, providers reported that they lost up to 30 percent of their clients to other providers, with some of those new entrants to the market.

The UK Domiciliary Care Market has Two Customers – The State Sector and Private Fee Payers

The historic, legal objective for all UK citizens to enjoy person centred control for the care support they needed was legislated for in 1990. The NHS and Community Care Act* gave individuals the right to have their care provided to meet their needs and delivered in the manner they wished to receive it. Here are two, true, small examples of people wishing to personalize their care package:

1)     A gentleman who was brought up to believe ladies wore dresses or skirts, not trousers, wished his care workers to not wear trousers as he felt uncomfortable around ladies wearing them.

2)     A lady did not wish to be assisted to bed at 7pm but changed to a provider who could offer her a time of choice.

Choice, regardless of privately funded or State funded care.

To encourage State funded recipients to be in control of their care support, it was and is possible to receive direct payments from the state into a personal bank account, so giving a level playing field for every individual. The take up of direct payments has plateaued, however, and this method of payment is not always offered by the UK’s bureaucratic State system.

Having funds to pay for care gives control.

Or that is the theory. However, the differences to have choice between State funding and individuals who have private funding is increasing. When care support is needed, you should be able to choose your provider. Should your chosen provider not offer you a care service you are happy with then you should be able to change providers.  For most people receiving State funded care, interaction with Social Services is necessary and without which, supportive care cannot be accessed. As a result, choice in care providers can be limited. Choice to change care provider is more difficult and time consuming. Some care providers do not work with customers who do not have Direct Payments. Many care providers do not work with local councils because they are unable, in their view, to receive adequate payments for the care support they are being asked to provide. In the last couple of years, many care providers have given back their council contracts.

The level playing field has come unstuck.

Individuals receiving the majority of State funding do not, in reality, have the freedom to choose their provider. Nor can they necessarily receive the amount of care support they think they need. They cannot ‘shop around’ for what they perceive could be a better and more personal service.

Individuals with funds have the freedom to look for the care support they need and want. They are open to innovative approaches, able to negotiate changes to care packages as and when they wish. They simply set the rules as a customer. They are happy to pay more for services they are satisfied with.

To attract private fee payers, care providers must give better service, be adaptable, give extra value, and facilitate other aspects of care provision, all in addition to the main event. They must be continually available and approachable in order to retain the clients they attract.

It is also essential, because of the large number of domiciliary care providers, that marketing and promoting their service offerings is ongoing and innovative.

Most of the UK domiciliary care providers are ‘for profit’ organisations. There are between 8000-9000 home care providers in the UK, mostly small to medium sized businesses.  Businesses which rely on State contracts for most of their financial turnover are likely to have a ‘one size fits all’ element to their delivery. This is because the work involved is more time orientated and follows a care plan delivering just the specific tasks for a certain length of State paid for time.

Businesses attracting the private fee payer have choice to offer customer led care support. They do not have a one-size-fits-all offer. They are in regular contact with their clients, client advocates, their families, and often associated professionals, and they are responsive to change. Importantly, private fee payers want consistency of care workers - regular faces in their home. Businesses attracting private fee payers may recruit differently, have differing specifications for applicants, for example minimum professional work qualifications before possible entry.

For many home care providers in the UK, unless Government gives local councils increasing funds, year on year, to fund the social care system, the trend for care providers to look for private fee payers to sustain their business will increase. For businesses which have never needed to market and promote for clients because State clients were simply offered to them, it will be a stiff learning curb, and many providers will cease trading.

How can we adapt beyond vanilla?

We need a new approach, but it has to fit with who we are. Providers that are supporting the elderly and people with a disability have a strong social-service and clinical focus. Their skills and experience in this space is enormous, and recognised globally. Equally, because of the way the sector has been funded for decades, many organisations have limited commercial experience. It wasn’t a priority to develop. The majority of providers have not needed to sell, compete, or differentiate their services because governments provided block funding or limited-service licenses that effectively sent them customers. The State and community both expect aged care organisations to become very different, yet aren’t providing a means to adapt and flourish.

The rules became so entrenched that innovation has been stifled. Executives inside human services would often hear from staff, “Are we allowed to do that, or provide that service?"

Use person-centred innovation to succeed

It is our job to help you design a way to achieve quality of life and well being for your aged care clients, whilst creating a successful, well funded organisation. We help aged care organisations who aim to become more person-centred, focused on individual needs and well-being, differentiated in the market, and the organisation of choice for your preferred client.

In our first team interactions, we help you use a series of tools like the Kano Customer Innovation Framework [5] to help unpack opportunities for growth. The framework has three axis:

Unspoken desires: These attributes provide satisfaction when achieved fully, but do not cause dissatisfaction when not fulfilled. Since these types of attributes of quality unexpectedly delight customers, they are often unspoken.

Spoken wants: These attributes result in satisfaction when fulfilled and dissatisfaction when not fulfilled. These are attributes that are spoken and the ones in which companies compete.

Must-be needs: Simply stated, these are the requirements that the customers expect and are taken for granted. When done well, customers are just neutral, but when done poorly, customers are very dissatisfied.

The following examples came out of a recent workshop for an aged care organisation in Queensland. We assessed 9 areas to innovate or change (outlined in the image below).

Surprising: These are things that your clients can’t tell you that they want (because they don’t know to ask for them), but if they had them, it would be unexpectedly wonderful. This might look like live-in support, or multi-generational engagement.

Interesting: These are things that might look good for marketing, but might not really be what your client wants. Social events and engagement communications might fit into this.

Premium: Things that cost more and a client segment is willing to pay for. Additional service offerings could fit in here.

Value: A mid-level service that feels right for the price.

Budget: A basic, affordable level of service. This might be no out-of-pocket costs.

Complaints: Things that people say they don’t want. This might include not enough choice for some, too much choice for others, and no premium offer.

Over serviced: Things we think are important, but the client doesn’t necessarily value them.

About right: A vanilla level of service.  

Rejections: Things the client does not want and may turn them away. This might include: invoices that frighten people; support services not being on time; an inconsistent team; and perceptions of quality (including sanitiser use).

The first step: Maturity Diagnostic Workshops

CapFeather’s Maturity Diagnostic Workshops help you understand your overall customer maturity, potential gaps, and opportunities for your organisation. Knowing where you are now is the first step in delivering what your clients need.

At CapFeather, we understand the decision to retain us as your strategy consultant is not something your team does every day. We have learned over decades of experience the single most important factor is learning how to collaborate. To eliminate the risk in this process we work with you at our cost to confirm we can succeed together. We facilitate four workshops covering the key search domains for your best next move.

Each workshop would require participants to take 15mins – 30mins to prepare and then get interactive for 90mins – 120 mins over 4 sessions.

Context Workshop

1.Explore in detail the range of products and services you currently offer.

2.List the current macro environmental trends the management team is aware of.

3.Run an opportunity | threat assessment for each trend against the organisational offerings.

4.CapFeather would analyse the results to assess your context maturity level.

5.You would gain prioritised critical external opportunities and threats.

Customer Workshop

1.Identify the different quality elements for the most important services.

2.Classify these into different types to identify expected | preferred | surprised customer value drivers.

3.Apply acumen-based discretion to evaluate service offering versus customer value drivers.

4.CapFeather would analyse the results to assess your customer maturity level.

5.You would gain specified key quality product and service gaps for competitive advantage.

Competitor Workshop

1.Identify the major market rivals for the most important services.

2.Assess their offerings against the expected | preferred | surprised customer value drivers.

3.Create a market map using two dimensions of customer value drivers and plot rivals to identify white spaces.

4.CapFeather would analyse the results to assess your competitor maturity level.

5.You would gain new market positioning options.

Capability Workshop

1.Identify the range of Physical | Reputation | Organisation | Financial | Individual | Technological resources in your organisation.

2.Analyse these for leverage, imitability, value, exclusivity to identify sustainable competitive advantages.

3.Estimate spare capacity available for growth in both tangible and intangible resources.

4.CapFeather would analyse the results to assess your capability maturity level.

5.You would gain sizing of spare capability and strategic capability gaps.

Next steps

If after the Maturity Diagnostic Workshops you want to deeply understand more about your customers and communicate change activities inside the organisation, CapFeather can:

• Conduct further research with clients

• Map the client journey

• Design the target state experience

• Run an innovation and change process to create the ideal result for the organisation

Alternatively, if you have a goal to move quickly to be a market leader or get a new revenue opportunity, CapFeather can help you:

Use the Lean CX Methodology to find and market test a new opportunity

Phase 1: Prepare and align the teams

Phase 2: Find an adjacent market position for the organisation

Phase 3: Design a minimum viable initiative to market test

Phase 4: Scale and refine the initiative with real market feedback 

Read more about the Lean CX Methodology for aged care.

Lean CX: How to Differentiate at Low Cost and Least Risk is now available through De Gruyter Publishing.

Co-author acknowledgement

We would like to thank Angela Gifford of Able Community Care Ltd for her contribution to this paper.

Find out more about the Maturity Diagnostic Workshops.

Get in touch with:

Matt Stanton, Director, UK/ EU

matt.stanton@capfeather.global

Why CapFeather?

We are innovation experts who apply a human lens to organisational and societal challenges. We value people and base our work inside a philosophy of kindness, whilst being driven by commercial success. We help mature firms find new and sustainable opportunities for customer growth by looking beyond the immediate horizon.

Ambidexterity is needed for exponential growth. While your team excels at business right now, we help you design the path for its future success.

Over 20 years of senior advisory, our people have worked on more than 200 projects to deliver bottom line growth and new revenue through product and service innovation - achieved though compelling customer
relationships. CapFeather has presence in Australia, the United Kingdom and North America.

References

[1] Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in Aging, 8, 1.

[2] https://www.austrade.gov.au/aged-care/

[3] KPMG (2017) Customer Experience in the Aging Sector

[4] Grant Thornton (2020) A Model for Transformation and Governance

[5] Kano, Noriaki; Nobuhiku Seraku; Fumio Takahashi; Shinichi Tsuji (April 1984). "Attractive quality and must-be quality". Journal of the Japanese Society for Quality Control (in Japanese).

Other readings

Doyle C, Lennox L, Bell D. 2013, ‘A systematic review of evidence on the links between patient experience and clinical safety and effectiveness’, BMJ Open, vol. 3, no. 1.

Cydulka R.K. et al 2011, ‘Association of patient satisfaction with complaints and risk management among emergency physicians’, Administration of Emergency Medicine, vol. 41, no. 4, pp. 405-411.

Park, G. W., Kim, Y., Park, K., & Agarwal, A. (2016). Patient-centric quality assessment framework for healthcare services. Technological Forecasting and Social Change, 113, 468-474.