“Client services chart” as a strategy for the improvement of the organizational efficiency: the case study of a disability service for adult age of the local sanitary agency of treviso.
Authors: Daniela Baciga, Annalisa Di Maso, Gian Piero Turchi, Roberta Durante
1. The work here presented deals with “Client services chart”.
2. The “Client services chart” were introduced in Italy by a Directive of President of the Council of Ministers, in January 27, 1994. This Directive provides the principles that should characterize the public utilities supply. In particular, the Directive was referred to those services ensuring at least the defence of those individual rights constitutionally protected, such as health care, assistance and social security, education and freedom of communication, freedom and safety of the individual.
3. The Chart is a document that public services assemble in order to protect citizens who use the services according to following principles:
- the principle of equality, impartiality and continuity of service supply;
- the right of citizens to choose the providers;
- citizens participation in the service;
- efficiency and effectiveness of services supply.
4. In this perspective, the “Client services chart” is focused on the relationship with the citizen-user and is an effective tool to guide the user in the use and access to services and to verify and monitor compliance with the minimum standards of quality that organization undertakes to pursue.
5. The current work highlights how the “Client services chart” become a tool not only for the citizen-user, but especially for the Organization management implementation.
6. How does the “Client services chart” becomes an instrument for management implementation?
The services chart describes services requirements allowing, in this way, its use and evaluation by the citizen-user; moreover, it is an opportunity for the organization (the service) to identify and to declare general objectives and strategic lines. In this way, the Organization can increase quality of the services, detecting citizen-user requirements and so improving services requirements.
7. In this sense, the setting up of the Services Chart is aimed to meet the needs of the citizen-user detected (which become so service requirements); it means that the organization is structured by objectives, rather than the “things to do”. This process triggers and generates organizational change.
8. The Chart is an instrument that acts on re-draw the organisational processes towards "transparency" for the citizen-user and towards efficiency standards for service supply.
9. “Client services chart” objectives are thus twofold:
- towards the citizen-user: to inform and guide to the use and choice of services;
- towards internal matrix: to improve efficiency and organizational management.
10. Here's an example of application of what we are saying. So that the “Client services chart” is not only a “finished product”, but also an instrument of organizational processes management.
11. In 2006 a Disability Service for adult age of the Local Sanitary Agency of Treviso (Veneto – Italia) has requested management consulting to construct the Client Services Chart. A one year project started at that moment and was constructed according to precise theoretical assumptions:
First theoretical assumption: the document " Client Services Chart " is the result of the organizational matrix structure. So, it can become an organization’s management instrument, because it can become a focus for roles positioning in the service matrix.
Second theoretical assumption: The organizational matrix is the result of interactions between the roles involved in the organization.
Therefore, since the structure of the matrix depends on how stable the roles still adhere to theirs responsibilities (objectives), it is essential to work for ensuring that the roles remain the most possible “adherent” to general objectives.
In particular, to “measure” the roles positioning within the organizational matrix, we use 2 indicators:
- The degree of fluctuation of “competences band”, that indicates how the roles are placed in the matrix using personal opinions rather than scientifically based theories.
-- The degree of fluctuation of the “objectives angle”, that indicates how the roles move away from the delegated objectives.
12. For the construction of the Client Services Chart, it was been created a structure that would allow the Service to respond to the objectives according to efficiency and effectiveness criteria. Since the structure is given by roles, we have proceeded with the involvement of all Service’s roles.
In particular, the strategies used in the project have been:
-- The survey and analysis of the organizational structure before the start up of the project;
-- The use of an organizational theory which would establish rigorously the structure cornerstones of the matrix;
-- The assignment, to the participants, of the role of “scientific supervisor”, for endorsing team works products;
-- The survey and Analysis of the organizational structure after the construction of Client Services Chart.
The structure recorded in T0
The matrix structure was detected by analysis of discursive practices used by roles, as previously presented in ASM Merano case study; this made possible to outline the fact that there was no shared objective.
To the question: "What are the general objectives of the service in which you operate?”, the number of answers correspond to the number of roles that have responded.
Another aspect emerged through this question, is that the answers mentioned as “objectives” of the Service by the roles correspond to strategies or performance: ie the roles didn’t responded to "what the organization pursues" (ie goal), but to “how it pursues” (ie strategies or performance).
This is linked to the fact that the definitions of objective, strategy and performance used by roles were not grounded on scientific criteria, but each role was using definitions of objective, strategy and performance based on personal criteria.
The outcome is a results orientation of roles and their position on "what there is to do" rather than on ensuring supplies of high quality service over time.
A team work have defined the objective sharing it with all roles of the Service, and in a manner that it should meet some criteria: abstraction (the objectives in its definition doesn’t correspond to the result) and measurability. Offered the scientific criteria for the three definitions (objectives, strategies, performances), the roles considered that the objectives were not indicated among the answers to the question.
The service operators have so worked through teamwork reviewing the organizational structure: they re-defined the service objectives, strategies and performance.
The general objective has been defined by roles as: “The health’s promotion and protection of persons with disabilities (as citizens with equal opportunities)”.
It was made declared by the group of participants a theoretical definition of “health”, so that the construct was not “interpreted” but was shared by all operators.
For HEALTH the group has understood:
To be able to develop one’s own potential
To maintain and strengthen their skills and autonomy
To use and maintain opportunities for one’s own care, in a psycho - physical and rehabilitative sense
To be able to be helped to activate family resources and support
To enjoy living environment that facilitate relations
To take advantage of appropriate and sufficient economic conditions
To enjoy equal opportunities to both physical and socio-cultural environments
On the basis of the concepts and constructs defined, the roles have thus achieved the Client Services Chart. Moreover, having identified the objectives it was possible to decline the appropriate strategies and performance of the Service and to identify relevant instruments for assessing the effectiveness, for evaluating the process and service’s quality.
Without a scientifically based definition of the concepts and constructs, the creation of measuring instruments would not have been possible as there wasn’t a definition of the investigation object.
The three types of evaluation are reported to different objects that are:
general objective, so the effectiveness evaluation method estimates the general objective degree of achievement;
strategies for the evaluation of implemented process: the reference are the modalities chosen for pursuing the objective (we are in the field of efficiency : “how”);
services for assessing the quality: the performance of the services-supply requirements.
CONCLUSIONS
The Client Services Chart has allowed an organizational change:
The roles have targets scientifically based and shared practices;
The Client Services Chart has become a tool that, since its construction, has acted on the management processes of Service;
It is a starting point for the Services, since this tool can become part of a continuous process of quality improving of services;
For citizens, the Client Services Chart becomes a useful tool for consultation about the provision of services in the territory, the standards of quality guaranteed, the assessment of the service itself. It becomes an instrument which, through its continuous updating, makes explicit the “link” between the organization (service) and the community where it is and is integrated.
Contact: labsalute.psicologia@unipd.it
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