Access: Can people actually use your service?

Once people have made the choice to get in touch, how easy is it to actually use your service and get the help they need?

This stage is all about making sure your door is open and things go smoothly.

So can people actually use your service?

The key questions I like to ask at this stage are:

• How will each of my customer groups prefer to contact me?

• What factors will affect how easy they find it?

• Can we make it any easier to access our support?

a) How will each of my customer groups prefer to contact me?

In the Margareting Model so far, we’ve looked at how people know that they need support, how they look for potential options, how they choose which one to go for, and now we need to make sure when they choose you that they can actually access your service.

The first step is always the hardest, isn’t it? It’s easy to feel a bit nervous about getting in touch, and I know I’m not the only one that’s put off filling in a referral form or had to steel myself to make a phone call. I know because I’ve been the one holding a friend’s hand at the drop-in because they didn't want to go alone, and the one pestering family to get their appointment booked. I’ve also been the member of staff looking at Google Analytics wondering why 600 people looked at the referral form page of our website this month, but we only had 400 referrals.

A long, detailed online referral form made that difficult first step even harder

We figured out that most people didn’t manage to fill in the referral form on their first try - because it’s nerve-wracking, because life is busy and you can get interrupted in the middle, because the form was too long or asked uncomfortable questions, there could be lots of reasons. So it’s worth making it as quick and easy as possible for people to take that first step, because not everyone will try again.

Talk to people about their preferences and find out what quick and easy means for them. For us, we found people liked to be able to get in touch online, but 1 in 10 said they felt less positive about the service after completing their referral - the experience of that initial contact actually put them off (it was no wonder so many people didn’t make it all the way to the end).

When we looked at our referral form we realised we didn’t actually need to ask all those questions in the first interaction people had with us. We cut the form in half so it was lighter for people, and asked the rest of the questions at a later stage. We saw a 6% increase in referrals straight away.

b) What factors will affect how easy they find it?

Are there ‘hard to reach’ communities, or just hard to reach services?

There are two parts to this:

1. Accessibility and inclusion: Make sure your door is open and welcoming to people across all the protected characteristics in the Equality Act (2010). I come across so many organisations looking for marketing tips on how to reach a more diverse audience, and I always say the place to start is checking they can reach you.

We’ll be sharing more tips on this, but in the meantime here are a few simple ways to start looking at accessibility and inclusion:

• Is there an open door? Do people have a choice of ways to make that initial contact with you? Can people communicate with you verbally, in writing, and face to face?

• Are you inviting people in? Do you proactively ask if people need reasonable adjustments when they get in touch? And then make those adjustments without affecting the speed or quality of the service they receive?

• Do people feel welcome? Does your organisation provide training and guidance for staff on accessibility and inclusion? Are they confident working with diverse communities and adapting the way they work for people’s different needs?

Each of these factors can affect whether someone sticks with your service after choosing you - Would you keep trying to access a service if you found it was difficult or impossible to get in touch in the first place, it was difficult or impossible to actually use the service, or if you didn’t feel safe and respected there?

2. Individual needs and preferences: A few other things worth considering are:

• Digital exclusion: There’s a common myth that this only affects older people, but before I explain why that isn’t true we need to look at that word “only” and make sure we’re seriously questioning anyone who says this as if that makes it OK to only have digital options. Get those people to have a word with themselves.

  The reason it’s not true is that actually the use of technology is linked with health and wealth - so regardless of age, if you’re well and you’ve got money you’ll be online as much as anyone. The association comes along because we’re all more likely to develop health problems as we get older, and most of us will have a lower income in retirement. But regardless of age, if you’re on a low income or you’re living with a long-term health condition, you’re less likely to have access to technology and will need offline options from community services.

• Literacy skills: About 1 in 7 adults in England only have primary school level literacy skills. When we’re writing information about the service and how to access it, it’s important to at least write in Plain English. It can help to test your leaflets and letters out with people to make sure they're understandable, but giving the option to speak to a human being is always better.

• Privacy: If yours is the kind of service that people often don’t want others to know they’re using, like mental health, debt advice or domestic violence you’re probably already all over this. And we're all well trained on keeping people's personal and sensitive information confidential, working in community services (unless it's part of the time-honoured tradition of making people declare their full name, date of birth and what ails ‘em to a whole waiting room, I'll never know how so many services get away with that one!). One thing we can sometimes overlook though, is whether people can come and go with a sense of discretion. We want people to know where we are, but that banner outside the building can sometimes mean service users feel like everyone else knows where they are too.

Can we make it any easier to access our support?

Making it easier for people to use our service tends to make it easier for us to provide the service too. After all, if people aren’t having to contact us time and again to chase things up, sort out problems or make complaints, our staff won’t need to spend time responding to those enquiries and can help more people.

In Systems Thinking they call this “Failure Demand” - the extra work that comes from people having to ask you again.

As an example, Healthwatch’s research into ‘hidden waits’ recently found that about 1 in 5 people they spoke to had 4 or more GP appointments before they got the referral they needed.

If that’s the case, it means 75% of the ‘demand’ from those patients was failure demand.

Or in other words, those practices could increase this portion of their capacity for appointments fourfold by addressing whatever issues are keeping them from making those referrals at the first appointment. That’s pretty powerful.

Now, if you're not familiar with Systems Thinking, it's definitely worth speaking to an expert for training or guidance. But as the Margareting Academy is here for those of us without that kind of budget, here are a few beginner-level tips for starting to explore user experience and failure demand in a DIY sort of a way:

Working together on this can also help get teams out of their silos and give everyone’s a more holistic view of how the service works

• Map your service user journeys: Getting a clear picture of the steps people go through as they use your service and what that experience is like can shed a lot of light on sticking points or frustrations that could lead to failure demand. The easiest way to do this, in my experience, is to use the service yourself (or find someone who won’t mind being your ‘mystery shopper’) and draw a little flowchart of the steps you took.
  Then, share that with your colleagues as the starting point to add in more detail, like if there are different routes people take through the service, or different service options to choose from, etc. (You can skip the first step and draw it together to begin with of course, I just find it's hard to collaborate around a blank piece of paper)

• Dig into the data: Once you’ve got your flowchart, see how you can add in some useful insights from the data you have. For example, can you put numbers against each step of the flowchart of how many people you see per month? That can show you where people drop out along the way, or where you might have bottlenecks causing delays. Or do you have any feedback you’ve received at each stage to show you which parts of the service work well and which could work better? (Or observations from your staff and volunteers about what they notice about people's reactions or questions at each stage?)

• Declutter your processes: When you’ve spotted the parts of your service that need attention, get together with the staff and volunteers in that part of the service to understand how things work. What steps do they take to provide that part of the service? What gets in their way, and how can you help things flow better? It's important to focus on the processes and not individual performance or behaviour here - most people want to do a good job, and this step only works when you approach it as an opportunity to help them do that.

It doesn’t need to be intimidating to bring service users into your project team. Just put the kettle on.

• Work with your service users. When you can point to the problem areas and describe the limitations and considerations for a potential solution, share that with people using the service and work together to find the best solution.

  One of the most common barriers to co-production seems to be a fear of people asking for things the organisation can't deliver. But it's only familiarity with the service that tells staff what's possible and what isn't, so these steps make that information shareable to bring everyone onto the same page.

  But if that's not an option, another way to make sure your decisions are guided by the people they'll affect is to test out a few options. Look for small (quick and cheap) ways to let people try out a potential change and see if it works before you finalise it.