Process analysis and requirement specification of Software as Service for Wmo provision applications at Dutch municipalities

(1)

Process analysis and requirement specification of

Software as Service for Wmo provision

applications at Dutch municipalities

Master thesis Business Administration: Business & ICT

Research Paper

Tjitte D. Bouma

(2)

2

Abstract

The goal of this thesis is configure software requirements for process support with Software as Service (SAS). The process used for this research is the application process for provisions supplied by Dutch municipalities under the Law for social support (In Dutch the Wet maatschappelijke Ondersteuning (Wmo)). The purpose of the Wmo is to enable Dutch citizens with chronic disabilities to live in their own homes and take part in society for as long as possible. The Wmo is executed by municipalities and the process for the applications is more or less the same at the different municipalities. SAS could support these processes by supporting the process at all the participating municipalities, while giving the freedom to the municipalities of organizing the process as they want to and dealing with the changes to the process over time.

The information resources used in this thesis are interviews with municipality employees and documentation. These interviews were constructed for the purpose of this thesis. With the gathered data the processes at several municipalities have been modelled. These process models were taken together and from this a generic process was constructed.

(3)

3

1 Introduction

1.1 Introduction to the problem

Business processes are a collection of related and structured tasks or activities and are needed by companies to reach their goals. Nowadays, these processes get more and more complex and are in need of support in the form of information systems. To meet this need, a company can either build a new system or buy an existing one. New, custom-made systems will probably be better adjusted to the system than the existing, often generic, ones, but are often very expensive, they will take a lot of time to create and often do not have the desired outcome. Buying an existing system is generally speaking cheaper, but could lead to other problems. For example, the bought system can be difficult to adjust to the process at hand or to connect to other systems within the company, or they can lack desired features.

When using existing systems to support the business process, three possible options can be taken into account. The first is adjusting the process to the system, the second is adjusting the system to the process and the third is adjusting both.

Adjusting the process to the system can have a positive outcome. However, when several competing organizations use the same system, this may also lead to isomorphism. Isomorphism means that the processes at the different organizations are equal (Benders et al, 2005). For example, the risk for isomorphism is high with standardized and generalized systems, while the vendors of these systems may promise that using their systems will save costs and increase profits (Davenport, 1998). These benefits may exist to some extent. However, standardized systems may push a company towards generic processes, even when customized processes may be a source of competitive advantage or when changing the processes would lead to harsh resistance from the employees. Even so, making changes to the system is often costly and could lead to problems with implementing new system updates. In such cases, the vendor may argue that these problems are caused by the customer and are not the vendor‟s fault (Benders et al, 2005).

A middle option could be adjusting both the process and the system. This option could still have negative outcomes, like resistance from employees and system errors as a result of changes to the software. Resistance will probably be lower, since fewer changes are made to the process and activities within the process. Moreover, the chance for system errors is smaller, since fewer changes are made to the system.

(5)

5

The SAS-LEG approach would take away redundancies and inefficiencies in the processes. It will deal with both the business and the software, and support their co-evolution. SAS-LEG is not only concerned with implementing the required functionality, but particularly emphasizes the satisfaction of desired quality attributes. This approach will presumably offer sufficient configuration flexibility, therefore it can be re-used by different organizations (SAS-LEG, 2010).

Software developed within the SAS-LEG project will be located on a vendor‟s server and can be used by Local EGovernments, for example municipalities. The local governments will be able to reconfigure the software, to better suit their processes. Thus the local governments will be enabled to keep differences in their way of working.

This approach does need further research before it can be implemented. To study this, a sample process was needed. The process to be studied should, in theory, be the same at several locations while having local varieties. A test bed with exactly these attributes was found at Dutch municipalities with the Law for social support (In Dutch the Wet maatschappelijke ondersteuning, in short Wmo).

1.1.1 Introduction to the Wet Maatschappelijke Ondersteuning (Wmo)

For Dutch citizens with chronic disabilities, such as chronic physical or mental problems, the law Wmo has been created to meet their needs. The purpose of the Wmo is to enable these people to live in their own homes and take part in society for as long as possible and overcome the obstacles that prevent them from leading a “normal” life. These obstacles can be found in everyday activities like eating, washing, using the toilet, buying groceries and cleaning or moving through the house. Examples of offered help are support in domestic care, transportation (with a wheelchair or taxi), adjusting the residency with a higher toilet or wheelchair-elevator and help with raising the children (MinVWS, Woordenlijst Zorgbegrippen, 2009).

To apply for the help offered by the Wmo, the citizens themselves or a person authorized by the citizen has to complete an application form. This application is sent to the municipality they live in and a consultant at the municipality will judge whether they qualify for help and if so, what help is needed. The indication can be done by the consultants, by the CIZ (Centrum Indicatiestelling Zorg or in English the Centre for Indication of Care) or by another external party specialized in the indication of these disabilities. If help is provided, the payment is performed by the municipality and in some cases partly by the citizen. The amount to be paid by the help receiver, the own contribution, is calculated by the CAK (Centraal Administratie Kantoor or Central Administrative Office). The provided help is performed by several different companies in the form of domestic care, in several intensities, wheelchairs, mobility scooters, large or small house modifications or collective transportation (MinVWS, Woordenlijst Zorgbegrippen, 2009; MinVWS, Wmo, 2008).

(6)

6

central Dutch government and the WVG was performed by local municipalities. What is left of the AWBZ is still handled by the central government, but the Wmo is performed by local municipalities. (MinVWS, Wmo, 2008).

The Dutch government had several reasons for replacing the AWBZ and the other laws with the Wmo. One of the reasons was the ongoing shift of the purpose of the AWBZ law from financing uninsurable costs for chronic illnesses to “custom made health care”. This caused the AWBZ to cover too much and to become increasingly expensive. In the future it would only get more expensive, with one important reason: the rise of the average age of the Dutch society. The AWBZ would eventually become too expensive, too complex and too bureaucratic (Min. VWS, 2004).

The AWBZ was taking away motivation from citizens to take care of themselves and to take their responsibilities with regard to their own actions. With this, and the goal of getting "one counter" at which citizens would be able to take care of all their needs, the Wmo was introduced (MinVWS, 2004). The AWBZ was cut down to only serve its purpose of insuring health risks that cannot be covered by commercial insurance contracts, and the "one counter" for the Wmo was introduced at the local municipalities.

The municipalities that still had the WVG could, more or less, easily introduce the Wmo. The WVG already delivered wheelchairs, transportation and house modifications. The main thing those municipalities had to do was add domestic care. However, the new law had to be embedded in the municipality rules and decision-rules which indicate when a citizen would receive certain care.

Although the Wmo applies to every municipality in the Netherlands and therefore offers the same service throughout the country, some differences arise in the execution of the process. The reason is that every single municipality is free in choosing how to organize their process (MinVWS, Wmo, 2008). These differences will be one of the major problems of this thesis. The way this process is performed at several municipalities will be compared and compiled into a generic process.

1.1.2 Developing Software as Service for Wmo

Developing SAS for processes such as used with the Wmo is the main focus of the SAS-LEG project. The project is initiated to develop a supporting information system for the processes at the different municipalities, as well as the possible changes to these processes over time. The focus is to make the deviations between the processes as standardised as possible. The difficulties arise with problems like the freedom of organizing the processes and the freedom in choosing the software package by the different municipalities. The freedom in organizing the process makes it rather difficult to offer support for the processes in a relatively low-budget fashion.

(7)

7

This research will show the differences between municipalities in the processes and indicate what kind of changes over time could occur. With this information a generic process will be created that will be able to handle the differences and future adaptations.

1.2 Problem statement

In this study the processes for the Wmo applications of several municipalities will be compared and basic requirements will be written for the software for these processes. The main question is:

What are the requirements for process support with Software as Service for the Wmo-applications at Dutch municipalities?

To research this main question it will be divided into several sub research questions, which can be divided as well:

1. How are the processes currently performed at the several municipalities? a. What activities and choices can be distinguished?

b. What data is needed to execute the activities? c. What is the output from the activities?

2. What similarities and differences can be found between the processes of the several municipalities?

a. How can the processes at the several municipalities be generalized? b. What will a generalized model of the process look like?

c. What are the variation points, i.e. differences between municipalities within the process?

3. What changes over time have been issued since the introduction of Wmo and what kind of changes can be expected?

a. What changes have been issued since the introduction of Wmo? b. What changes can be expected in the future?

c. How can the changes be categorized?

d. How can be anticipated upon these changes?

e. What are the change points, i.e. spots in the processes where the possible changes take place?

1.3 Relevance and motivation

The relevance of this study lies in the early stages of the SAS-LEG project. The SAS-LEG project uses the process for the application of the Wmo as a test bed to develop technologies with regard to SAS. In this study different processes of the Wmo applications at several municipalities will be analyzed and basic requirements for the software will be written to support those processes. This will result in a generic process model of the Wmo amongst others.

(8)

8

quality attributes, instead of only implementing the required functionality. The SAS approach will add flexibility to the configuration, so it can be reused at several different organizations, during both design-time and run-time (SAS-LEG, 2010).

1.4 The outline of this research

(9)

9

2 Research Methods

To answer the research questions stated above, structured interviews will be held with representatives of the municipalities to get most of the necessary information about the Wmo process. Documentation received (apart from the interviews) is used to complete information needed. After analyzing the results from the interviews and documentation, the processes will be modelled and analyzed. The analysis will include the differences between the processes at the several municipalities.

2.1 Interviews and documentation

The available process descriptions of the Wmo processes are not specifically for the implementation of the process at the several municipalities, therefore these can only be used as a starting point for this research. Municipalities are free to choose how to organize their processes; moreover documentation at the local municipalities is often incomplete or non-existing. To understand how the processes are actually organized, structured interviews are needed with process experts at the municipalities. That is why interviews were chosen as the main information resource.

At seven municipalities within the province of Groningen interviews have been held with employees. The province of Groningen was chosen because of the expected relative small diversity, in order to facilitate the comparison of the processes. The seven municipalities that were interviewed are Delfzijl, Groningen, Haren, Leek, Marum, Winschoten and Winsum. The employees that were interviewed at the municipalities were either the coordinators of the Wmo department or the consultants, which are the main executers of the studied Wmo process.

The interview has been constructed for this research and can be found in Appendix A: Interview Layout. All the interviews have been performed in Dutch, translation to English is for this paper and future references only.

The interviews were recorded on audio and have been transcribed in Dutch. The Dutch transcription was translated and summarized in English. Documentation received from several municipalities was used to complete the information received through the interviews. The English summaries have been added to this thesis in Appendix B: Interview Results.

2.2 Modelling and analyzing the processes

With the information gathered from the interviews and the documentation, process models were constructed for the seven municipalities. These process models can be found in Appendix B: Interview Results, along with the English summaries of the interviews.

(10)

10

1. The original processes are compared and the activities done by all of the municipalities are taken together to make one new model in which all municipalities are taken into account. Within this step, the official order of documents and activities is taken into account, thus an application form is always followed by a decision and a decision is needed for an objection against the decision.

2. Activities done by only some of the municipalities are modelled as variations. These variations are added to the generic process or in an extended generic process to show the position of the variations in the process.

The models are constructed using Unified Modelling Language 2.0 (UML), since UML is an important current standard for modelling processes (Dennis et al, 2005; Selic, 2006).

To get the models readable within this thesis, a Main Generic Process Model was first constructed, consisting of six Generic Process Components. The Main Generic Process, the Generic Process Components and the variations have been added to chapter 3. In that chapter the variation points are discussed as well.

2.3 Analyzing the possible changes over time

The interviews also covered changes over time. These are changes that have occurred since the introduction of the Wmo in January 2007, as well as changes that are to be expected. The changes over time are analyzed for a better understanding in how far the processes are subject to change and what the consequences of these changes are for the process model and for software. The analysis of the possible changes over time can be found in chapter 4.

2.4 Analyzing secondary information

(11)

11

3 Process analysis

In this chapter the Wmo processes of the several municipalities are analysed. To supply a complete picture on the processes, some background information about the municipalities is given, including some of the similarities and differences between them. In the same section the most obvious differences and similarities between the processes at the several municipalities are explained.

The second section will contain the Generic Process Model and the six Generic Process Components as well as a section on the data resources used in the process. For every Generic Process Component the original processes will first be discussed, secondly the generic process will be explained in a textual process description, and thirdly the process model will be presented. After the process model the existing variations and sub processes will be discussed and explained. The choices made for the generic processes will be explained in the process description and the variations.

In the third section of this chapter the Variations points of the generic process are given and discussed. This chapter will end with a conclusion, where a short answer is given to the research questions applicable to this chapter.

3.1 The municipalities

All seven interviewed municipalities are within the province of Groningen. The city of Groningen is relatively large, compared to the others. Some municipalities are quite small, i.e. below 15 thousand citizens, but most are medium sized, i.e. between 15 and 30 thousand. The major difference is the number of applications received per week. At the municipality of Groningen there are almost 200 applications a week with regard to the Wmo, at Marum only 4 or 5. This difference is translated into the level of professionalism. At Groningen the process was clearly designed and all decisions and payments are thoroughly checked. At smaller municipalities there is a pattern in the process, and the process is the same for almost every application, but it depends on the consultant how the process is exactly executed. Statistics and the number of applications can be found in Table 1 below.

Table 1: Municipality statistics (Source: Centraal Bureau voor Statistiek, except for number of applications). Average income for The Netherlands as a whole in 2005 was €21.000.

Almost all municipalities had the WVG before the Wmo process was constructed and added domestic care to this process. This is the reason why, at some municipalities, the domestic care and the other provisions are still, more or less, separated. But most of the municipalities

(12)

12

are planning or are already working to a process where there is no difference between these provisions.

Every municipality can choose its own software provider, but there are several regions to be pointed out. Most of the municipalities in the east of the province use the same software provider; the same can be said about the municipalities in the middle of the province and in the west of the province. This can be explained by co-operations between municipalities which are close to each other.

3.2 Generic Process Model

After all the data from the seven municipalities was gathered, process models were constructed for each municipality. These process models can be found in Appendix B. Although there are several differences, a Generic Process Model can be made. In this section this generic process model is shown and explained. This section will end with information on the data resources used in this process.

The Generic Process Model (GPM) is the same for all the participating municipalities, but for the Generic Process Components (GPC) choices and generalizations had to be made. After discussing each component in detail, the choices will be explained and the variations will be shown.

The steps that were used in the GPC were the steps that were most common between the municipalities, although some steps were relocated for some municipalities. Some municipalities already performed research before the application was turned in by the citizen, where others wait for the application to be entered into the system. Another example is the role of tender: some municipalities wait for the tender or procurement procedure for large house modifications to be completed and afterwards complete the decision (beschikking), where others first complete the decision and afterwards hold the tender procedure. For both examples a choice has to be made for the generic process.

3.2.1 Top-Level Generic Process Model

To give the reader an idea about how the process, in short, is structured, a simplified process description is given here. The model of the Generic Process Model is given in Figure 1. A variation to the GPM can be found after the process description and model, this is the process for urgent cases.

3.2.1.1 Process description

All the Wmo processes follow the same steps. First, the citizen, or a representative, contacts the municipality. The municipality employee will ask a few questions about the situation of the citizen, to get an idea whether an application is necessary and probable to succeed, or the employee will immediately give or sent the application form to the citizen.

(13)

13

After the decision has been sent to the citizen, he or she can object to the decision. If a citizen does not object, (s)he may either choose for a Personal Budget (Persoonsgebonden Budget (PGB)) or Care in Kind (Zorg in Natura). This choice is often already made in the application form and determines for a part how the information in the decision is presented.

If a citizen does object, this objection can either be successful or unsuccessful. If the objection is unsuccessful and the decision was negative, the process ends. If the objection is unsuccessful and the decision was positive, the process continues with the personal budget or care in kind. If the objection is successful, the process continues at the Research and Decision phase.

When a Personal Budget is chosen, the citizen receives a certain amount of money for the provisions assigned. The payment is often done in instalments, this way the sum paid at once is lower, preventing fraud. The correct expenditure of the money is checked afterwards. When Care in Kind is chosen, the contracted suppliers are contacted to eventually supply the citizen with the assigned provisions. The process ends with the payment of the invoices received from the suppliers. The contracts with the suppliers and the decisions don‟t end with the end of the process; the end of the contracts and decisions is stated in those documents.

The Generic Process Model or the top level of the Wmo process can be seen in Figure 1. The process is divided into several components. These are the Question phase, the Research and Decision phase, the Objection phase, the Personal Budget phase (PGB phase), the Provisions phase, and the Payment phase. These components were carefully distilled from the processes of the municipalities, which can be found in Appendix B. The GPM has been separated because of reasons concerning readability and because it can be explained more thoroughly this way. Provisions [Personal Budget] Payment Objection [Objection] [Provisions] Question Research and Decision [Provisions] Personal Budget [Personal Budget] [No application]

[Application] [Unsuccessful objection

& negative decision]

[Successful objection]

Figure 1: Top-Level Generic Process Model

3.2.1.2 Variation

The process in case of urgency

(14)

14

situation escalates rapidly. Urgent cases are usually applications for wheelchairs and other small provisions. Large house modifications won‟t be done in such a fashion, because these cannot be delivered within a few days or weeks.

If a case is considered an urgent case, the question phase is gone through fast, possibly within a day or a few days, and is followed by a supply order to the supplier for an urgent delivery. After the supply order has been issued, the research process and decision process are performed. These two process parts do not differ much from the normal process, and is discussed in detail in 3.2.3 with the Research and Decision phase. The decision is followed by the possible objection (bezwaar), which can always follow a decision. The objection part of the process also does not differ much from the normal circumstances; this part is further discussed in section 3.2.4. The outcome of the objection process does differ from normal cases: if there is a negative decision and an unsuccessful objection, the supply order is cancelled or, if the delivery is already done, the supplier is ordered to retrieve the provision. The PGB phase is only different because the delivery is already done and the provision phase is skipped for that same reason. The process in case of urgency ends with the payment phase. The PGB is discussed in section 3.2.5, the Provision phase in 3.2.6 and the Payment phase in 3.2.7. The process for urgent cases is shown in Figure 2 below.

Case is a case of urgency

Fill out application form

Issue supply order [Actions required]

[No actions required]

Decision process Research process Objection process [Objection] Payment process [No objection] [Successful objection] [Positive decision] [Negative decision] [Unsuccessful objection] Enter application into system Cancel supply order or order supplier to retrieve provision [Dossier study] Order medical advice Execute home visit Perform dossier study [Medical advice] [Home visit]

Figure 2: Process variation: the process in case of urgency

3.2.2 Question phase

The first phase is the “Question phase”, in which the citizen comes to the municipality with a question. Here a first answer and the application form is given and received back with information. This section will be started with looking at how the municipalities organized this part of the process. After discussing these, the Generic Process Component will be discussed and shown. This section will end with information on the variations and sub processes within this process component.

3.2.2.1 The original processes

(15)

15

Application form variation

At the municipalities of Winsum, Marum, Winschoten and Leek the Question phase is fairly short. They only take on the call, check whether the call is for a Wmo provision, give or sent the application form and receive and insert the application form into the system. Two examples of this variation can be seen in Figure 3 and 4 below. The most basic is seen is Figure 3, which is the Question phase at the municipality at Winsum.

Citizen asks question about Wmo provision

Give or sent application form

Receive and insert application form

into the system

To Research and Decision phase

Figure 3: Question phase at the municipality of Winsum

At the municipality of Marum a check was inserted to lower the load of work from citizens that clearly do not qualify for a provision, although the citizens do have the option to apply anyway. This can be seen in Figure 4.

Citizen asks a question about Wmo provision (telephone or at desk at municipality) Give or sent application form

into the system [Qualifies for provision] [Does not qualify for provision] Give information

and advice [Does not apply] [Does apply] To Research and Decision phase

Figure 4: Question phase at the municipality of Marum

Telephone variation

The second variation can be called the “Telephone variation”. At the municipality of Groningen the entire question clarification is done through the telephone at the moment the citizen calls the municipality. The possibility does exist to visit the municipality‟s office, but about 97% of the citizens prefer to call.

(16)

16

[Does not qualify for DUVA] [No Wmo question/

Question for advice] Intake and

question clarification (by

telephone)

into the system Sent application form [Qualifies for DUVA] Order delivery of provision (Delivery by external party) Give information and advice [No application form received] [Qualifies for DUVA] Check supplied data [Does not qualify for DUVA] To Research and Decision phase [Wmo question] [Application form received]

Figure 5: Question phase at the municipality of Groningen

Research variation

At the municipality of Delfzijl and Haren research is done prior to the sending of the application form. In Figure 6 the question phase of Delfzijl is shown, as it was executed at the time of the interview. In Figure 7 the planned changes at the Delfzijl municipality are inserted into the process model.

The model shown in Figure 6 shows the question clarification at the start of the process; the citizens are invited to the Front Office for an intake. But when the application is difficult, the intake is put through to SCIO Consult, their medical examiner, before the application form is handed over.

Intake (incl. question clarification) (At Wmo portal (Front

office)) [Domestic care] [Other provisions] Give application form for other

provisions Give application form for domestic

care Insert (incl. scan) application form

into the system

Give advice and information Medical advice received (from SCIO Consult) [No medical advice] [Medical

advice] To Research and Decision phase [No Wmo

question]

[Wmo question]

Figure 6: Current question phase at the municipality of Delfzijl

(17)

17

Intake (At Wmo portal (Front

office))

Give / sent application form

Insert (incl. scan) application form

into the system Give advice and

information Medical advice received (from SCIO Consult) [No medical advice] [Medical advice] To Research and Decision phase [Situation is known] [Situation is not known] Plan home visit

Execute home visit (including question clarification) [No Wmo question] [Wmo question]

Figure 7: Question phase at Delfzijl municipality after the planned changes

3.2.2.2 The generic process

When taking the original question phase processes together, a generic process can be constructed. In the Generic Process Component all the variations have been excluded, as is shown in Figure 8. The process with the variations is shown in Figure 9 on the next page. The process description below is of the Generic Process Component 1, the Question phase.

Citizen/ Social Worker/ Neighbour/Family member contacts municipality with question Give information and advice Give/sent application form to citizen To Research and Decision phase Insert application

form into the system [No Wmo question] [Wmo question] [No application form received] [Application form received]

Figure 8: Generic Process Component 1 - Question phase

The GPC starts with the citizen, or a representative of the citizen, contacting the municipality with a question. The representative can be a legal guardian, a social worker already supplying the citizen with provisions, or a worried neighbour, family-member or friend. The question can be for two things; provisions or information. When information is wanted, the contacted employee will give this information or will put this person through.

When provisions are asked, the citizen that wants to apply for a provision will receive an application form. On this application form, personal information will be entered as well as information about the handicap and social environment. There is also a consent form for the retrieval of medical information from the general practitioner. Both the form and the consent have to be signed by the citizen.

When the application form is received at the municipality, it will be inserted into the information system. After this the process continues with the next process component, the Research and Decision phase, which can be found in section 3.2.3.

(18)

18

One design decision has been made in the Question clarification variation of the Extended GPC. The box containing four other boxes with ways of performing the question clarification was modelled this way to facilitate the possibility of performing all the question clarifications in a parallel and/or sequential order. This way of modelling gives a better overview of the possible question clarifications. If at other municipalities other ways of question clarifications are used, or when new ways of question clarifications are introduced at the participating municipalities, these activities can easily be added to the process model. Using forks was another option, but forks would make it harder for new ways of question clarifications to be added and does not accurately support the random order in which the question clarifications can occur. Citizen/Social Worker/ Neighbour/Family member contacts municipality with question Give information and advice Give information

and advice [Citizen does not apply] Give/sent application form to citizen [No primary judgment] [Citizen does apply] To Research and Decision phase Insert application

form into the system [Clearly negative primary judgment] [Positive primary judgment] Execute quick procedure [Quick procedure] [Question clarification] [No quick procedure] [No question clarification] [Primary judgment applicable] [Qualifies] To Research and Decision phase [Does not qualify] [No Wmo question] [Wmo question] [No application form received] [Application form received] Determine question clarification requirements [Research insufficient] [Research sufficient] [No urgency] [Case is a case of urgency]

Begin process for urgent cases Question clarification by medical advice Question clarification by home visit Question clarification by phone Question clarification with meeting

Figure 9: Extended Generic Process Component 1 - Question phase

3.2.2.3 Variations and sub processes

Urgency process

(19)

19

can be seen as question clarifications, these question clarifications are explained later in this section. The question clarifications taken for urgent cases are at Marum a quickly planned and executed home visit, at Delfzijl a fast medical view on the case from SCIO Consult, and at Winschoten a dossier research. Other municipalities didn‟t mention question clarifications for urgent cases. After the quick research has been done, an application form is completed and signed by the citizen, and the application form is entered into the system. An important difference to the normal process is that a supply order is issued right after the application form is received. The process continues at the Research and Decision phase after this sub process. The Question phase sub process for urgent cases is shown in Figure 10.

Case is a case of urgency

Fill out application form

Issue supply order

[Actions required]

[No actions required]

Enter application into system [Dossier study] Order medical advice Execute home visit Perform dossier study [Medical advice] [Home visit] To Research and Decision phase

Figure 10: Question phase sub process: Urgency process

Quick procedure

If the citizen gives some pre-specified answers to certain questions of the employee of the municipality, the citizen qualifies for a quick procedure. The submitted data is checked and confirmed, the delivery is ordered from the contracted external party. After this the process continues at the writing of the decision in the Research and Decision phase. When the citizen does not qualify for a quick procedure, the process continues in the Question phase at the question clarifications. The quick procedure can be seen in Figure 11 below.

[Qualifies] Check supplied data To Research and Decision phase (qualifies) Back to Question phase [Does not qualify] Back to Question phase [Does not qualify] [Qualifies] Order delivery of provision (Delivery by external party)

Figure 11: Question phase sub process: Quick procedure

Question clarifications

(20)

20

of the model and clarify the possibility of simultaneous actions. All of the question clarifications are usually done no more than once at this stage in the process and usually only a few of the choices are executed per case.

[Medical advice]

Order medical advice (from external party)

Plan home visit

Call citizen (if needed) [Home visit] [Phone conversation] Execute home visit (including question clarification)

Plan meeting (if needed) [Meeting with citizen] Hold meeting at municipality Receive medical advice (from external party) Hold question clarification by phone [Finished] [Not finished] Back to Question phase

Figure 12: Question phase sub process: Question clarification

Some municipalities have standard rules for performing a home visit or ordering medical advice. When a situation is not known, for example because a citizen is new in the municipality, the municipality of Leek always performs a home visit. This is because they want to know the situation the citizen is in and want to make sure they do everything possible to help the citizen; maybe the citizen qualifies for more provisions than originally asked for. At Delfzijl municipality medical advice is ordered when the case is complex. At Groningen municipality they try to do as much question clarification as possible by using only the phone.

Primary judgment

After the question clarification the process executer, i.e. employee, can decide whether or not a primary judgment is applicable. When it is applicable and can be given, the next question is whether the primary judgment is clearly negative. When this is the case, a positive decision for the application is highly improbable and information and advice is given to the citizen. The citizen can still choose to apply, because this is a legal right. This choice can be for several reasons of which one is the possibility to object to the decision. When a primary judgment is positive, the process continues to the next step.

Other variations

Calling the municipality is, for all the participating municipalities, not the only option to contact the municipality. The other options are visiting the front office or desk at the municipality office or e-mailing.

The first phone call or meeting with the citizen ends with the application form sent or given to the citizen or can have an end of the process. The employee taking the first call is not the same at every municipality. For example, at Haren municipality this is a complete separate Front Office; at other municipalities they use one or more consultants.

(21)

21

exactly where to direct the citizen to if the question is not for a Wmo provision, or will be able to call back with information, if the information is not at hand. This is derived from the One-Desk approach, which implies that the citizen can go to any desk with their problems where they may be redirected if necessary. At other municipalities the level of knowledge is less of an issue, because the municipalities are smaller they cannot reach that level of professionalism within the budget, although this is not the only reason.

Delfzijl has separate application forms for domestic care and for other provisions. They do have a main application form, with the personal information in it. The question phase of Delfzijl can be seen in Figure 6. Because they are about to change this, as can be seen in Figure 7, this was not modelled into the GPC.

The employee entering the application into the system can be a consultant or an administrative employee. At some municipalities the application form is not only entered into the system, but also scanned and added to the case in the information system.

3.2.3 Research and Decision phase

The second Generic Process Component is the “Research and Decision phase”. In the Research and Decision phase, the consultant will try to get a clear picture of the situation of the citizen and the handicap limiting their daily and social activities. At the end of the Research and Decision phase a decision (beschikking) is made, checked, signed and sent to the citizen. The generic Research and Decision phase is shown in Figure 18.

First the original processes of the municipalities will be shown and explained and then the constructed GPC is discussed. This section will end with the variations in this component of the process.

A few variations of the research part of this component can be distinguished; the home visit variation, the provision-divided variation and the simple research variation. After these three variations have been discussed, the decision part of the phase is explained and shown.

Home visit variation

The research part of the Research and Decision phase of the municipalities of Marum, Haren and Delfzijl are fairly simple. The most important distinction is the fact that they execute a home visit for every citizen filing an application, they want to get to know the citizens they help with provisions. Only when the situation is already known, this step is skipped. For example, if a home visit has recently been done. This variation is shown in Figure 13.

[Situation is known] [Situation is not known] Execute home visit

Sent to the CIZ [Case is

complex]

Make report and indication [Case is not

complex]

To Decision

(22)

22

The provision-divided variation

For Leek the documentation received gave a more complete picture, so a more detailed process could be modelled. The research part of the phase starts at Leek with the standard home visit when the situation is unknown and medical advice is standard when there is any doubt about the handicap. After that the process depends on the provision applied for. Applications for domestic care are sent to the CIZ, for large house modification external advice is ordered and the tender procedure is started, and for wheelchairs and transportation further research is done. The process joins again at the activity “Write report and indication”. The research part of Leek is shown in Figure 14.

Sent email with primary judgment

to CIZ

Indication by CIZ

Write report and indication Give information and advice [Domestic care] [Wheelchairs/ Transportation] Check submitted data [Home visit] Execute intake by telephone [Intake by telephone]

[Medical advice] Medical advice (by GGD Groningen)

[Wheelchair] [Qualifies for wheelchair] Order wheelchair [Transportation] [Large home modification] Order external building advice Tender procedure by citizen [Citizen is house owner] Tender procedure (by municipality in co-operation with the owner) [Citizen is not house owner] [Small home modification] Write advice Execute home visit [Situation is known]

[No doubt about handicap] Medical advice (by

GGD Groningen) [Doubt about handicap] [Situation is not known] Execute house visit (if wheelchair,

take measures)

[Does not qualify for wheelchair]

To Decision

Figure 14: Research part of the Research and Decision phase of Leek municipality

Simple research variation

For Groningen and Winsum the research part of the Research and Decision phase are modelled in a different way. After the cases are allocated to the consultants, the consultant decides whether research is needed, and if so, which research is needed. For Groningen they can choose for a home visit, a multidisciplinary meeting or a study of the dossier of the citizen. The interviewed employee of Groningen told that consultants can call citizens at any time in the process when the consultants have questions. At Winsum municipality the choices are a medical advice, a home visit and a dossier study. The research part of the phase of Groningen municipality is shown in Figure 15.

Job allocation (by Mid Office) Report and indication (by consultant) [Dossier research] [Medical examination] [Home visit] Execute home visit Perform dossier research Hold multidisciplinary meeting [Further research needed] A To Decision [No further research needed] A

(23)

23

The decision part of the phase

The process leading up to the decision is quite similar for all municipalities. After the report is written and an indication is made, the decision is written, checked, approved, signed and sent to the citizen. At Groningen the decision is written by a back office and is checked by

multiple people, including the consultant that wrote the report. In Figure 16 and 17 the decision parts of respectively Leek and Groningen are shown.

Write decision

Check report and decision (by

colleague)

Sign decision (by coordinator) [Decision

approved] [Decision not approved]

Sent decision (and other documents)

to citizen and complete dossier

Figure 16: Decision part of the Research and Decision phase of Leek municipality

Write decision (by Back Office)

Sign decision (by other colleague) Check decision

[Decision approved] [Decision not approved]

Figure 17: Decision part of the Research and Decision phase of Groningen municipality

3.2.3.2 The generic process

From the Question phase the cases enter the Research and Decision phase. The first thing to be done next is the job allocation; the case has to be assigned to one of the consultants at the municipality.

This consultant will look at the application and decide whether further actions are needed. When the citizen is already known or the case is fairly simple, this may not be necessary. If further actions are needed, the consultant has to decide which actions. There are eleven options, these can all be seen in Figure 18 and these are explained further in section 3.2.3.3. All the data collected from the actions are put together in a report and the conclusion of this report is the indication whether a provision is needed and which provisions may help the citizen.

With regard to the report a decision (beschikking) is written, this can be done by the consultant or a separate administrative employee. When the decision is written by the administrative employee, the decision is first checked by the consultant and afterwards checked by one or more other employees. When the decision is written by the consultant, it is only checked by one or more other employees. Other employees can be another consultant, a juridical specialist or a supervisor. If the decision is not approved, it has to be rewritten and afterwards checked again. If the decision is approved, it is signed by the employee responsible for the Wmo budget, usually the head of the Wmo department. A (copy of the) signed decision is then sent to the citizen.

(24)

24

and the citizen received a negative decision, the process ends or, for urgent cases, the previously issued supply order is cancelled or the supplier is order to retrieve the provision(s). If objection was not chosen and the citizen received a positive decision, the process proceeds to the second choice.

The second choice has, for most municipalities, already been made in the application form. This is the choice for a personal budget (PGB) or care in kind. If a PGB is chosen, the process continues with the Personal Budget phase, found in section 3.2.5. If care in kind is chosen, the process continues at the Provision phase, in section 3.2.6. The third option at the second choice is for urgent cases, these go directly to the Payment phase, since the delivery has already been done.

The box with possible actions is subject to the same design decision as the Question phase for question clarifications. The reasoning for this decision can be found in section 3.2.2.2.

Job allocation/ Assign case to consultant

Write report and indication (by

consultant)

Write decision

Check decision

Sign and sent decision to citizen [Decision approved] [Decision not approved] [Positive decision]

[No objection] To Objection phase To Personal budget phase To Provisions phase From Question phase (Normal cases) [Action needed] From Objection phase

[No action needed]

[Research sufficient]

[Objection]

[Care in kind] [Personal budget] Determine research requirements [Research insufficient] Home visit External medical advice Execute dossier study Conversation with citizen by telephone Conversation with citizen with meeting Multidisciplinary meeting External building advice Start tenderprocedure

Write advice (for small house modifications) Sent case to other

indication office Order wheelchair [Negative decision] From Question phase (Urgency cases) [Urgency case] To Payment phase Cancel supply order / order supplier to retrieve provision

[No urgency case] [Urgency case]

Figure 18: Generic Process Component 2 - Research and Decision phase

3.2.3.3 Variations and sub processes

In Figure 18 several actions can be seen. Some of these actions are research towards clarifying the situation of the citizens; others are for how to implement the provision. These actions can be done in any order and have separate conditions at the several municipalities. Next the processes of these actions are shown and explained in more detail. A model is shown that may be used when there is more than one activity to be distinguished.

Dossier study

(25)

25

Home visit

In Figure 19 the home visits are split in the activities “Plan home visit” and “Execute home visit”, because there is a distinct time and place difference between these two activities. At some municipalities the home visit is a standard procedure, which may only be skipped when a home visit has recently been made.

Plan home visit Execute home visit

Figure 19: Research and Decision phase sub process: Home visit

Conversation

When a consultant needs more information from the citizen, the consultant can call or meet with the citizen. Both of these actions can be separated into two steps. In Figure 20 the telephone conversation is split into “Call citizen” and “Hold conversation with citizen”. And in Figure 21 the meeting with the citizen at the municipality office is split like the home visit, in the planning of the meeting and the meeting itself.

Call citizen Hold conversation with citizen

Figure 20: Research and Decision phase sub process: Telephone conversation

Plan meeting with citizen

Hold meeting with citizen

Figure 21: Research and Decision phase sub process: Meeting with citizen at the municipality

Write advice

At Leek the consultant writes advice for small house modifications. This advice contains measurements from the location where the modification will be placed, taken by the consultant. These measurements are usually taken during a home visit.

Multidisciplinary meeting

At Groningen municipality a multidisciplinary meeting is one of the options for further research. A multidisciplinary meeting is a meeting between the consultant and several experts. The participating parties are the consultant, specialists, a legal counsellor, a doctor and a house modification specialist. Not all parties are always present, depending on the provisions applied for. Figure 22 shows that this meeting first needs to be planned before it is held.

Plan multidisciplinary meeting Hold multidisciplinary meeting

Figure 22: Research and Decision phase sub process: Multidisciplinary meeting

External advice

(26)

26

interviews, being SCIO Consult (http://www.scioconsult.nl/) and GGD Groningen (http://ggd.groningen.nl/), but other parties can exist as well. For building advice SCIO Consult has been mentioned as well, although other departments at the same municipality can also be the „external‟ party. In Figure 23 and Figure 24 can be seen that the external advice processes are separated in the steps “Order external advice” and “Receive advice”. The period of time between these steps can vary from a few days to several months.

Some of the municipalities have a standard procedure when they suspect the case is going to lead up to an objection. If so, they order a medical examination, to have a strong case for the objection committee.

Order external medical advice

Receive medical advice

Figure 23: Research and Decision phase sub process: External medical advice

Order external building advice

Receive building advice

Figure 24: Research and Decision phase sub process: External building advice

Tender procedure

One municipality differentiated between house owners and rental housing. Several municipalities named the incapability of the citizen as a reason to perform the tender procedure themselves. All the checks were inserted into the model in Figure 25 to give a complete overview of the possible choices that can be made. This process ends when a tender offer is approved or if the tender offers do not yet need approval, this can also be done later in the process in the Provision phase. The signing of the contract is also done in the Provision phase. [Citizen is house owner] Tender procedure by municipality in co-operation with the owner [Citizen is not house owner] [Tender not approved] Tender procedure by citizen [Citizen is not capable] [Citizen is capable] Tender procedure by municipality [Tender approved] [Approval not applicable]

Figure 25: Research and Decision phase sub process: Tender procedure

Other indication office

(27)

27

and the indication. External indication offices named in the interviews were the CIZ or a local separate indication department.

Check submitted data and write primary judgment

Sent case to other indication office

Receive indication advice

Figure 26: Research and Decision phase sub process: Other indication office

Order wheelchair

When a wheelchair is likely to be provided, the measurements may already be taken in this part of the process and the wheelchair may be ordered at the supplier. The ordering of the wheelchair in this part of the process is important for the speed in the process: quickly after the decision has been issued, the wheelchair can be delivered. In Figure 27 the process for ordering a wheelchair can be seen.

Take wheelchair

measurements Order wheelchair

Figure 27: Research and Decision phase sub process: Order wheelchair

Other variations

The Research and the Decision part of this phase could have been separated, but they were put together because the decision is a direct result of the report and indication.

Marum and Leek are neighbouring municipalities and work together on particular fields. These are the only two municipalities maintaining good relations with the CIZ. One reason for this good relation is that some of the consultants used to work there.

At Delfzijl the tender procedure for large house modifications is done prior to the writing of the decision. This is done to make the decisions complete with all the correct numbers.

3.2.4 Objection phase

The third component is usually in case of a less positive decision than was hoped for or a negative decision and is called the “Objection phase” (Bezwaarprocedure). If the citizen disagrees with the decision, the citizen can object to this decision. This objection will be dealt with by the Objection Committee (Bezwarencommissie) who will decide whether the decision is correct, whether the decision was made correctly and whether the case was thoroughly studied. Whatever the result of the Objection Committee, both parties are able to file an appeal and go to court. The Objection phase is shown later in this chapter in Figure 28.

(28)

28

upon how to continue and Marum continues at the decision writing with a new decision based on the committees decision.

If the decision is negative or less favourable than expected by the citizen, the citizen can file an objection. The objection committee, a separate committee within the municipality, will judge whether the objection was justified. They can decide whether the research was done properly and whether the conclusion was correct.

If the objection was successful, the municipality can appeal in court, if the objection was unsuccessful, the citizen can appeal in court. When the appeal of the citizen was successful, or the appeal of the municipality unsuccessful, the process continues after the job allocation. If the citizen did not object to a negative decision, the citizen‟s appeal to a negative decision was not successful or the appeal of the municipality was successful, the process ends for normal cases. For urgency cases the supply order is cancelled or the supplier is ordered to retrieve the provisions. If the citizen did not appeal to a positive decision, had an unsuccessful appeal or the appeal of the municipality was successful for a positive decision, the process continues to the next step, which is the urgency case, PGB or care in kind choice.

The urgency case, PGB or care in kind choice is the same as the choice at the end of the Research and Decision phase and has, for most municipalities, already been made in the question phase. If a PGB was chosen, the process continues with the Personal Budget phase, found in section 3.2.5. If care in kind was chosen, the process continues at the Provisions phase, in section 3.2.6. If the case is an urgency case, the provision has already been delivered and is continued at the Payment phase.

From Research and Decision phase [Objection unsuccessfull] [Citizen appeals] [Appeal successful] To Research and Decision phase [Objection successful] To Provision phase [Citizen does not appeal] [Municipality appeals] [Municipality does not appeal] [Appeal unsuccessful] To Personal Budget phase [Care in kind] [Appeal unsuccessful] [Personal budget] [Positive decision] [Negative decision] [Appeal successful] [Positive decision] [Negative decision] [No urgency case] [Urgency case] Cancel supply order / order supplier to retrieve provision [Urgency case] _{To Payment} phase

Figure 28: General Process Component 3 - Objection phase

3.2.4.3 Variations

(29)

29

The numbers we got from some municipalities show that the amount of objections is small on the number of total applications. The number of successful objections is very small.

Groningen prioritizes on speed. Since this limits their research time, the objection committee decides more often than in other municipalities that more research is needed. This research will be conducted by the consultant, before calling the objection justified or not.

3.2.5 Personal Budget phase

The fourth component is the “Personal Budget phase”. At this phase, the citizens who chose a Personal Budget (PGB) receive payment. This component includes the check of the proper spending of the budget afterwards. The Personal Budget phase is drawn in Figure 29.

Only two variations of the personal budget have been found and both can be modelled in the generic process. This part of the process can be outsourced or kept in-house. Marum and Leek have the Personal Budget phase outsourced at a health insurer and Groningen, Delfzijl and Haren perform the PGB component in-house. The processes of these five municipalities have been used in the construction of the generic process for this component. The results from the other two municipalities were insufficient to include in the GPC.

The process starts after the decision has been issued or the objection was finished and if a personal budget (Persoonsgebonden Budget (PGB)) was chosen in the application form. This component is entered from the Research and Decision phase or the Objection phase.

The first choice that has to be made is whether the case is handled in-house or is outsourced to an external party. Every municipality either always performs this phase in-house or always has it outsourced.

If the municipality has decided to outsource this process, the case is handed over to the external party. This external party is the same for all the participating municipalities with this choice, which is the health insurer called Menzis.

When the municipality decided to perform this phase in-house, information and advice is given to the citizen about possible suppliers and about the organization and documentation of the PGB.

After information is given, the payment is executed. A PGB is given for a fixed period of time. If the payment is too high to be paid at once, it is paid in instalments to lower the risk of fraud. The decision includes the time period the PGB is given and the amount to be paid. This amount can be increased or decreased over time as can be specified in the decision.

When the payments have been executed the expenses have to be checked. This can be done periodically or at the end of the PGB period, but in most cases the PGB is checked annually. For this check, the municipality receives the needed information from the citizen. The same check is done by the external party when the payment is outsourced.

(30)

30

From Research and Decision Phase From Objection Phase

[Outsourced] Sent case to external party Give information and advice [In-house] (Periodically) check for correct

use of the Personal Budget

Payment

Figure 29: General Process Component 4 - Personal Budget phase

3.2.5.3 Variations

It is possible that information and advice is given to the citizen before the case is handed over to the external party, or only information.

The external party supplies the municipality with information about the expenditure of the citizen, also periodically. The municipality pays the external party the amount specified in the decisions; this money is used by the external party to pay the PGB‟s. The payment at the municipalities is done by a financial department or a financial employee, depending on the size of the municipality.

When the external party detects a case of fraud, they discuss this with the municipality first. The outcome of the discussion will determine how to handle the case. As this is mostly cases-dependent, the interviews with the municipalities did not provide information as to how this is handled.

3.2.6 Provisions phase

The fifth component is the “Provisions phase”. The process for the several provisions, household care, wheelchairs, house modifications and transportation, are separated for the citizens who chose care in kind rather than a personal budget. The Provisions phase contains the steps where the municipality and the suppliers communicate about a new client. This phase ends with the delivery of the provisions. The Provisions phase is modelled in Figure 33.

For the Provision phase there are two major variations. The first occurs when the tender procedure is already almost finished, the second occurs when the tender procedure only just started or still has to start.

Tender procedure finished

(31)

31 [House

modification]

Choose tender

offer Sign contract

Sent delivery order to (chosen or contracted) supplier [Transportation/ Domestic care/ Wheelchair]

Figure 30: Provision phase of Leek Municipality

Tender procedure started

At Groningen, Haren and Marum the tender procedure starts after the decision is finished. For house modifications at Marum municipality SCIO Consult is first asked for advice and they wait for a report before they ask the citizen to perform the tender procedure. This municipality also has a tender procedure for wheelchairs which is always performed, but also always approved. The models of Groningen and Marum are shown in Figure 31 and Figure 32.

Sent delivery order to supplier [Large house modification]

Delivery of provision (by supplier) Check chosen tender (with decision) Tender procedure (by citizen) Give information about possible suppliers Sent delivery order to contracted supplier [Domestic care] Give information about possible suppliers Sent delivery order to contracted supplier [Wheelchair] [Small house modification/ Transportation] Sent delivery order to chosen supplier

[Tender not approved]

[Tender approved]

Figure 31: Provision phase at Groningen municipality

Sent email to supplier for wheelchairs (Schreuder) [Wheelchair]

Receive tender Approve tender

Delivery of wheelchair (by

Schreuder) Ask advice (from

SCIO Consult) [House

Modification]

Receive report Ask citizen for tenders [Tender not approved] Execute house modification (by contracted supplier) [Tender approved] Sent email to previous chosen supplier

[Domestic care] Executing domestic care (by external supplier) [Transportation] Sent email to

contracted supplier

Supplier delivers the transportation card and the transportation

To Payment phase

Figure 32: Provision phase at Marum municipality

Process analysis and requirement specification of Software as Service for Wmo provision applications at Dutch municipalities