Business intelligence in the Wmo

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Business intelligence in the Wmo

Supporting municipalities with decision making

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Business intelligence in the Wmo

Supporting municipalities with decision making

University of Groningen

Faculty of Economics and Business Master’s Thesis Technology Management

Name: Nico Nimeijer

E-mail: N.Nimeijer@student.rug.nl Student Number: 1747673

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Management Summary

Een Nederlandstalige managementsamenvatting is te vinden in Appendix I.

Since the introduction of the Social support act (Wmo, Wet maatschappelijke ondersteuning) in 2007, Dutch municipalities have a comprehensive responsibility for social policy on local level. The introduction of the Wmo had major consequences for the organization of municipalities in the Netherlands, because they had to deal with additional tasks and a budget that involves up to twenty percent of the municipality’s budget. Currently, the national government is increasing the pressure on the local government to reduce costs of executing the Wmo and become more effective and efficient. Business intelligence, as a collection of information technology tools, procedures, and methodologies, can help municipalities to achieve this. Therefore the research question is:

How can business intelligence assist municipalities in increasing effectiveness and efficiency of Wmo expenditures?

Currently, municipalities do not only require more effective and efficient policy, but the absence of a performance measurement system makes it also difficult to identify possible fields of improvement. The environment of municipalities is constantly changing, inhabitants become more demanding and it might not always be clear what the problem situation is. The strategic decisions that municipalities have to take, should anticipate on this. Ideally, the new Wmo policy manages to integrate the performance areas of the Wmo in order to result in one integrated policy with a central position for inhabitants. Municipalities have to take three steps to achieve this.

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Management Summary performance indicators that are relevant to them. Municipalities should base the required KPI’s on the main strategy for the Wmo.

Thirdly, municipalities should anticipate on the feedback provided by the performance measurement system. If the values of the KPI’s are not in line with the strategy of the municipality, the Wmo policy should be adapted. When these adoptions require new strategic decisions, DE services can be used.

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Contents

1. Introduction

This chapter starts with the initial motive for this study. In the subsequent sections this motive is explained in more detail, resulting in a research goal and research question. This chapter ends with the research approach.

1.1. Initial motive

Municipalities in the Netherlands have to deal with increasing responsibilities. In 2007, municipalities became responsible for the Social support act (Wet maatschappelijke ondersteuning, Wmo). Currently, the central government considers to transfer more responsibilities to municipalities.

These municipalities are struggling with the question how to execute the regulations they became responsible for. While municipalities are still struggling with the question how to execute the regulations, the central government expects them to reduce costs. This seems very difficult to achieve in practice.

In this changing environment municipalities have to decide on how to become more effective and efficient. Business Intelligence offers opportunities to support municipalities in making these decisions.

1.2. Municipalities

Municipalities are the smallest administrative subdivision that has democratically elected representations in the Netherlands. Municipalities have the task to implement national policy and to make decisions regarding local problems. Funding is received from central government general funds (Gemeentefonds, more than 90 percent of municipality’s budget), targeted payments, and local taxes.

The tasks of the local government include housing, traffic, environment, and education. Increasingly, the municipality becomes also responsible for tasks concerning healthcare, welfare, culture, and sports and recreation. This trend to decentralize tasks should give the municipality more leeway and responsibility (Rijksoverheid 2011a).

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Introduction the city council. The city council is also responsible for appointing aldermen. Figure 1.1 shows a simplified organizational chart of a municipality.

Figure 1.1: Organizational chart of a municipality

A recent example where municipalities received more responsibilities is the introduction of the social support act (Wmo), which was introduced in 2007. More reallocation of laws is to be expected in the coming years, in which the municipality will obtain more tasks. Currently, the central government intends to transfer parts of the Exceptional medical expenses act (Algemene wet bijzondere ziektekosten, AWBZ) to municipalities. This means that the number of tasks for the local government increases.

According to the national government, the implementation of laws on a local level increases involvement of citizens and offers municipalities the possibility to adapt it to local needs (De Klerk et al. 2010). Furthermore, the national government argues that municipalities should be able to offer the same services as the national government against lower costs (Vereniging van Nederlandse gemeenten, 2011a). Consequently, municipalities are cut on their budgets for social services. Further budget cuts from the national government are expected in the coming years. Municipalities, as small organizational units, should anticipate on this.

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Introduction

1.3. Wmo

The social support act (In Dutch: Wet maatschappelijke ondersteuning, Wmo) is the Dutch law for social support of individuals and is executed by municipalities. The act came into force on 1 January 2007 and aims to promote social and life skills and participation of people in society. The Wmo replaces several other social laws. With the introduction of the new social support act, municipalities became responsible for supporting citizens in running their households, move themselves in and around their houses, and participate in social activities. Moreover, the Wmo supports people that work as a volunteer to improve their neighborhood or care for individuals that require care.

The new focus of social support is to compensate people for disabilities in order to enable them to participate in society. In this sense the Wmo is a compensational law. Compensation can consist of individual and general services. In order to implement this compensation mechanism, municipalities have to change their approach from offering specific supporting tools or services (e.g. a crutch or walker) into solving problems of individuals (e.g. an individual has to visit the hospital once a week). The Wmo is financed by the ‘Gemeentefonds’.

The Wmo consists of nine performance areas that serve as constraints for municipalities. Municipalities are free to adapt their policy to the local situation, problems, and demands of inhabitants within the legal framework. The following performance areas are defined (Rijksoverheid 2011b):

1. Promoting social cohesion of social consistency in villages and neighborhoods 2. Preventive support to youth with problems and parents with education problems 3. Providing information, advice, and support to clients

4. Supporting informal care givers and volunteers

5. Promote participation in social activities of disabled persons and support them to function independently

6. Support people with disabilities, chronic illness, or psycho social problems 7. Offer social care and implement suppression policy to domestic violence 8. Promote public mental health

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Introduction The implementation of the Wmo by municipalities is in development. Domestic help, which is part of the Wmo, had the most impact on the organization of the municipality in both financial as organizational perspective. Therefore, most municipalities focused on this aspect of the Wmo when the act was introduced in 2007.

In 2011, municipalities are still struggling with the implementation of the Wmo. During exploring interviews, which were held at the start of this study, it was indicated that municipalities realize that a more integrated approach is necessary in order to become more effective and efficient. The project ‘De Kanteling’, an initiative of the Dutch association of municipalities, is an example of this. This project aims to support municipalities in developing integrated policy that includes all components of the Wmo (Rijksoverheid 2011b). Additionally, some municipalities have developed their own local initiatives. Despite these initiatives, municipalities have not managed to find structural innovative solutions for the integration of the Wmo.

The following section treats the definition of effectiveness and efficiency and the implications of an increased effectiveness and efficiency for municipalities.

1.4. Effectiveness and efficiency

The available budget for Wmo tasks before 2007, and before the introduction of the Wmo, was reduced when these tasks went over to the Wmo. At the same time the central government assumed that municipalities were better able to serve the needs of the citizens concerning social services than the central government was. This put pressure on municipalities to become more effective and efficient.

Effectiveness is defined as the proportion between the achieved result and the aimed result. It describes to what extend a certain goal is achieved. In terms of Wmo policy this means to what extend the performance criteria are achieved (In ‘t Veld et al. 2007). Efficiency determines how much waste is involved in the execution of policy. Thus, when the Wmo is seen as a health care system, more efficiency means achieving the same goals and meeting the same performance criteria against less expenses. This implies that society makes choices that maximize health outcomes gained from the resources allocated to healthcare (Weinstein & Stason 1977).

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Introduction

1.5. Business intelligence

The role of information technology (IT) has changed over the last decades. Until the mid 1990s, IT had not much impact on strategy and business operations and was mainly used for supporting activities targeted towards local improvements and incremental cost savings (McFarlan 1984). After the mid 1990s, companies also started to use IT for strategic and operational purposes, leading to competitive advantages. Nowadays, IT is also used to ensure process agility (Keen & Sol, 2008). In the case of non-profit organizations, like municipalities, the use of IT can lead to an increased efficiency and effectiveness (Ittner & Larcker 1998). Business Intelligence (BI) can be used to achieve this. It uses IT to turn data into information and then into knowledge (Golfarelli et al. 2004) and includes architectures, tools, databases, applications, and methodologies (Turban et al. 2008).

Business process agility is an important factor in current business processes. It is a combination of speed, flexibility, coordination, collaboration and innovation (Keen & Sol 2008). Business environments change quickly, and processes become increasingly complex, which makes coordination and collaboration more important. For municipalities, business process agility is important because municipalities become responsible for more tasks, inhabitants are more demanding than before and expect to be treated as ‘customers’.

BI takes advantage of the already developed and installed components of IT technologies to help companies leverage their current IT investments and use valuable data stored in legacy and transactional systems (Turban et al. 2008). BI can be applied to facilitate many activities such as data mining, forecasting, business analysis, balanced scorecard preparation, and many more (Moss, & Atre 2003). These techniques can benefit municipalities in two ways. Firstly, it can assist municipalities in defining a strategy concerning Wmo policy in terms of effectiveness and efficiency. Secondly, BI can provide feedback about the executed strategy in terms of performance measures.

A recent development in the use of IT and BI is decision enhancement (DE). DE is a lens that focuses on stakeholders in decision arenas and their decisions that have to be taken (Keen & Sol 2008). Decision enhancement can be viewed as the link between people that make decisions, the decision making process and the technology that supports the people and process. For effective decision making it is important that people, process and technology work together (Figure 1.2). DE with its services,

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Introduction Municipalities struggle with the implementation of the Wmo. They indicated to have a need for more effectiveness and efficiency, but the required information and knowledge are missing. Current innovations can be classified as ‘lucky shots’ because they are not based on performance indicators.

1.6. Research goal

The way municipalities implement the Wmo has not changed since 2007. Municipalities spend approximately an equal amount of money on the same goals regarding Wmo topics as previously under the former regulations (which were replaced by the Wmo). Nevertheless, there is a trend in which the local government aims to become more efficient in providing health care and social support. This trend is a result of budget cuts of the national government, the increasing average age of the population, and the declining number of inhabitants in some regions. This resulted in some (local) innovations for a more effective and efficient Wmo. In the period ahead, municipalities can expect a further increase of tasks and budget cuts, which should be anticipated on.

BI tools can assist municipalities in structuring the Wmo policy and in taking informed decisions that should lead to more effective and efficient policy.

The need for more effectiveness and efficiency in Wmo policy, combined with the possibilities that BI offers, leads to the following goal for this study: determine how municipalities can apply BI for the improvement of effectiveness and efficiency in Wmo expenditures.

1.7. Research question

The research goal formulated in the previous section results in the following main research question:

How can business intelligence assist municipalities in increasing effectiveness and efficiency of Wmo expenditures?

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Introduction

Figure 1.3: Prerequisites of effective decision making

The model in Figure 1.3 shows stakeholders and knowledge as the first and second prerequisite. These are captured in the first sub question.

Q1 What is the current situation concerning policy making and the use of information systems?

The second sub question focuses on the type of decisions that have to be taken by municipalities (decisions that matter). Identification of these decisions is based on comparable decisions that municipalities have taken in the past. The second question is:

Q2 Which decisions have to be taken by decision makers in municipalities?

Depending on the decisions that have to be taken and the situation municipalities are in, the prerequisites capabilities and design focus on how municipalities can be supported in taking decisions. This leads to the following sub question:

Q3 How can municipalities be supported in taking decisions?

Finally, there is data required to support the decision making process. Therefore, the fourth sub question focuses on identifying the required data.

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Introduction

1.8. Approach

The final section of this chapter treats how this paper can be read. Since this chapter introduced the research problem and research question, the second chapter continuous with how this question will be answered.

In chapter 3, the first sub question (Q1) is answered. Answering this question requires the analysis of the current situation. Chapter 4 discusses the decisions that have to be taken (Q2). Chapter 5 introduces business intelligence techniques that can assist municipalities in taking these decisions themselves (Q3). In chapter 6 the data that municipalities require for the decision making process is identified (Q4). Finally, in chapter 7 the conclusions, recommendations and points for future research are given.

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Research design

2. Research design

This study is designed according to the diagnosis – design – change methodology as shown in Figure 2.1 (De Leeuw 2003). In this study only the first two stages are covered. The change phase is out of scope for this study. Table 2.1 illustrates the research phases with the corresponding chapters in this paper.

Research Phase Chapter

Diagnosis 1-6

Design 7

Change Out of scope

Table 2.1: Research phases with corresponding chapters

Section 2.1 and 2.2 discuss the scope and information collection aspects of this study respectively.

2.1. Scope

Figure 2.2 shows the scope of this study. This image is based on the municipality’s organization as given in Figure 1.1. A simplification of a generalized municipality’s organization is shown within the dotted square.

Figure 2.2: Scope

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Research design Department(s) responsible for the execution of the nine performance areas are represented by ‘Department responsible for Wmo’ and are headed by the executive officer. These department(s) have to account to the Alderman. Departments are externally advised by one or more groups, depending on the municipality. Furthermore, both internal as external organizations are responsible for the execution of the Wmo policy. The total scope consists of the darkest colored part of Figure 2.2.

2.2. Information collection

The diagnosis phase aims to define the causes and measures that are required to answer the main research question. The data that is required for the diagnosis is obtained from interviews and is compared to scientific literature.

Two rounds of interviews have resulted in the information required for an overview of the current situation, the problem and a direction for a possible solution. The first round of interviews was conducted in order to attain a problem description. These semi-structured interviews (Table 2.2) were held with employees of the municipality’s representing organizations in the province of Groningen.

Company / institution Function interviewee

Vereniging van Groninger Gemeenten Project leader housing and care Vereniging van Groninger Gemeenten Secretary

Table 2.2: Exploring interviews

The second round of interviews were conducted with policy makers from municipalities, former aldermen, domain experts and a stakeholder. The interviews were semi-structured. The overview of interviewees is shown in Table 2.3.

Large, middle, and small municipalities were selected in the provinces of Groningen and Drenthe. The involvement of this broad range of municipalities has resulted in a pluralistic picture of the current state of Wmo implementation and execution. Furthermore, an interview with an expert in the field has been conducted, which has provided the necessary feedback on the process.

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Research design

Company / institution Function interviewee Municipality of Aa en Hunze Policy maker

Former Alderman

Municipality of Bedum Policy maker

Municipality of De Wolden Former Alderman Municipality of Groningen Coordinator Wmo Municipality of Midden-Drenthe Policy maker Municipality of Vlagtwedde Policy maker

Municipality of Winsum Policy maker

Frieslab Program Manager

Zorgkantoor Menzis Manager procurement long-term care

Table 2.3: Second round of interviews

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Current situation

3. Current situation

This chapter answers the first sub question: “What is the current situation concerning policy making and the use of information systems?”. This question is answered in four sections. Firstly, the section facts and figures will outline the environment in which the municipality has to operate. Secondly, the stakeholders that are involved in the Wmo are identified and described in section 2. Thirdly, section 3 lists information that municipalities have available concerning Wmo policy. Fourthly, the SWOT analysis, described in section 4, provides better insight in the external and internal environment. Fourthly, Section 4 enumerates the main problems with the current system. Finally, the answer to the first sub question is summarized in section 5.

3.1. Facts and figures

This section describes the number of potential Wmo clients and the available budget for municipalities. Table 3.1 shows the basic figures of the situation in which municipalities have to operate. The table shows that the annual budget for Wmo is between six and twenty percent of the municipalities total budget, which is substantial. Furthermore, the smaller municipalities have relatively more inhabitants that have reached the age of 65.

Municipality Inhabitants Total annual budget (x € 1,000,000) Annual Wmo budget (x € 1,000,000) Annual Wmo budget (%) Persons >65 (%) Aa en Hunze 25 771 51 3.4 7 19 Bedum 10 491 18.5 - 16 De Wolden 23 544 43.8 6.6 15 18 Groningen 187 298 786 48.8 6 11 Midden Drenthe 33 575 66.2 10.7 16 18 Vlagtwedde 16 265 45 3.1 7 20 Winsum 14.003 27.6 5.4 20 -

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Current situation

3.2. Stakeholders

Stakeholders are important for the implementation of a strategy. According to Applegate et al. (2007) a business model defines how municipalities “interact with its environment to define a unique strategy, attract the resources and build the capabilities to execute it, and, in the process, create value for all stakeholders”. Furthermore, Keen and Sol (2008) argue that stakeholders should be involved in the decision making process. Therefore, it is important to know who the stakeholders are. This section will identify the most important stakeholders for the Wmo policy.

Table 3.2 lists stakeholders that are involved in the execution of the Wmo act. In different municipalities, different organizations are involved, in these cases Table 3.2 mentions a generic name and description of the stakeholder.

Name stakeholder Description

Municipality “Problem owner”

Welfare organizations Nonprofit organizations that enable people to participate in society

Domestic help organizations Providers of domestic help

Youth care Provide youth care

Care offices Responsible for allocating AWBZ care

Humanitas Non-profit organization that assist people that have problems related to Wmo

Housing adjustment companies Adjust houses for disabled people Advisory groups Wmo board and client board National and regional

collaborations

Organizations as the vereniging van Groninger gemeenten (VGG), vereniging van Drentse gemeenten (VDG), and vereniging van Nederlandse gemeenten (VNG), which are collaborations of municipalities.

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Current situation The following subsections will describe the various stakeholders and their main interests.

3.2.1. Municipality

As problem owner, the municipality has the main interest in increasing effectiveness and efficiency of the Wmo. It has the obligation to inhabitants to compensate them for their inabilities. Especially in larger municipalities, the responsibility for performance areas is spread over different departments. The Wmo desk, as part of the municipality’s organizations, has its own responsibilities considering the execution of a front desk. Since the municipality has a central position in this paper it will not be further discussed here.

3.2.2. Welfare organizations

Every municipality has its own welfare organization or organizations. Most welfare organizations have very broad tasks that mainly involve the support of social life for different groups in the municipality, like children, youth, elderly, and people with social problems. Welfare organizations are partly financed by municipalities and have to account to municipalities about their annual results.

3.2.3. Domestic help

Domestic help is provided by organizations that traditionally deliver services that cover the whole spectrum of assistance at home. Besides domestic help, these organizations often provide home care. Domestic help organizations can apply for contracts with the municipality, or can deliver care to individuals with a personal budget. These organizations are held accountable for their provided services by the municipality.

3.2.4. Youth care

Youth care organizations are specialized in supporting youth (< 18 years) that have problems in growing up, and their parents that experience problems while raising their children. The youth care organizations are based in the largest municipality in a region. In the province of Groningen, this is the city of Groningen.

3.2.5. Care offices

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Current situation disabled persons with congenital, physical, or mental disorders (Rijksoverheid 2011c). Currently, the AWBZ is a national insurance scheme under the responsibility of the national government, but the central government considers to change this. These changes are discussed in section 3.3.5.

The CIZ (Centrum Indicatiestelling Zorg) determines whether or not a client needs care. The care office (Zorgkantoor) is responsible for the execution of the care by care providers. The following types of care are currently part of the AWBZ:

Personal care, for example assistance with washing, dressing, shaving, and medication Nursing, for example wound care and injections

Accompaniment with practical issues in life Stay in nursing homes

Treatment, for example revalidation or daytime activities Short stay

3.2.6. Humanitas

Humanitas is an organization that supports people with social problems. The organization runs primarily on volunteers and is financed by donations. Humanitas is a partner for municipalities in providing social assistance to inhabitants.

3.2.7. Housing adjustment companies

Housing adjustment companies are commercial companies that adjust houses of persons that have an indication from the municipality. These companies can be hired by either the municipality or individuals with a personal budget.

3.2.8. Advisory group

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Current situation

3.2.9. National and regional collaborations

Organizations like the national and regional cooperation between municipalities aim to support municipalities with strategic issues. For example, the national municipality organization (VNG) has developed a model regulation that municipalities can use as a basis for their local regulation. Moreover, these organizations are a share point for best practices.

In the Netherlands each province has its own community, for the provinces of Groningen and Drenthe these are the VGG and VDG respectively. The national representing organization is the Vereniging voor Nederlandse Gemeenten (VNG).

3.2.10. Inhabitants

Perhaps the most important stakeholder are the inhabitants of a municipality. The Wmo is founded to socially support this group of people. The voice of the inhabitants in policy making is represented by the advisory groups and within the democratic representation of the municipality.

3.3. Execution of Wmo by municipalities

This section describes how the Wmo is executed by municipalities. The focus is on both the past and the current situation. The subsections are organized by items that interviewees indicated as important or as underperforming.

3.3.1. How municipalities deal with the implementation of the Wmo

This first subsection describes how municipalities dealt with the implementation of the Wmo. Most parts of the current Wmo act were already executed by municipalities under the wings of other regulations that were replaced by the Wmo. This holds for performance areas 1, 2, and 4-9. Performance area 3, which includes inform, advice and support clients, is an exception. All municipalities indicated that performance area 3 had a large impact on the organization. This made the municipalities decide to focus on the implementation of this particular performance area. The other performance areas were left unchanged.

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Current situation how many persons require help. Secondly, municipalities indicated to have problems with determining the right performance indicators that were required for measuring the performance of suppliers.

The Wmo desk is a front office where clients can obtain all required information and apply for support (see also section 3.3.2). The relatively high impact of performance area 3 made the municipalities in 2007 to focus on getting the system up and running, rather than to try to be as efficient as possible.

In 2012, all of the municipalities under consideration have to present a new policy plan for the next four years. The municipalities indicated that they aim at a more integrated approach, which means that concepts suggested in “De Kanteling” will be applied. The Kanteling aims for a more integrated approach and a central position for the customer / inhabitant. The VNG has an example policy that most municipalities use as a starting point for their own local policy. Furthermore, municipalities cooperate in a regional context. In 2013, municipalities can expect a further increase in tasks because of the transfer of the AWBZ to municipalities.

3.3.2. Wmo desk

The Wmo desk acts as a front office for inhabitants that are in need for social support. All municipalities under consideration have a Wmo desk that is located either in the town hall or in other central places. The municipality collaborates with welfare foundations in running these desks (Bouma 2010).

Table 3.3 shows the information systems that municipalities use for handling the requests. These systems are connected with the municipalities database (GBA). Bouma (2010) indicated that CiVision has problems with exporting management information. Municipalities using the other system (EBB and GWS4ALL) indicated that these systems were capable of exporting many different kinds of reports and were satisfied.

Information system Municipality

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Current situation Recently, an attempt was made to define a generic process model for the Wmo application for a project that aims to develop software as a service technology for the Wmo (Bouma 2010). This generic process model provides insight in the Wmo desk process and can help municipalities to optimize their process.

3.3.3. Information systems

The information systems for the Wmo desk were identified in the previous sub section. However, municipalities have information sources for the other areas of the Wmo as well. Table 3.4 describes these sources.

Information system Kind of information Performance area(s) Description Wmo information system Delivered support to clients 3 Municipality database

GBA (Basic records of municipalities inhabitants)

-

Benchmark SGBO Financial and usage of Wmo facilities

1-9 Complete Wmo

Evaluation Wmo policy

Soft data about functioning of policy

1-9 Complete Wmo

Welfare foundation Annual report 1, 2, 4-6 Social cohesion, youth, informal care, participation, disabled people

Home care Annual report 3

Addiction Annual report 9 Addiction policy

Menzis Wmo

support

Accounting personal budget

1-9 Personal budget

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Current situation The information sources shown in Table 3.4 mainly show sources of so called ‘soft’ information, but lack quantitative data about performance, and needs of inhabitants. The integrated view on the total Wmo policy should come from the ‘evaluation Wmo policy’ which is executed by every municipality individually. Comparisons with other municipalities can be made based on the ‘benchmark SGBO’. Furthermore, the municipality receives periodically performance reports from external parties which are responsible for parts of the Wmo policy (such as the Welfare organization, child care, and home care companies). Menzis Wmo support is responsible for accounting the personal budgets. Persons can choose to request a personal budget instead of contracted care, which they can use to buy the required care themselves. These persons should account their expenses to Menzis Wmo support.

Based on the information sources that were discussed in this sub section, municipalities execute their current performance measurements. The following section discusses how this is implemented.

3.3.4. Performance measurement

The Wmo legislation requires municipalities to keep track on the following two performance aspects:

1. A satisfaction study among inhabitants and clients, which is composed in cooperation with representatives of welfare organizations

2. Performance data about Wmo, defined as ministerial regulation

The research institute SGBO (sgbo.nl) performs an annual benchmark on a broad set of criteria that cover the legal obligations. Municipalities can participate in this benchmark. These criteria are the only formally defined performance evaluation mechanisms.

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Current situation

3.3.5. Care office

Care offices have two linkages to the Wmo: the transition from AWBZ to Wmo and patients with a declining health condition. These two points are discussed in this sub section.

In 2013, municipalities can expect to get new tasks assigned. The government agreed on the transfer of parts of the AWBZ, concerning daytime activities and activating guidance, to the municipalities. This results in the local government being responsible for approximately 170.000 additional patients and €2.2 billion of additional budget. At the same time, the central government wants to cut €140 million on this budget (Vereniging van Nederlandse Gemeenten 2011). Other parts of the AWBZ, such as care in care homes and mental health, will be transferred to private insurance companies. In the future, the AWBZ only consists of so called ‘uninsurable health care’ (Interview Zorgkantoor 2011). In the transition period, care offices must provide all relevant information concerning the AWBZ to municipalities.

The second link between Wmo care and the AWBZ is in case of declining health conditions of patients. These patients cannot be helped under the Wmo, because they get more serious problems, and have to appeal on the AWBZ (Duits 2010; Bouma 2010). In general, AWBZ care is more expensive and intensive care than Wmo care. Therefore, care offices can benefit from investments in preventive care as part of the Wmo.

Municipalities indicated that attempts have been made to make agreements with care offices and providers of AWBZ care with the goal to cooperate. Except the municipality of Groningen, all municipalities indicated that it was impossible to make agreements on this field because the care office and providers of AWBZ care were not willing to cooperate. The municipality of Groningen indicated that an agreement was made about a less expensive health insurance for people with welfare assistance. Furthermore, they have recently received information about AWBZ patients that is relevant for the transfer of AWBZ tasks to the Wmo.

3.3.6. Best practices

This final sub section treats best practices. The municipality of Aa en Hunze indicated that it submitted a successful project for a European Award. ‘Successful’ projects are collected in databases and can be consulted publicly (European Commission 2011). Also the VNG made an attempt to collect best practices on its website (Vereniging voor Nederlandse Gemeenten 2011b).

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Current situation

3.4. SWOT analysis

This section will perform a strengths, weaknesses, opportunities and threats analysis. The subsequent elements are discussed in the next sub sections. The results presented in Figure 3.1 are mainly based on points that were also mentioned in the preceding sections. Including these points in a SWOT analysis adds to a more comprehensive understanding of the current situation of municipalities.

3.4.1. Strengths

The strength of the Wmo, as

legislation that is executed by local governments, is that it offers possibilities to focus on individuals and small groups of persons. Municipalities can be flexible in how policy is executed and adapt policy to the local situation.

3.4.2. Weaknesses

Municipalities have limited financial possibilities to hire expertise on a topic. Therefore, especially small municipalities have problems with meeting the goals that the central government expects the municipalities to meet. For example, a professional IT organization, and sufficient human capacity to define strategic plans.

A second weakness is that many organizations are involved in executing the Wmo policy. These organizations often obtain the mandate to operate in a municipality through public procurement. This means that the municipality depends on the outcomes of the public procurement for the organizations it has to cooperate with.

3.4.3. Opportunities

The increasing number of laws that are executed by the local government offers opportunities as well. Municipalities are able to develop integrated policies that involve more areas of policy.

SWOT analysis Strengths Focus on individuals Flexible Weaknesses Many stakeholders Lack of expertise Opportunities Economies of scale More responsibilities offers more possibilities Threats Budget reductions Constantly changing political environment

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Current situation For example, for inhabitants this has as a consequence that they can turn to one office. This office will assist them with all their problems.

A second opportunity is the increasing number of elderly people in the Netherlands. This enables the possibility to work with economies of scale.

3.4.4. Threats

Two threats can be identified. Firstly, a changing political environment can lead to changing policy because political parties have their own focus areas. This means that after elections the Wmo policy can be changed because a political party has a different ideology concerning municipal policy. Secondly, the central government aims at a budget reduction for municipalities. When the budget is reduced too far, municipalities can get financial problems. Municipalities might be no longer able to deliver the requested support.

3.5. Conclusion

This chapter described the current situation concerning policy making and the use of information systems. In organizational perspective, municipalities are in a constant changing environment because they have to deal with an increasing number of tasks and responsibilities. This results in the need for new policy that leads to more effective and efficient policy. Simultaneously, municipalities require performance indicators to keep track on the performance of the Wmo policy. Because the situation is constantly changing, the system of executing the Wmo should be flexible as well.

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Decisions that have to be taken

4. Decisions that have to be taken

This chapter describes the decisions that municipalities have to make and answers sub question 2: “Which decisions have to be taken by decision makers in municipalities?”. This question is mainly answered by providing examples of these decisions. The first section discusses what literature describes as decisions that have to be taken in strategic situations. The second section enumerates four practical examples of decisions that municipalities have to take. These examples were mentioned during the interviews.

4.1. Strategic decisions

In chapter 3 was concluded that municipalities have to deal with changing or agile situations. Changing and agile situations might become problematic when the municipality’s current policy for dealing with these situations does not lead to a sufficient level of effectiveness and efficiency. It is not always clear what the problem is. In this situation, the municipality is dealing with a wicked problem (Rittel & Webber 1973). Decisions taken by public organizations, like municipalities, often affect many people. Problem solving at municipalities can therefore have serious consequences. Moreover, it can be difficult to estimate the consequences of decisions because many decisions are based on assumptions or involve different policy areas. These decisions about wicked, consequential, and uncertain situations are called decisions that matter (Keen & Sol 2008).

BI can facilitate municipalities in closing gaps between the current performance and the desired performance (Turban et al. 2008). In other words, facilitate municipalities in taking the decisions that matter in order to arrive at the desired level of effectiveness and efficiency, which leads to the desired level of performance.

Before municipalities are able to make decisions on how to implement the Wmo, they should define a goal. This goal should be based on strategic objectives. Strategic objectives are broad statements or general courses of action that prescribe targeted directions for an organization, in this case the municipality. Strategic objectives should be derived from the overarching business strategy and vision (Wade & Recardo 2001).

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Decisions that have to be taken The following section will introduce a number of typical decisions that municipalities have taken, or could take in order to increase the effectiveness and efficiency of the Wmo.

4.2. Examples of decisions

This section will describe some examples from current praxis of initiatives that municipalities took, or ideas that the interviewees at municipalities suggested to become more efficient and effective. The examples have in common to be an attempt to increase efficiency of the Wmo by introducing innovative solutions that integrate the performance areas of the Wmo.

4.2.1. Alfacheque

The municipality of Vlagtwedde had to deal with an increasing demand for social services and higher costs of domestic help. To handle both problems with one solution, the municipality started an initiative that originated in the municipality of Tilburg and is called ‘alfacheque’. The project is an example of integral policy making and incorporates the nine performance areas of the Wmo (interview Vlagtwedde 2011).

Within the municipalities that participate in the alfacheque project, Wmo clients with an indication for domestic help can choose between three options. The first two options are the regular options; contracted domestic help and personal budget. At the third option clients can decide to receive alfacheques. These alfacheques can be handed in at a special private company. In exchange, this company takes care of the clients receiving the required domestic help. The private company takes care of the administration and matches clients with someone in the database. This person is paid with alfacheques. The database of the private company is filled with persons that receive social security benefits (WWB, and SW) (Blauwdruk alfacheque 2010). The alfacheque concept has multiple advantages for the municipality. Firstly, it reduces the total costs of municipalities (Wmo + costs of social befits), because persons that work as a domestic helper do not need any other payments from the municipality. Because of lower execution costs, the costs of domestic help are reduced with approximately €6,- per hour. Secondly, the concept stimulates persons that have social problems to stay involved in society. In this way it stimulates social cohesion (performance area 1) (Blauwdruk alfacheque 2010).

4.2.2. Virtual desk

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Decisions that have to be taken banks and other services in the villages. At the same time, the average age of the population is increasing.

To overcome these problems, the alderman came up with the concept of virtual desks. The virtual desk is a pc with internet that is placed within a community center. The pc offers inhabitants of a village the possibility to get in contact with the municipality, bank or insurance company. The system can be used to ask questions, but also to upload or print forms directly. Through the introduction of the virtual desk, inhabitants of villages get social services close to home. For elderly people, the desk enables them to stay independent for a longer period. Furthermore, the system adds to social cohesion because the quality of life in the villages is improved (interview Aa en Hunze 2011).

According to the interviewee in Aa en Hunze, the success of the project can be measured by the number of service-organizations that participate in the project. How often the desks are used is not explicitly measured. The project is seen as a first step towards a virtual desk in every house (interview Aa en Hunze 2011).

4.2.3. Adjusted bus stops

The third example is recently executed in the city of Groningen. The Wmo describes that elderly and disabled persons should be kept active in social life. An important aspect in this field is to foster mobility. Since the law does not describe how municipalities should foster mobility, municipalities are free to experiment. The municipality of Groningen started the adjusted bus stops project in the city of Groningen.

This measure improved the mobility of a large group of elderly and disabled persons, which increased social cohesion and prevents isolation. Simultaneously, this initiative promotes the use of public transport. When public transport is used more often, the public transport company is able to drive more frequently on a specific line. This resulted in a win-win situation for both elderly and disabled people, and public transport.

4.2.4. Seated patient transport

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Decisions that have to be taken As part of the Wmo, municipalities have to compensate inhabitants for their immobility. Municipalities can choose which means of transport it offers to inhabitants. A taxi service is one of these services.

To summarize the situation: there are two systems that offer taxi services to ‘customers’, which are paid by two different organizations. In praxis this means that different taxies are used to transport customers. Combining taxi rides would offer the possibility to transport patients more efficiently.

4.3. Conclusion

This chapter ends with an answer to sub question 2: “Which decisions have to be taken by decision makers in municipalities?”.

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Support decision making

5. Support decision making

This chapter answers the third sub question: “How can municipalities be supported in taking decisions?”. To answer this question the theoretical perspective on decision support is taken as departure and is discussed in section 5.1. In the succeeding sections this theoretical perspective is linked to the practical implications.

In chapter 4, “decisions that matter” were defined as strategic decisions. Decision Enhancement (DE) is a field of practice that enables people to make these decisions. DE combines people with process and technology (Keen & Sol 2008). The people were discussed in chapter 3, in particularly in section 3.2 where stakeholders are listed. Process is defined as the process to come to a decision, and technology are the tools and suites that are used to support the process and people. In this chapter the link between people, process and technology is established. The structure of this chapter is based on a standard framework for BI, which is shown in Figure 5.1.

Figure 5.1: Generic BI architecture (Turban et al., 2008)

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5.1. Decision enhancement

Decisions that matter, and decisions concerning problems of strategic importance are decisions that can be supported by decision enhancement (DE) tools (Keen & Sol, 2008). Figure 5.2 shows the elements of DE services. The DE services link technology and process with the people that actually make the decision.

Figure 5.2: Suites, studios and architecture of DE services (Keen & Sol 2008) The DE services have the following elements (Keen & Sol 2008):

1. Landscaping. This element involves the description of the context such as issues, time, vision and priorities. These items are thoroughly discussed in the preceding chapters. 2. Governance. This point involves the identification of stakeholders, as discussed in

chapter 3. It is important to include all groups of stakeholders in the planning process. Excluding groups can cause problems in later stages when decisions are implemented. 3. Blueprints. These are the constraints and guidelines that make the problem manageable

and meaningful.

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Support decision making 5. Suite. The suite contains technologies that can be used in the studio. These technologies use data that is available from several external sources in order to support the decision makers. The chosen models must correspond to the key individual business processes and can be scenario building, visualization or simulations.

The decision enhancement studio with its process, people and suites, constrained by the landscaping issues supports the stakeholders in a decision process. Alderman and policy makers of the municipality can invite stakeholders from diverse groups, such as advisory groups, care providers, and the Wmo desk to join the process in the studio. Techniques as scenario building, simulation, and visualization can provide instant results to the participants about the effects of the proposed scenarios. A further discussion of the requirements is discussed in more depth in the following sub sections.

5.1.1. Blueprints

The decision process needs support and direction in order to move the participants towards the goal. Before actually inviting stakeholders, an inventory of their viewpoint is required. This will make it easier to invite the optimal set of stakeholders that enables a balanced discussion. Moreover, to avoid surprises during the meeting and build commitment for coming session results, individual party interest should be explicated and ambitions should be well managed (Van den Herik, & De Vreede 1997).

The constraints are also part of the blueprint. These constraints involve for example the maximum budget the municipality has available and the text of the legislations involved. The law does not mention many constraints, but it is important that the final Wmo implementation covers at least the nine performance areas.

Finally, a municipality has to define a procedure. This procedure depends on the topics that will be covered during the individual sessions. Not every stakeholder should necessarily be invited to every session or be involved at every level of decision making. There should not be more stakeholders invited as is practically possible in the studio (Keen & Sol 2008).

5.1.2. Studio

The studio is the location where the actual decisions are made. All components of the DE services come together in the studio.

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Support decision making 2008). Cooperation and participation of stakeholders in the process is a requirement for a success of the studio.

Process coordinators are appointed to accompany the process. There are three types of process coordinators, which are the process coordinator, domain experts and suit managers. Firstly, the process coordinator helps to address the problem openly and creatively. Secondly, domain experts have knowledge about specific fields of the Wmo, such as social cohesion, and housing adjustments. Finally, suit managers are responsible for the software in the suites. The suites should be configured in order to be used in the decision making process (Keen & Sol 2008). The room that will be used as a studio should be prepared for collaboration. This means that it should be equipped with the required collaboration and simulation tools. Group support systems (GSS) can be used for a number of tasks. The main characteristics are structuring of activities, generating ideas and improving group communication. GSS has as an advantage that it can reduce the time required for a project. Furthermore, it has the potential to increase the productivity of brainstorming teams: more ideas and better ideas are generated and stakeholders at all levels can be involved (Den Hengst & De Vreede 2004). EasyWinWin is a methodology that is based on GSS principles, and supports collaboration (Gruenbacher 2000). GroupSystems is an off-the-shelf product that supports the ideas of EasyWinWin (groupsystems.com).

Appendix II. shows the steps that EasyWinWin provides to users to come to a decision.

5.1.3. Suite

The suite supports the processes in the studio visually. During the various phases of EasyWinWin many ideas are proposed. Technologies that are part of the suite offer possibilities to visualize these ideas.

Data that is required for the simulation can be obtained from techniques that include spreadsheets, probabilistic and statistical analysis, and data from the data warehouse (Keen & Sol 2008). A list of available and required data can be found in chapters 3 and 6. These analysis lead to visual displays of scenarios that were output of the brainstorm sessions and visualization can show the effects of a scenario. Scenarios can be displayed on numerous levels as well as the financial forecasts belonging to the scenarios.

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Figure 5.3: Screenshot from DataScene (CyberWit 2011)

5.2. Performance measurement

DE services can assist municipalities in taking decisions. Consequentially, municipalities will execute the new policy that is a result of the decision. This new policy requires a performance measurement system that keeps track on performance. A system for Wmo performance measurement is currently not available in the seven municipalities. The performance measurement system provides feedback about the policy that is executed. For a performance measurement system to be effective it should have a number of ingredients, which are listed below (Turban et al. 2008):

Measures should be a mix of past, present and future

Measures need to have targets that are based on research and reality rather than be arbitrary

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Support decision making Measures should focus on key factors

Measures should start at the top and flow down to the bottom

The following sub section introduces the balanced scorecard which addresses the first three bullet points. The final two bullets are addressed in the final sub section.

5.2.1. Balanced scorecard

A performance measurement system that is often used in commercial as well as non-profit organizations is the balanced scorecard (Figure 5.4). This measurement system was introduced because the traditional financial performance measurement systems are not sufficient for non-profit companies. The balanced scorecard complements financial measurements with customer, internal process, and learning and growth measures (Kaplan 2001). These measures are called performance indicators.

Figure 5.4: Balanced scorecard (Kaplan 2001)

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Support decision making The balanced scorecard principle can be used for tracking the performance of policy at certain points in time. For municipalities it is important that the four perspectives are represented and the indicators being measured represent the strategy. Kaplan (2001) emphasizes the importance of having a clear strategy before focusing on the strategy statements. The four perspectives of the balanced scorecard are briefly described below:

Customer perspective

At nonprofit companies, customers both finance and receive a service. In the case of the Wmo, the services are paid (indirectly) by tax payers, while at the same time it are the same tax payers that benefit. Therefore both this customer and donor perspective should be incorporated into the balanced scorecard (Kaplan 2001).

Learning and growth

In the learning and growth perspective, the focus is on measuring competencies of employees, the adequacy of the information system and whether the employees are aligned with the vision, strategy and cultural values of the municipality (Atkinson et al. 2007).

Internal perspective

The internal perspective, or process perspectives, measures the internal organization. This perspective should determine the ‘how’ of the strategy, in other words does the customer get what he requires and is it delivered efficiently. The internal perspective can be divided in operation processes, customer management processes, innovation processes and regulatory and social processes (Atkinson et al. 2007). For inhabitants of municipalities this means that the process of how the social support is delivered should be incorporated into this perspective.

Financial Perspective

The final perspective is the financial. This perspective measures the financial consequences of the municipality’s policy.

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Support decision making a more user friendly overview. Moreover the performance indicators shown on the performance dashboards can be adapted to the users (Turban et al. 2008), which means that every user will receive its personalized dashboard.

5.2.2. Performance dashboards

Performance dashboards provide a visual display of important information that is consolidated and arranged on a single screen so that information can be digested at a single glance and easily explored (Turban et al. 2008).

A dashboard shows (Figure 5.5) a number of key performance indicators (KPI) that are displayed visually. Data and KPI’s can be represented by charts, performance bars, etc. Furthermore, the dashboard offers possibilities to scroll down in the data when required. The use of tabs on the screen offers the possibility to use different start screens for individual projects and can show information on distinct levels and time periods.

Figure 5.5: Screenshot of an example performance dashboard

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Support decision making Information about specific parts of the Wmo (for example a project or performance area) represents specific performance indicators for that area. Note that Turban et al. (2008) indicate 3-5 performance indicators as optimal. Clicking on a KPI should result in showing more detailed information about that KPI. For instance clicking on the financial KPI in Figure 5.5, results in displaying more detailed financial information.

A performance dashboard should meet a number of criteria that enable an optimal visualization of the KPI’s the list below shows the most important criteria:

Graphical representations are clearer than statistic figures (Tufte 1986).

The description at graphical representations should be consistent, complete and in detail. Otherwise the data can be misinterpreted (Tufte 1986).

Time dependent graphical representations are most suitable for the representation of large amounts of data with a high variety (Tufte 1986).

The use graphical representations where the user has to estimate the size of a surface (e.g. a pie chart) has to be avoided. Therefore, it is important to mention the value of the surface size (Tufte 1986).

Mind the use of unnecessary ink. This promotes a clear representation of the data (Blasio & Bisantz 2001).

The definition of the KPI is out of scope for this research. Each municipality should first define their main strategy and goals concerning the Wmo, before KPI’s can be defined.

5.3. Data warehouse and business analytics

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Support decision making With respect to the architecture of the data warehouse, there are a number of issues that should be taken into account. Since municipalities have to deal with many kinds of data, which is structured, semi-structured, unstructured, internal and external, the data warehouse should be capable of handling all sorts of data. In literature a number of proposals have been made about how to deal with these issues (Vassiliadis et al. 1999; Dayal et al. 2009). The practical choices that have to be made on this topic are out of scope for this study.

The following sub sections describe a number of issues that are related to the implementation of a data warehouse.

5.3.1. Business analytics

Business analytics is a broad category of applications and techniques for gathering, storing, analyzing, and providing access to data to help enterprise users make better business and strategic decisions (Turban et al., 2008). Data that is extracted from external sources is often not in the right format to be directly stored in the data warehouse or processed by an application. Data analytics comprises a number of techniques that make data ready to be stored or processed.

5.3.2. Privacy issues

Organizations in the Netherlands that store and process personal data have to conform to strict regulations that are described in the Data protection act (Wbp, Wet bescherming persoonsgegevens) (Sauerwein & Linnemann 2002). Therefore, it is important that data is stored and coupled anonymously. This means that data cannot be traced back to an individual. Furthermore, municipalities should carefully consider who gets access to which part of the data.

5.3.3. Maintenance

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Support decision making limited in-house ICT capabilities and human resources. For these municipalities it might be necessary to cooperate with other municipalities or to use the infrastructure of a larger municipality. The municipality of Ten Boer is an example of a municipality that has close cooperation with the municipality of Groningen (Ten Boer 2011).

5.4. Conclusion

This chapter finishes with answering the third sub question: “How can municipalities be supported in taking decisions?”.

Municipalities should take decisions that matter in order to direct their policy towards the strategic goals and take decisions that increase the effectiveness and efficiency of the Wmo policy. This chapter introduced two concepts to support municipalities in taking decisions and the corresponding infrastructural implications.

Firstly, the concept of decision enhancement (DE) services was introduced. These DE services should enable municipalities to take decisions based on the current situation, vision and input of stakeholders. Stakeholders that meet in a studio and are supported by collaboration tools and suites, are aiming to come to a joint decision about how to implement the Wmo in a municipality.

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Required data

6. Required data

This chapter will answer the fourth sub question: “Which data is required in order to be able to take decisions?”. This question is answered by providing an overview of the data and information sources that municipalities have available and require for the decision making process and performance evaluation.

6.1. Data sources required for DE

This study identified many information sources at both municipalities and stakeholders. These information sources contain information that municipalities require for the decision making process concerning Wmo. Municipalities should aim to obtain all relevant data from stakeholders about Wmo related topics and combine it with internal data. Preferably this data is quantitative in order to be able to transfer it directly to the data warehouse. For stakeholders that are contracted by municipalities, the municipality should obtain access to the original data from municipalities, but these stakeholders must be willing to cooperate.

Municipalities can distinguish three types of information sources: internal (quantitative) data, external data that can be accessed and external data that cannot directly be accessed. Firstly, from the generic list of available data sources (provided in chapter 3) it became apparent that, a small number of municipalities have access to quantitative internal data. There is a short list of information sources that can be transferred directly to a data warehouse. These internally available data includes:

Municipality database Wmo information system

Results of a satisfaction study (if performed)

Performance data about Wmo, defined as ministerial regulation and (also) collected by SGBO

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Required data The third group of information sources consists of data that has to be obtained from external sources. These sources contain best practices as collected by the Dutch association of municipalities (VNG) and European Union.

The list of organizations the municipality cooperates with, is municipality specific and depends on the local situation. The following example lists the information sources for the municipality of Aa en Hunze.

Example: inventory of information sources at Aa en Hunze

Table 6.1 lists the information sources that are, or should become available within the municipality of Aa en Hunze. The fourth, fifth, and sixth column shows respectively whether the data is internally available, externally available, or whether access should be obtained. Note that for data sources that are externally available, direct access to the databases is not available yet.

Source Description Internally

available

Externally available

Should be obtained Best practices Available from national and European

sources



Benchmark Wmo Executed by SGBO 

Wmo desk Wmo desk Aa en Hunze 

Achmea Zorgkantoor

Care office 

CJG Centrum voor jeugd en gezin (youth care) 

Stichting welzijn Aa en Hunze