Access to public services: the forgotten link to equity

The recent academic debate around public services is taking a hard look at value creation mechanisms. Specifically, whether these services are public or private, users interact with the institution-service provider, and it’s primarily in this interactive dynamic that value creation happens. Users themselves contribute to the interaction with their experience and skills, which means that service provision – even for the exact same service - will never be identical for different users. There are any number of individual, social and educational characteristics as well as aspects of the users’ work and life that determine their ability to create value when interacting with public services. And if we consider the ones that target the most vulnerable groups, they will likely find these services particularly difficult to navigate, as they have a lower level of education, fewer social ties, a higher risk of social exclusion, and so forth. In terms of public health care and social services, we need also to think about the correlation between health outcomes and socio-demographic characteristics: people who live alone, outside of urban centers, with low levels of education are on average more socially vulnerable and less healthy.

The risk, though, is that the interaction between the public service and the user starts off on the wrong foot, if it begins at all. That’s why the prerequisite for value creation in this scenario lies in the moment the user accesses the service, the initial contact between supply and demand. Often in this context, the public service provider takes for granted the fact that whoever needs a certain service will go to the service portal to request it, or send an email or make a phone call, or visit the dedicated website. In other words, the assumption is that users themselves will connect with the service provider. From that point, as long as certain criteria are met, access is granted. But in actual fact, there is no guarantee that simply accessing a service leads ipso facto to resolving the need that prompted the user to reach out to the service provider in the first place.

In a collaboration with a large Italian city and its welfare department, our team of researchers explored the modes of access for municipal social services. Specifically, we adopted a mixed methodology following five steps. First, by doing a desk analysis of municipal documents and the city’s website, our team was able to draw up a map of available welfare services and the relative access channels. Second, we conducted semi-structured interviews with supervisors responsible for service access and provision, which gave us insider insight - from the perspective of social service providers – into access mechanisms.

Thanks to our map, we then tracked the access channels available for every service provided in the welfare sector. These channels included digital, web, email, telephone and in-person. For the next step the team used the mystery shopping technique, a common practice in marketing, but not very often seen in the context of public services. Specifically, this involved first creating five user profiles for social services (personas) and then posing as users looking for information and directions for navigating the city’s social service offering. This meant the research team could scrutinize the user experience in terms of service access, verifying the timing and responses as well. The results of this analysis were then put on the table for discussion in five focus groups with the heads of municipal social services, with the aim of working together to design a new access model for the city’s social services.

Our findings show major fragmentation as far as access channels and consequently multiple access paths, leaving users confused as to which way to go. The city’s attempt to bundle and simplify these channels had positive – albeit partial – results, leaving traditional channels earmarked for specific services next to general service channels. The city had already made an initial effort to create a central office to handle the numerous incoming requests from various channels, assessing them using a standard method. But with no clear channel strategy, no single filter to make a consistent assessment of service requests, and no identification of homogenous target user groups, the access route was not very clear. In fact, if the access phase of service provision isn’t properly managed, public value can be lost because users won’t be directed to the services they need, in some cases.

Public institutions must do more to verify how users access to their services, and how these services can help guarantee greater equity. Complicated, confusing mechanisms could compound the chances that users “self-select” the wrong service, when they should have found what they needed elsewhere. This is even more evident for vulnerable users who have fewer resources. The risk is deteriorating the outcomes of the services in question, diminishing their effectiveness and appropriateness, and exacerbating inequalities in the system.  

That’s why quantitative mechanisms need to be deployed to monitor the users who access services via various channels, the obstacles they encounter, the time it takes, and so on. What’s more, the effectiveness of service access should be ascertained through mystery user analysis, which would enable service managers to gauge the experience of real users, and not simply consider a theoretical or ideal access scenario.