I have pondered over this question many times. If I was in charge what would I do, what would I say, what would I want to achieve? During the last three decades working in the NHS (currently as Associate Director for Transformation at Staffordshire and Stoke-on-Trent Partnership NHS Trust), I have seen governments, policies and leaders come and go…people enthused and wanting to make a difference only to move on in what seems a very short space of time.
Over the years I have been frustrated, bewildered and just plain bored at the ever-changing approach we take to embedding improvements. So if I had the chance to speak with whoever will be the Secretary of State for Health after next week's election, just what would I say?
I’d say that that I think those working in the NHS want to do the right thing for people using our services. However, to truly improve the NHS, we need people with the right skills and enthusiasm to develop the right relationships with others to embrace, design and deliver change.
In the public sector we seem to talk about change but often struggle to actually do it. Then along comes a change in policy and so what was likely a good idea at the time gets lost in translation through another round of structural changes and ultimately rarely delivered.
The points below are my blueprint that I carry with me. I call it ‘the common sense approach to delivery’ – not over complicated, easy to communicate and explain to others and most importantly achievable.
Develop a culture of continuous improvement
We absolutely need to develop a culture of continuous improvement that focuses on the individual. This means remembering why we are here. In my mind, that’s delivering the best care possible, recognising that the way we deliver care should be constantly improving, doing things differently where we know it’s better for patients, staff and the organisation – it’s about doing the right thing.
Care needs are increasing and resources are tight. We must look for the best value to deliver the best care for better outcomes, we need to keep our eye on the long-term goal, not just concentrate on the here and now.
Support from back office functions
Frontline staff need to be freed up to provide care, with support from back office staff to capture data and outcomes which can tell us if we are doing the right thing, including capturing what works and what doesn't. We need better ways of sharing best practice to help and inspire others.
Incentivise partnership and collaboration
Incentives should be aligned to developing relationships that focus on partnership and collaboration to achieve outcomes that are clear and measurable. At the moment it seems there are more perverse incentives preventing this – organisations are all vying for a share of the finances, when together we have far more opportunity to provide better, more efficient care.
Use staff and patient views to shape services
We need to listen to staff and patients, and demonstrate that their views are used to help shape services in the future. People who are on the receiving end of care should always be asked their opinion, and opportunities to give opinions and feedback need to be simple and transparent.
More importantly we need to share and use this valuable insight. This isn’t about being reactive, but using information in a systematic way and, just as importantly, letting people know what has happened as a result of their feedback.
Better use of technology
We need to make use of technology to support staff and patients. It’s no good having technology as an add-on, it needs to be built in to workflow and be the accepted norm. If staff aren’t ready to embrace this way of working, we must work out how to support them so that they are. This is a priority – otherwise we will always do it the old way and change will take a very long time.
We also can't quibble about providing people with the technology or who pays for it, we simply have to do it. Most patients have technology – such as smart phones, TVs or other internet access – or can access it through family and friends. Staff also need to be equipped and, more importantly, know how to use it – we need clear basic competencies here as part of mandatory training.
Create a culture of innovation
We need to create a culture of innovation and enthusiasm that isn’t risk averse. Staff and patients should be encouraged to give us their ideas and we should support them to test it. A national searchable database of what’s been tried already could help avoid reinventing the wheel. We need to be prepared to make mistakes and share that learning, as well to prevent others going down the same path.
Communicate, communicate communicate
We need to communicate, communicate, communicate – share best practice, recognise opportunities for improvement and learn from mistakes or things we could do better. The NHS is guilty of not communicating with a single voice, vision or leadership. We are separate entities with separate goals, we need to be more joined up to collaborate and share benefits.
Finally, we need constant leadership within organisations with a single vision that doesn’t completely change every time a CEO moves on. Above all, we cannot operate as separate systems but, in my view, need to operate as a whole.
With that in mind, we cannot do just one thing for improvement to really embed, we need all of the above – tackling things in isolation means that failure will be inevitable.
Joanne is Associate Director of Transformation & Innovation at Staffordshire and Stoke-on-Trent Partnership Trust and a OnlyWan Leaders for Change Fellow, www..com/jhardingnhs
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