A different perspective required?
I’m supposed to be Christmas shopping, but having lost the will to live hours ago, I’ve decided to grab a hot chocolate and post a final year reflection. My wife may have nothing to open on Christmas day, and my kids may well be appalled, but I will at least have achieved some form of cathartic release. I’m sure she will understand….
I think it’s fair to say that we, the NHS, are in troubling times. We’ve been here before. In fact, it feels like we are always here. Yet, the sense of increasing despondency is palpable.
Apparently, we are not as productive as we should be. Many have commented on what we really mean by this. Like those others, I question whether we are measuring the right things, or at least the things we could be measuring to highlight some of the areas we surpass in. I also wonder about our efficiency and effectiveness in such a highly complex system. Crudely, are our efforts being put to best use? But here’s the rub, it’s difficult to transform such a complex system to one that is significantly more efficient and effective with limited funding, little headspace, lack of staff and ever-increasing demands. As many organisations and systems ponder how best to claw back to initial overspend targets, we need to be honest with ourselves. We simply will not be able to eat this particular elephant in one sitting, even if covered in whipped cream, chocolate sprinkles and a dash of cinnamon.
So what can we on focus on?
There is clearly an argument for shifting the conversation and metrics submission from x contact within y wait times. There are other aspects to good quality care provision. Simply driving increased ‘production’ in the turnover of patient appointments does little to nothing to address actual experience and outcomes, and indeed one could easily highlight the risk inherent to the quality of care provided in such a sausage factory approach.
Digging a little deeper into experience, there is a well evidenced global shift into a more consumerist approach to health consumption, driven largely through people becoming more active participants in their health rather than passive recipients. People are seeking services that are more convenient to their lifestyles, consistent in approach, and transparent. As our home and social lives are increasingly played out through technology, it is perhaps not surprising that we would wish the same for our health and care needs.
Examples include ready access to a range of wellbeing information and self-management tools relevant to our needs. Maybe we would like to know more about what services are offered in our local area, and what the criteria may be to access them. We might be offered some automated screening tools to help decide whether we meet these criteria or not, and to be signposted accordingly. If our health changes, we may wish to access and update our care plans or comment on strategies we’ve been employing. We may wish to submit data from monitoring devices and to know if we have breached certain clinically relevant levels. We may feel our situation has changed enough to warrant direct contact with a health professional. We would almost certainly expect our data to be available to the clinicians helping us, across services and locations, to avoid repeating our stories and support better collaborative decision-making. We would likely want a way of delivering feedback on what worked well, and less well, and whether we achieved our expected outcomes to enable service improvement.
Meeting these expectations requires a better understanding of the experiences of users of health care services, and those delivering it. What are the resources, mechanisms and tools we need to employ to help develop and transform operating models to deliver the experiences and outcomes wished for? Engagement and involvement of public, users of services, carers and staff is critical if we are to better understand needs, wants and the problems we are trying to solve. Furthermore, we need to work hand in hand as we explore solutions, to ensure they are fit for purpose. Building partnerships with diverse industry partners is a key element as we seek to learn from the fertile pastures that exist within our wider system networks. Fusion teams can take many forms, and within the current contextual constraints it is the cross pollination of skills, knowledge and experience, that we must draw on to succeed.
Growing talent and capability in user experience research, service design, health technology adoption and change, and platform and application development, is essential. We cannot underestimate the need to also develop and recruit those with the necessary soft skills that will help us communicate and build strong relationships between health and care, and diverse industries including academia, specialist consultancy, private industry and voluntary care sector partners.
Funding needs to be appropriately aligned, recurrent, and needs to look beyond purchasing and implementing monolithic EPRs; there’s a wider technological world to play with here. Whilst EPRs are seen as core consideration, and they rightly have their place, they have limits. De-coupling data and building the right digital platform capabilities are key, and the funding must follow.
This short article would not be complete without reference to leadership. The requirements go well beyond that of defining and articulating a vision and calling to the banner. Rather it is one that understands the shifting sands of time and can flex between necessary structures whilst maintaining an agile approach, championing value add and the benefit of collaboration and cross-industry pollination. One that can talk to board and build a strong narrative, whilst drawing on experiences of using services and spending time with front-line staff to understand the day-to-day challenges.
With this in mind, my concern within the current financial climate, with recruitment challenges, ongoing disquiet over pay and ever-increasing demands for additional productivity, is that not only can we not eat the elephant in pieces, but it is in fact getting back up and limping smartly away. As I finish the dregs of my chocolate drink and prepare to enter the Christmas fray once again, having consumed more calories in one sitting than I care to think about, one thought sticks firmly in my mind. Perhaps it is in fact time we let the elephant go; not in any way to admit defeat, but to recognise that we need to think about the task differently.
