Following on from the previous post about the impending visit of UK health reformer, Professor Lord Ara Darzi, the article below profiles another NHS transformer, Jim Easton, who is also heading for Australia later this month.
It identifies some of the ingredients of successful quality improvement, including ensuring leaders have the narrative skills to engage key staff, and the alignment of rewards and incentives with desired outcomes.
What does it take to improve the quality of healthcare?
Terrie Paul writes:
Jim Easton, the NHS Director of Service Transformation, is the person responsible for delivering the £20bn of efficiency and cost reduction saving in the NHS under the QIPP (Quality Innovation, Productivity and Prevention) agenda developed by Lord Darzi.
The task faced by his team is monumental, but the signs are that he is making progress with £5bn of audited savings made to date. His approach is to use quality as a means of controlling and driving down cost.
At the Institute for Healthcare Improvement conference in Paris in April, Easton outlined his approach and gave a preview of the Change Model he and colleagues from the NHS Institute have developed to control and drive efficiencies.
The NHS Change Model is a single operating framework for everyone in the system. It’s a vehicle, and a way of making sense at every level, of the ‘how’ and ‘why’ of delivering improvement. It brings together everything the NHS knows about delivering change to the system.
In his address in Paris, Easton made it clear that efficiency is of itself not the silver bullet: you have to do ‘unpleasant things’ to redeploy people or close wards once an efficiency gain has been made, otherwise it isn’t realised.
He also stated that there were many valid and usable quality improvement tools available to everyone in healthcare. What tends to happen in deciding how to use them is that ‘Islands of excellence’ are created in the system, but that these remain isolated and are not system wide.
As a result, a key component of the Change Model is the spread and widespread adoption of improvement initiatives such that they become fundamental to the whole system, not merely a feature of small parts of it.
In driving change the process of engagement with key staff is paramount. However, the effort to do so in a constructive manner can be at the expense of discipline, and the spread and adoption of improvement does require a disciplined approach if it is to succeed.
A key to unlocking much of the success of improvement lies in aligning it with a common purpose. Making people better is the reason why most healthcare professionals started up. Reference to this reason or purpose, and the willingness to repeat the message endlessly and back it up with engaging narrative is always necessary.
Closely associated with the notion of a disciplined approach is that of rigour on delivery. Easton cites the well-documented effectiveness of the WHO Surgical Checklist, and the disappointing fact that some surgeons still refuse to use it.
In order to deliver sustainable improvement and to create widespread adoption, a rigorous delivery standard has to be applied. The Change Model also requires the measurement of outcomes to be transparent: to be accessible to the wider public, both from an ethical standpoint but also as a powerful driver of improvement, despite the challenging nature of what it reveals at the start of the improvement process.
Another important driver of change and improvement is that of aligning rewards and incentives with desired outcomes. Too many systems hamper effective improvement by failing to align incentives and it is difficult to do this well, but is fundamental to long term effectiveness.
Lastly Easton believes that we have to move from communication to engagement. Tell people once and a few will retain it. Tell everyone, face to face, several times and they will take on your position eventually.
The job of ‘engagement’ rather than mere communication is very challenging, and the NHS Institute has been working on developing narrative skills in leaders to improve engagement.
Easton speaks about the need for leadership for change and the need to benchmark outcomes at the best rather than the average level, despite the fact that being ‘as good’ as other institutions or systems can be a comfortable state of mind.
It won’t lead to improvement however and the need for leaders who can engage with their teams to create the exceptional rather than the adequate is another key component of the Change Model.
Given the impressive early results the Change Model is delivering and the sheer size of the challenge, all eyes will be on the UK to see if it continues to do so.
• Jim Easton and his NHS colleagues will deliver a 2 day workshop outlining the Change Model approach in Sydney 14 – 15 May. The Australian Healthcare and Hospitals Association (AHHA) is partnering with the NHSI at this event entitled: Healthcare Leadership for Challenging Times. To register, visit http://ahha.asn.au/event/healthcare-leadership-challenging-times or telephone (02) 6162 0780