NHS Improvement have announced that they will expand the ‘Model Hospital’ database to include mental health, community, specialist acute and ambulance trusts. For me this raises a question about driving sustainable improvement: how helpful will simply providing further data really be, unless additional support to change behaviours is provided?
The current prototype of the model for acute hospitals (deployed at the beginning of the year) was the result of recommendations by Lord Carter as part of his review of NHS productivity. The thinking was that some common metrics would help describe what ‘good looks like’.
Whilst it is useful to be able to compare apples with apples in terms of performance, the starting point for the Carter review was to ‘follow the money’ and understand operating expenditure. This is expected to help organisations focus on key areas where productivity gains can be achieved.
The financial position is, of course, critical, and Trusts entering special measures or ‘turn-around’ in recent years have largely been supported to establish cost improvement programmes. However, how effective and sustainable has this approach been? NHS Improvement is estimating that the Trust deficit in 2017/18 will be between £500m and £600m, and we have already seen at least one trust go back into special measures having failed to maintain standards.
One of the key problems is that many of the performance indicators used in NHS hospitals are simply a thermometer for the wider health and care system. An appreciation of the whole system is needed if the root cause of issues is to be understood. The indicators also only measure how we are dealing with demand, rather than addressing failure demand, or opportunities to address demand differently. For example, breeches of the four-hour target in A & E are likely to be an indicator of lack of primary care access, or lack of community and social care provision.
Exceptional performance requires constant focus from leadership, proactive engagement with staff and an analytical eye on the detail in order to make step changes in improvement. Critically, engagement and relationship building also need to extend across organisational boundaries, including with social care colleagues. Therefore, Local Sustainability and Transformation Plans (STPs) should present health and care systems with a real opportunity. Yet, those cross-system relationships are still highly variable at best.
Within the remit of the Five Year Forward View, health and care economies have a real opportunity to make more radical changes. These include establishing working arrangements and relationships that can fundamentally look to change the system and manage demand in a way that actually improves outcomes for both patients and staff.
Our experience at IMPOWER is that sustainable change depends on getting the relationships and behaviour right, as much as it depends on finding new and innovative ways of delivering care. Whilst we do of course work with finance, process and supporting technologies, we actually prioritise getting the relationships right in a way that works at a local level. We apply recognised behavioural science approaches to help shift thinking and behaviours, whilst keeping people engaged in the process.
I for one welcome the work NHS Improvement is doing to provide good quality, standardised data in the ‘Model Hospital’ programme. However, it is only part of the picture, let’s not forget that it is people who really drive change; we shouldn’t underestimate the impact of human factors on sustaining a better future.