BUSINESS IMPROVEMENT
W
e strongly believe that NHS Trusts can retain their self- management to deliver all that outsourcing claims to
deliver, and much more, for the benefi t of the country and its people by retaining sur- pluses within the NHS.
As outsiders looking into the NHS we would not claim to understand the politics and complexity of the operational environ- ment. However, equally, this gives us an unbiased opportunity to ask questions and make suggestions to promote debate about the opportunity to adopt a different organi- sational approach – many of the principles of which we can readily identify working within successful Trusts.
If Trusts have all the knowledge and expe- rience, then why are they losing bids and being outsourced?
What can the private company achieve that the NHS can’t do for itself? What is so unique about the way the private companies operate that the NHS can’t adopt itself?
For some Trusts the major issue is that of insuffi cient resources (people, money, in- vestment, time); they enter a spiral of fail- ure and lose their freedom to act indepen- dently. They wish to implement change, but change is always ‘resource intensive’ and less effi cient in the short term. They are faced with additional costs to improve their performance, yet are trapped in the situation where funding is hard to obtain.
Foundation Trusts that have won a degree of independence and are considered to be a ‘good risk’ are better placed to obtain fi - nance and resources for the initiatives they wish to take on.
It appears that private healthcare providers can more easily access borrowing because shareholders feel they can deliver effi cien- cies by creating and operating in a non- bureaucratic environment to deliver the patient services and profi ts for future devel- opment, along with shareholder dividends.
So shareholder confi dence, and therefore investment, go hand-in-hand with operat- ing in a different way to deliver effective, high-quality patient services in the most effi cient way.
How might each Trust take charge?
With the NHS, as with any large organisa- tion, there are parts that perform extreme- ly well and others that under-perform. Accepting that the nature of the services provided are extremely complex and that
the local environments vary tremendously, why is it that under-performing Trusts (or elements of Trusts) cannot emulate the successful Trusts, but private companies apparently can?
Has the private sector got a monopoly on talented people, or are they creating an environment that frees them to contribute and provides them with the resources and reward that motivates them to deliver?
Nothing we read about from the private companies’ approach is new; for exam- ple involving clinicians and other clinical staff in decision making for the good of the patients, giving employees a stake in the organisation’s success. ICI took this approach in the 1950s and AstraZeneca continues this today; the John Lewis Part- nership takes employee ownership a step further.
Why can’t a successful value proposition and operational model be developed based upon the many successful Trusts?
Is it because even the most successful Trusts may not have an underlying ap- proach that can be shared internally and transferred and rely on the localised intui- tion, experience and talent of their leader- ship? We believe that all organisations can improve by applying a set of core organi- sational principles that all leaders at every level can tap into and apply consciously and consistently; a shared mental model.
So why can’t the NHS heal itself? Well it can!
Caroline Shaw, who runs The Christie in Manchester, outlines in her recent inter- view with National Health Executive how applying a business strategy has trans- formed the Trust.
She said: “The Trust is run as an effective and effi cient business, with a clear vision and understanding of its purposes and identifi ed business streams that must dem- onstrate their contribution to the delivery of the value proposition to its stakehold- ers. Taking a view of the organisation as a whole, adopting a very clear management structure, making shared decisions with input from employees of all disciplines and patients, are seen as critical features in de- livering the very best ‘patient experience’ possible.” (‘Head for Business’, NHE, Sept/ Oct 2011)
Other parts of the NHS have been equally successful in turning around their situation. In their report to Government, ‘Engaging
for Success: enhancing performance through employee engagement’, David MacLeod and Nita Clarke said: “The London Ambulance Service has been compared with organisations like John Lewis Partnership, Tesco, Sainsbury’s, Standard Chartered Bank, BAE Systems, Toyota, Babcock Marine Clyde, Google, Telefónica O2.
“It has transformed its service delivery… in the past few years. A service that was criticised by London’s media as the ‘worst’ ambulance service in Britain in 1997 was hailed ten years later as the best.”
It is our contention that Acute and Founda- tion Trusts need to ‘insource’, by applying principles from the best Trusts and the suc- cessful outsourced providers internally to their own Trusts.
One option is to take control of their local context and situation to deliver value to all stakeholders (including staff, patients, community, and government as part of their local governance arrangements). For the success of Trusts like The Christie to be repeated, the fi rst requirement is to de- velop a value proposition that delivers their stakeholders’ purposes; to understand what they do and what they don’t do and deliver using a defi ned business strategy.
To improve their delivery signifi cantly, whether successful or failing, the Acute and Foundation Trusts might consider:
• Looking beyond their organisational charts, which do not embody or help them to manage the complexity of their operation.
• Understanding how to support their people’s productivity and local decision making to increase effi ciency, innovation and patient awareness, and not be driven purely by the standardisation of policies and processes.
• Ensuring they have the organisational agility to respond to ever-changing ex- ternal and internal pressures.
• Understanding the role of leadership in the organisation and the value of posi- tively developing leaders at all levels and in all disciplines.
• Connecting all their people in a way that gives each person their own line of sight from their day-to-day activities to the de- livery of the stakeholder value proposi- tion. This can help create the motivation to initiate and introduce changes they see are necessary not just those imposed by others.
• Creating feedback loops both up and down the organisation to allow all in- dividuals to contribute their know-how and innovation. Continued overleaf >
national health executive Jan/Feb 12 | 25
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