HOW WE DELIVER SUCCESSFUL AND SUSTAINABLE CHANGE
Our proven track-record of delivering successful and sustainable transformation, in often challenging environments, is based on a consistent approach to managing change. In summary, it’s about being clear up front why and what we need to change, before we collaboratively design, test, and then implement changes to existing ways of working.
In terms of benefits delivery, we baseline where the client is up-front, through interviews, surveys, process and activity mapping and both data and financial analysis. We then clarify the ‘case for change’, and identify and quantify the potential opportunities, and relevant key performance indicators (KPIs) we can track over time.
We then measure and monitor the success of the changes during programme implementation, to both track the benefits and also take any corrective action where required. These typically include both ‘hard’ metrics e.g. cost savings, compliance or staff turnover; as well as ‘soft’ metrics e.g. staff engagement or staff satisfaction.
STRATEGY AND SUSTAINABILITY
All our Executive and Board Director clients rank strategy and sustainability as one of top three issues on their agendas. While dealing with day to day targets and operational pressures, making the right strategic decisions, in a timely way, is essential to create efficient and sustainable healthcare organisations, at all levels.
The days of glossy and expensive strategy reports that get shelved and never implemented are long gone. Beyond deep sector knowledge and sound strategic thinking, the key to the development and implementation of a successful strategy is executive engagement.
We work with Boards and Executive teams to create alignment around strategic objectives and priorities, based on facts, evidence and vision. We then work with Senior Managers to ensure the right level of buy-in and create the conditions for the successful implementation of the key strategic decisions we helped to make.
FRONT-LINE SERVICE TRANSFORMATION
We should all agree that patients and, in a broader sense users, should always come first. However, the service and quality of care that patients actually receive, and ultimately the success of all healthcare organisations, is driven by the quality of their service delivery.
In our experience, delivering excellent care requires continuous service improvement based on the latest clinical and non-clinical best-practices, and whilst not easy to do, is something all clinical and non-clinical staff should be doing on a constant basis.
The common denominator for us in achieving both clinical and non-clinical service improvements is the ability to work with front-line managers and staff to firstly identify the key issues and then find the answers that they very often already have. We then support them with our experience, to identify and implement alternative ways of working, to enable them to transform and then continuously improve their services, whether it be to accelerate discharges on a never-big-enough ward, or being able to treat more patients per day at home with the same level of staff in the community.
Even the more optimistic outlook for the health or care systems and all their constituent parts suggest that the current financial pressure is here to stay. Efficiency is not only about reducing costs, it is also doing more without having access to additional resources.
While, in recent years, many of the easier efficiency improvements have already been delivered, we are never surprised to find many additional opportunities, some more obvious than others, in all the organisations we partner with. Sometimes because inefficiencies tend to creep back in, even after a strong efficiency drive. Or simply because day-to-day pressure leaves little time for stepping back and looking at what we do with a fresh perspective.
Well, this is what we do. We take an objective fact-based look about what our clients do and how they work, and then using our experience across dozens of clients and within different environments, we identify smarter ways of working. We then share our findings and a potential vision of the future and then collaboratively work with the client team to create the case for change and the plan to make it happen.
All of our projects have enabled our clients to deliver more with fewer or equal resources, be they clinical or non-clinical time, facilities, assets or consumables, whilst simultaneously improving patient care and staff satisfaction.
COST REDUCTION AND PROCUREMENT
One of the regularly untapped sources of value, whether it be in terms of service or quality delivery, is procurement and contract management. Ignoring for a moment the specifics of negotiating and managing contracts, or generating other sources of funding, we regularly see significant opportunities in our clients’ direct or indirect non-pay spend, which is generally poorly understood, unmanaged and fragmented.
This is typically the case across all key direct or indirect spend categories, whether it be clinical products and supplies, temporary labour, estates and FM, IT services, HR or professional services. Typically, due to a lack of internal expertise, the irony is that while some of the ‘easy wins’ like office supplies may have received significant attention, we often see large multi-million-pound 3rd party, sub-contract and outsourced contracts broadly untouched from a procurement and contracts perspective, with limited management of the associated service, quality and performance delivery.
Indeed, many of our clients can’t even say what they spend on 3rd parties, with whom, or on what, given issues with poor spend categorisation and reporting. Finally, procurement in the health and care sectors is typically well behind the curve in terms of appropriate skills, processes and tools, with procurement typically being seen as a transactional, back-office function without the capacity or the technical and softer skills that procurement teams in other sectors have had in place for many years.
Finally, while we also see clients spending a considerable amount of time, energy and investment in pursuing new business, with all the associated politics and risks, both in terms of the bid management process and then associated implementation, very little attention is paid to an area which can deliver immediate bottom-line benefits and is entirely within their control.
The good news is that building on our past experience in many other sectors, and knowledge of the latest procurement and supply-chain best-practice, is that we know how to rapidly achieve a step-change in procurement and contracting, and have a proven track-record of delivering major financial, service and quality improvement benefits from procurement and contract management for our clients.
BESPOKE TOOLS AND TECHNOLOGY
However good or expensive their core technology systems may be, many health and care organisations find that there are often specific clinical or organisational needs that are not covered by their core systems. We also regularly find a proliferation of manual or highly inefficient spreadsheet-based reporting processes that run alongside core systems, creating not only a huge administrative burden, but also inaccurate and untimely data. We also see countless examples of unnecessary reporting, and of lack of associated insights or decision-making.
While we do not believe that implementing new systems is ever the answer to any organisational challenge or opportunity, having the right tools is essential to deliver change, as well to support the day-to-day running of any successful health or care organisation. Over the years, we have rapidly developed a range of simple, low maintenance and extremely cost effective tools, either entirely bespoke or rapidly tailored to address each client’s specific needs. These include:
A comprehensive bespoke ward management system to manage daily ward operations and reduce length-of-stay by proactively managing admissions (including mandatory audits), monitoring the patient journey, measuring and monitoring bottlenecks and delays, and then proactively managing the discharge process
A simple measurement tool to capture the value being added by a number of Community Services admission avoidance and accelerate discharge teams working with the local Acute hospital
A bespoke order management suite for wheelchairs services, enabling the ordering, proactive tracking and management of thousands of orders p.a., including direct links to client-specific product prices, across preferred suppliers. The tool also provides automated commissioner and finance reports and a range of internal management reports to enable the tracking of critical KPIs, such as product costs, category spend, key supplier compliance, spend by patient type, supplier lead-times and contract breaches
We don’t believe in technology for technology’s sake, and we are very happy if we already find all the right tools in place to successfully deliver change. However, when we find key gaps in enabling tools and technology, our process, analytical and rapid development skills enable us to fill these gaps, in a simple, pragmatic and cost effective way.
COMMUNITY HEALTHCARE TRANSFORMATION
While currently only accounting for approximately 10% of the overall healthcare service budget in the UK, we are convinced that Community Healthcare Services will provide most of the answers to the long-term sustainability of the healthcare system. This may be by supporting the prevention agenda, by preventing unnecessary admissions and re-admissions to the Acute, or accelerating associated discharges.
However, in order to play an ever bigger role, Community Healthcare providers will need to keep evolving and not just to become more efficient. They will need to keep challenging the boundaries of what they currently do, be able to clearly articulate and prove the value they provide, and improve the way they interface and collaborate with the rest of the healthcare system.
The opportunities are there for the taking, and transformation in its broader sense is the key to unlock them. Change is hard, not only when it is about identifying new operating models and pathways, and integrating services, but also when simply improving existing services.
Nevertheless, we have a consistent and proven track-record of successful transformation within Community Services, and we are keen to continue to help our Community Services clients play an ever bigger role in this ever evolving healthcare system.
CORPORATE SERVICES TRANSFORMATION
No matter how big or small a health or care organisation may be, one common critical success factor is the quality of their corporate services, from HR to IT, Finance, Quality Management and Reporting.
In our experience, save a few exceptions, the quality of corporate services across the health and care sectors tends to hinder, rather than enable, successful service delivery. Busy Executive teams focused on front-line services tend to underestimate the level of investment and management attention required to create high performing corporate functions. Even if it is rare for external auditors such as the CQC to point at deficiencies in corporate services, we encountered many instances of poor or inefficient front-line delivery because of the lack of appropriate support from corporate services.
We successfully work with Executive Managers to re-address the balance, ensuring not only that the appropriate level of resources are allocated to deliver efficient and effective corporate services, but also that they actually enable rather than block successful front-line service delivery.
TRANSFORMATION PROGRAMME LEADERSHIP
It is hard to think of a health or care organisation, no matter how big or small, that has not recently embraced a change programme of some sort. Among many success stories, we encountered at least as many examples of slow, stalled or abandoned transformation plans.
The most common reasons of failure include: the lack of a clear case of change, a scope that is too ambitious, a shortage of experienced resources to lead the programme, insufficient executive support and dare we say it often the quality and approach of external advisors brought in to help!
While we believe that successful change programmes ultimately have to be designed, owned and delivered by client executives, managers and staff, we have often been called in to help get things back on-track or, even better, to help set-up successful transformation programmes correctly in the first place. Clarity of vision, objectives and timelines, a strong and compelling case for change for staff and patients, with full executive backing, an appropriate and achievable scope, sufficient levels of experienced resources and simple monitoring and communication plans… These are just some of the key elements that we bring to the organisation, when we help to set-up, deliver or get back on-track client transformation programmes.