Andrew Corbett-Nolan on why NHS organisations need to share best practice in order to improve their service.
At the Good Governance Institute (GGI) we are often asked what other NHS organisations are doing to address problems, innovative and improve.
When answering these questions, I’m always struck by how little of this information is easily accessed and promoted.
The NHS should be shouting from the rooftops about the great stuff it’s doing, not sweeping it under the rug.
Helen Bevan, director of service transformation at the NHS Institute for Innovation and Improvement, recently suggested that the best performing organisations are those that have “a leadership that promotes knowledge sharing internally and externally and a curiosity to learn (and steal ideas) from the best…[and as] a result…demonstrate adaptability and preparedness for the challenges of tomorrow.”
Similarly Sir David Dalton, chief executive of Salford Royal NHS Foundation Trust (one of the top performing trusts in the country), recognises that “the notion that any institution or individual has nothing to learn is a hubristic, dangerous fantasy,” and that “it would stretch credulity beyond breaking point to suggest that there isn’t a ward somewhere in the country that is doing something in an innovative and duplicable way.”
So, if we agree that there is a need to communicate and share in order to excel then why does this not happen more?
The key issues
Part of the problem is a long-standing silo mentality. NHS organisations tend to be distinctive, with differing geographies, population needs and objectives, and they have traditionally done little to share their experiences of these.
Recent moves to integrate organisations and devolve budgets are welcome and should help to foster better working across organisations. However, this will be no easy fix and a lot of hard work will need to take place in order to ensure that any learning from pioneers such as Manchester, Cornwall and the many Vanguard sites are shared and absorbed.
Professional silos are also strong in the NHS and hamper service improvement activities. They have to be broken down in order to encourage shared working. Technology has the potential to support this change and can play an important role in improving efficiencies.
Despite this, technology in the NHS often lags behind other sectors. For example, it’s not uncommon for staff to not have access to an NHS email. Shifting mindsets around how staff work, interact with one another and access information will be crucial to realising the goal of a paperless NHS.
The use of online forums and apps designed to allow clinicians, managers and staff to network, gather patient experience and keep abreast of developments in the NHS should not be underestimated.
At Birmingham’s Children’s Hospital they are working to create an online application that is able to provide managers, clinicians and members of the public with real time updates on the performance of the Trust, based on patient feedback. But how well publicised is this?
There is also an issue around funding. Early adopters of innovative practice need to be supported in order to network and exchange ideas.
With the NHS facing unprecedented funding cuts to deliver the £30bn of efficiency savings required by 2020, there is a real danger that opportunities for learning and sharing – ie attending conferences and undertaking courses – will be the first to be cut, despite these playing a fundamental role in ensuring the NHS remains viable.
A collaborative approach
When organisations do partner, share best practice and learn from each other, significant improvements to quality and patient safety usually follow. A good example of this was the collaborative approach taken to improve cancer and emergency care services in the early 2000s.
The Emergency Services Collaborative was designed in 2002 to support the NHS plan that all patients will be admitted, discharged or transferred within four hours from arrival at A&E. Trusts were mandated to meet over a period of two days, four times during the course of the year long programme, to learn about service redesign and share experience.
The target was subsequently achieved. Conversely, NHS England figures show that in the week before Christmas 2014 just 82.1% of patients were treated within four hours – the worst level on record.
On a lesser note, The Foundation Trust Network’s ‘Review of Buddying Arrangements, with a Focus on Trusts in Special Measures and their Buddying Organisations’highlighted the benefits of mutual learning and support, recommending that “consideration… be given by national bodies, and the sector itself, to how to promote the use of buddying more widely within the provider sector, as one important means of encouraging shared learning and driving improvement.”
We should also be looking at examples of great healthcare from elsewhere. In a recent report – ‘Goldberg III: Can the NHS Deliver Integration? Lessons from Around the World’ – the GGI’s David Goldberg makes a compelling argument for NHS organisations to stop working in isolation in order to provide an integrated, aligned and joined-up health and social care service.
In doing this, he highlights a range of examples of best practice from the UK, Europe and the rest of the world, such as the Buurtzorg Model in the Netherlands and the Kaiser Permanente Model in the US. We ignore these at our peril.
Organisations must not be too afraid or too proud to look elsewhere for solutions. Working in isolation tends to hinder organisations rather than help and it is likely that if your organisation is struggling with a problem then someone somewhere else has grappled with, and solved, the same problem before.
At the same time, we in the NHS need to make such case studies and models readily available and adaptable for NHS organisations. Doing so will save time, energy and ultimately improve the quality of care.
Andrew Corbett-Nolan is chief executive of the Good Governance Institute.
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