How to deliver real change by doing the right thing for the patient

In our post about the recent announcements, we recognised that, as the NHS is restructured from the Centre out, the challenge for Acute Trusts remains the same – deliver more, with better outcomes for less money.  

The traditional operational and process improvement models of the past decades can only support a system to deliver when the population and context remains the same, which it hasn’t. The past decade in particular has played host to a number of shifts which have had a material impact on the external and internal factors affecting our Acute Trusts: 

• An ageing population with more people suffering from multimorbidity – several chronic health conditions at once which require long-term support to manage effectively and prevent escalations and crises 

• The Covid-19 pandemic which has left a legacy of mental health problems, missed diagnoses, extensive waiting lists for routine operations and treatments, and, arguably, a more anxious and risk-averse population 

• An exhausted health workforce. The constant push for change and improvement amongst a stretched workforce has caused fatigue and unhelpful divisions between clinical and administrative staff and rifts between the organisations within a system 

At IMPOWER, we think that a new series of tools is needed to create the sustainable change needed for patients which supports our population, the health and care system and our health and care workforce to thrive. This new approach puts better decision making at the heart of the change and means that staff are empowered to work differently with their patients and each other to get better outcomes and, in the process of making better decisions with and for patients, save money. 

Delivering savings for acute trusts is most often directly a result of doing the right thing for the patient. For example, not admitting a frail elderly person to an acute ward and therefore not paying for a lengthy stay in hospital and an increased care package on discharge due to deconditioning but instead putting in place the right support and medical oversight for them to recover well at home. Or discharging someone directly from the assessment unit once they are deemed medically fit and staff have had a strengths-based conversation with them about how they can stay at home safely putting a full plan in place to support them using Tech Enabled Care options and VCSE support to maximise their independence. 

Supporting leaders to use new approaches and different tools to grip operational and behavioural issues so that frontline teams hit performance targets (without cracking under pressure) is the right answer to the delivery challenge. Working differently like this also means that staff are empowered to do the right things for their patients and gain an increased sense of satisfaction from achieving better outcomes for them. For example, if a ward team is able to work together with a patient and their family to get them discharged home a week earlier with bridging support and virtual care they will know that the outcome is better for that patient who is no longer at risk of hospital acquired infection or falls on the ward, and will recover better in their own environment

When we work with frontline teams and leadership in acute settings we bring people together around the problem, recognising it as shared and not one professional or teams fault, and bring their motivation to do the right thing for patients to the forefront, focussing on what support people need and how we can achieve this, not what might go wrong. We upskill staff teams in ABS techniques so that they can have better conversations with each other, with staff from other organisations such as Social Care Workers, and with patients and their families/carers. ABS is a set of methods and approaches we can use to influence and change behaviours which are detrimental to the improvement we want to see. For example, an elderly patient’s family might be worried about them returning home and this might result in behaviours such as not making decisions about their care or not engaging with the discharge process. In this scenario we would encourage staff to think about whether a different messenger might help, for example a conversation with the consultant where they could be reminded that the hospital is not the normal environment and that they would be doing the right thing for the patient by supporting them to be safely discharged as soon as possible.  

We also coproduce strengths-based tools with staff to support them to have these kinds of conversations and help them to influence others to achieve shared goals. For example, redesigning a form which prompts them to have a strengths and outcomes-based conversation about discharge with a patient rather than the old form which simply asks for the recommended pathway and what needs they have. Importantly, we work with clinicians, empowering them and the extended health professional team to lead the change they want to see.  

Our observations and conversations with frontline staff inform the rapid design and mobilisation of test and learn interventions which might range from factors they can immediately control (the controllable space) to things they might need support from other teams or organisations to achieve (the influenceable space). This means that the change work we do is sustainable because it solves the problem rather than shifting it to another part of the system. Putting the person we are supporting at the heart of the design process means that we have to work as a system-wide team to enable them to make smooth transitions between services and organisations, getting them home as soon as safely possible if we can.  

For system leaders to succeed in delivering operational improvements which save money, the right conditions need to be in place. For example, leaders need to stand together behind a clear vision with one clear aim e.g. to reduce the time spent by over 65’s in hospital. Leaders need to act decisively to make time for the change process in the workplans of frontline staff – sending the message that this isn’t something extra to do when you have time, it’s an important part of your role and development. The metrics leaders can choose to support the delivery of change can make a real difference if they matter to staff and motivate them every day to keep up the good work. Having these so called ‘primed’ metrics in place for each ward to track their own progress makes a real difference to the sustainability of the intervention. Each ward can see the successes and sticking points in their own data on a live basis so that they can iterate the interventions and celebrate the wins.  

Tools such as Applied Behavioural Science (ABS) and strengths-based approaches, alongside carefully building the conditions for success as a leadership team and setting Primed performance metrics, not only produce better experiences and outcomes for patients but also build resilience in the workforce and strategic headspace for leaders. 

To summarise, here are the key messages: 

• The health landscape has changed drastically, but operational and process improvement tools have stayed the same and so they no longer support sustainable change 

• Change management tools such as ABS, strengths-based approaches, leadership conditions for success and the right performance metrics support frontline staff to lead the change and create an environment where the easiest thing to do is also the right thing for the patient  

• We work with frontline teams, clinicians and system leaders to create sustainable changes which produce better outcomes for people, support and empower staff and save money 

Get in touch to hear more about how we can work with you to deliver better outcomes which cost less.