The Perceived Problems
Healthcare providers and commissioners face multiple challenges. They increasingly recognise that the NHS must change the way it operates to effectively meet future challenges. Commonly held opinions dominate discussion – from a belief in rising demand for healthcare services, costs associated with technological and treatment advances, increasing public expectations and a funding gap of £30 billion.
Conventional Approach to Change
Conventional approaches adopt an internal activity and cost-reduction focus. They typically involve workshops to agree service models and action plans. These tend to be accompanied by artificial modelling of service capacity and staff resourcing which arrive at ‘optimum levels’ of activity ‘contacts’ that are then tested in workshop environments. Following this type of analysis, work is undertaken to standardise service processes so as to reduce variation and waste.
Inherent within this approach is a belief that there is a capacity problem; solutions can be found via workshops and abstract planning models that determine staff resourcing. Workforce planning often ensues to try and address the perceived problem of the ‘plateaued worker’. The logic equates to stable staffing levels and standardised processes which will lead to activity and cost reduction gains. Standardising processes typically take place in workshop environments, far are removed from where the real work occurs.
Yet, in service organisations, seeking to standardise processes often creates problems. In healthcare there is high variability of patient demand; standardising processes will only cause service performance to fall (as the standard offering fails to meet the natural variation in needs) and costs increase (as the service provider’s standard work leads to more activity creating additional process waste and rework).
Adopting a Different Tact for Better Results
To address these challenges I have pioneered a new and refreshing approach to healthcare analysis – the Consumption Demand Method™. The starting point for improved services at less cost rests on more intelligent use of data to inform future performance improvement through intelligent system and service redesign. This alternative approach to realising better healthcare services and less cost begins with looking at healthcare data differently, not from an activity but patient-centred perspective.
Unlike existing practice, this work establishes time-series data to understand the true nature of person-demand for acute services in order to better understand the root-cause(s) of service challenges facing healthcare commissioners and providers alike. From understanding patient demands it is possible to develop knowledge as to ‘who, where and why’ these demands exist in the first place and how best to meet them in order to provide more effective, person-centred services at less expense.
The Method is directly influencing commissioners and providers, helping to challenge conventional thinking about healthcare demand. A recent study of secondary healthcare demand reveals counter-intuitive truths about the true nature of service demand. Unlike activity-levels, patient-centred demand in secondary care is not rising, but entirely stable and predictable. This is bad but good news.
Rather the root-cause for increases in activity (and associated costs) lay in the inability to successfully design service responses based on genuine understanding of patient needs. This inability drives ‘amplification of demand’ from relatively small numbers of patients – the ‘vital few’.
I have utilised the Method to establish a series of ‘demand-led’ improvement projects. These include work in the following areas:
- Primary care transformation
- Delayed transfers of care (DTOC)
- Accident and emergency
- Referral time to treatment (RTT)
- Integrated diabetes service
- Sustained high-cost users
- Long-term conditions
- Out-of-hours provision
- NHS 111
Moreover, the Method has also been successfully used to perform wide-ranging reviews of medical specialities and existing improvement schemes. One such review of a two-year QIPP scheme in paediatric urgent care, which cost seven figures to resource, found that the local healthcare economy would have saved more money by not doing anything! The work analysed demand for services against stated project aims, proposed changes in both design and process and realised operational savings.
The approach and work also acts as a catalyst in providing knowledge and skills transfer to senior clinicians, commissioners and specialists in the analysis of consumption data and redesign of service models and care systems against patient-level demand as opposed to arbitrary and abstract activity indicators.
In fact, the Method effectively identifies ‘business gaps’, encourages thinking about the real problems, asks intelligent questions and provides the means to sustainably improve performance. It deliberately keeps abstract programme and project management, risk assessments and associated document reporting to a minimum as they impede real change.
More intelligent use of data in this way can better inform future commissioning and operational improvement through system and service redesign. After all the NHS has exhausted all other misguided approaches – standardising; over-medicalising; functionalising and commercialising operations. We need to humanise healthcare and focus as much on care needs as medical treatments.
For more information see Front-to-Back Thinking – humanising healthcare – Dibley Consulting or contact me at firstname.lastname@example.org