Change will always require a senior champion

Change requires a senior champion

Grassroot ideas are to be encouraged, but their viability demands strong guidance from the top.



KPMG in the UK


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Healthcare collaboration requires serious investment and organisational commitment. That can only happen when the management team champion the collaboration.

Implementing change successfully, either in the NHS or anywhere else, requires a particular type of person. They need to be energised, passionate people with a driving vision and also senior enough to command respect from people both in the organisation and around it, including regulators.

Sir Robert Naylor, Chief Executive of University College Hospital London, is recognised as a very powerful figure who has sponsored change, taking his hospital from the brink of financial failure to being one of the most successful Trusts in the country.

Equally the board of West Middlesex hospital was incredibly brave in recognising they weren’t financially sustainable in the long run and putting their hand up before it failed. The leadership demonstrated by the Chairman, Chief Executive and the rest of the management team, in making that decision was inspiring, and it couldn’t have come from anywhere but the top.

Bottom-up change does matter and good leaders listen, but successful leaders inspire, persist and drive through. It is naive to think change will happen without a senior champion.

Think about a nurse who wants to change the model of care on her ward.  She’s only going to be able to do that with the support of a strong sponsor further up the chain, such as a matron or the director of nursing.

It is important to encourage innovation on the ground, but strong top down leadership is essential when deciding which initiatives to back and which are undeliverable. This idea that bottom up change just magically blossoms simply doesn’t work. All this does, is lead to inconsistent practice and as research shows, poor patient outcomes.

For example, there’s a golden rule that if you present at hospital with have a heart attack at hospital, you should be given aspirin. Despite this, studies between 2002 and 2012 show that anywhere from 5-15% of patients did not receive this treatment.

Conversely, one hospital in a not particularly affluent part of Korea achieves heart surgery outcomes far ahead of the best hospitals in the West. How do they achieve this? By taking the research on best practice and implementing it without deviation. The patient outcomes speak for themselves.

A similarly standardised approach is used in the Ramsay group of hospitals in Australia. They use similar clinical equipment, prosthetics, drugs, methodologies, even down to linens and bed layouts, to provide a consistent clinical approach and patient experience. I think this strictly imposed accepted practice is the way to achieve the best patient outcomes, and that’s something that can only come from the top down. 

Another interesting, and possibly more achievable, model for the NHS is the Premier group in the US. A collaboration of about 100 individual not-for-profit hospitals worked out a series of best practice guidelines to promote quality, around 10 simple protocols per clinical area. This helps lead to standardisation while managing the level of top-down instruction.

Premier trained the its staff in implementing the protocols and also audited their compliance levels. So as in the NHS, you have individual organisations working collaboratively to achieve positive patient outcomes. This is a model that we could successfully adopt in this country. 

Standardisation is important, but it’s only part of the story. Any change process requires supportive, inspiring leadership. This extends to cultural attitudes and vision, such as the bold, anti-bullying stance recently taken by the head of the Australian Army. 

This need for leadership, combined with standardisation, is why top-down is really the only way forward for healthcare collaboration in the NHS.

This article represents the views of the author only, and does not necessarily represent the views or professional advice of KPMG in the UK.

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