NHS practice must be standardised for collaboration to work

NHS practice must be standardised

The most effective method of healthcare collaboration will be determined by the problem that is being addressed and the benefits that are being sought



KPMG in the UK


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NHS organisations are grappling with the increasing needs and expectations of patients, advances in technology and new thinking around clinical practice. One response from trusts has been to collaborate with their peers but what is the best way of doing so? Beccy Fenton advocates greater standardisation across the NHS. That, she says, would allow for greater collaboration across the organisation in the future.

Financial sustainability, clinical integration, and operational and clinical performance are the top three reasons for collaboration within the NHS. 

Hospital mergers can be very helpful in terms of implementing economies of scale, reconfiguring clinical services to improve quality and safety, or stabilising a financially failing trust. Mergers also enable the transfer of good practice from the leadership and management team of the acquiring trust.

This transfer is not necessarily straightforward for a number of reasons, the main one being the lack of standardisation and codification of the way things are done in NHS hospitals.

The NHS, and medical profession in general, has a large degree of autonomy which drives innovation. This has led to medical advances in treatments driven by entrepreneurial clinicians who want to improve their services.

Entrepreneurial culture permeates across organisations into management as well, and runs counter to the idea of standardisation which you might find in, say, manufacturing industries.

As a result, hospitals tend to be reliant on capable individuals running a tight ship. However these individuals often end up firefighting operational pressures on a daily basis, in part due to the fact that standard ways of working aren’t properly embedded as they would be in another industry.

I just don’t think it’s possible for good managers or clinical leaders to then replicate what they’re doing across more than two or more sites. The lack of standardisation and codification means managers have to inject a significant amount of personal effort into running things and there just isn’t enough physical capacity to go round.  Staff end up spreading themselves too thinly and performance is compromised.

It is only by balancing this entrepreneurial model, with a greater degree of standardisation that collaboration through the concept of hospital chains could work in the NHS. 

I’d argue the adoption of lean continuous improvement processes and tools, which require a high degree of standardisation, would allow for the system to codify good practice, improve the quality and productivity of processes and be run in a much more effective way.  The NHS can learn from the many examples in the private sector, such as Toyota and Jaguar Land Rover.

In addition to standardisation, another of the founding principles of lean continuous improvement, is front-line empowerment – giving people the skills to operate within standards. If those standards aren’t achieving the best results for patients or staff, or value for money, then the staff are skilled and empowered to improve them. In that way there’s a systematic way of making improvements which can still support the drive for innovation. I believe you can achieve a balance between innovation and standardisation.

Implementing these changes within the NHS would require a total overhaul of the way it currently operates. It would need buy in and belief from the leadership to succeed. 

The NHS needs to look at examples from other industries in the private sector as well as different healthcare models in other countries, to see what is possible. There are effective examples of multi-site chains in healthcare, where individual organisations work to a standardised model.

None of this is straightforward, and it will require further research and investment at a national level, possibly being trialled in some high-performing organisations which have already started to head in this direction. The adoption of a standardised lean continuous improvement methodology would enable the NHS to deliver far greater value for money, improved quality and higher staff morale.

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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