Helen Bevan on NHS finance directors

Helen Bevan

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As an NHS improvement leader I work with many staff groups. One group that was barely on my radar a year ago, but with which I now work with regularly, is NHS finance leaders.

There is a body of evidence that making the finance director a quality champion is one of the best strategies for achieving quality improvement results across the whole system. Why? Because when we start to think about the relationship between cost and quality in a different way, magic happens.

We can think about healthcare or health promotion processes as a simple three-stage model. Stage one is inputs (staff, supplies and equipment). Stage two is the process (evaluating, diagnosing, treating, communicating etc). Stage three is outputs (quality, safety, results and costs).

When NHS finance leaders think about cost-cutting, they typically focus on the first stage and constrain inputs. Yet we could achieve maybe 10 times the leverage by focusing instead on the second stage; working in partnership with clinical leaders to drive out the waste and unnecessary variation in the system and make sure every patient gets safe, reliable, effective care.

The currency of leadership is attention. This approach requires finance leaders to switch their attention to areas that might not be their traditional domain. It means getting much closer to the clinical business of the organisation and appreciating opportunities for improvement from a clinical perspective.

International healthcare experience suggests organisations with engaged finance directors tend to adopt quality as the strategy, rather than seeing it as one of many strategies. In these organisations, finance directors are role models in their approach to improvement and waste reduction and encourage serious investment in improvement.

This is my specification for the finance director of the future:

• acts as a champion of quality improvement in partnership with other strategic leaders such as the director of nursing and the medical director;

• drives the delivery of benefits to achieve improvement goals;

• is skilled in tools and methods for improving quality and value;

• operates at the interface between clinical processes and management of resources;

• is able to frame efficiency and productivity issues in ways that connect with the values and priorities of clinical teams;

• in addition to being skilled at retrospective analysis (seeking the differences, discrepancies and exceptions to balance off) is also forward looking; seeking to create a different future.

We need to stop viewing cost and quality as separate entities. They are complementary dimensions of the same quality equation.

So we should consider setting explicit goals for reducing variation or waste within every quality or safety initiative. We should also, as a minimum, monitor quality as a balancing measure to every cost reduction initiative.