Stephen Eames on the need to make changes

Its aim is to sustain the vision of “high quality care for all”, while delivering efficiency savings and minimising waste: causes we can all passionately believe in. My understanding is that QIPP - equipped with its own csar, NHS South Central’s chief executive Jim Easton - will focus on producing metrics and best practice, rolling out programmes that are known to work, and advising on big ticket issues like current national policy, the tariff, pay and national procurements. Territory that is, at the very least, of interest to many other players, such as the regulators, the NHS Institute and the emerging quality observatories.

So I fervently hope that the emphasis will be on this initiative as a philosophy, and not a bureaucracy. This train of thought brings to mind a variation on that old joke: “How many central initiatives does it take to change a light bulb? Answer: One to change the bulb and 440 to do the paperwork”. And it feels like most of the people doing the paperwork work in institutions like mine.

Contrast this with Building Britain’s Future, set out recently by the government, which mainlines on turning NHS targets into enforceable patient entitlements. The main theme is a “customer led” approach to shaping public services by extending choice and giving sharper teeth to consumers through applying sanctions. The clear implication is that there should be more streamlined government and a significant cut in bureaucracy.

Jim Easton and QIPP could make a real connection with this in making sure that all the quangos reduce the amount of form filling they require, reducing a significant cost burden and enabling the frontline to focus more sharply on providing value added services to consumers.

Contrast again with the National Audit Office report on Agenda for Change, which suggests we have succeeded in rewarding our staff, but with very little gain in terms of productivity and/or widespread changes in the way staff work. In the light of the massive growth in public expenditure on health in the past decade, it is difficult to argue that there is no room for making efficiency savings while pushing up quality.

No commentator I am aware of suggests the NHS will be impervious to the recession, and it will inevitably lead to pay restraint and reductions in the cost of the workforce. So the benefits originally envisaged by Agenda for Change and big pay reforms for hospital doctors, GPs and dentists really do need to be fully realised because the alternatives look to me to be much less palatable.

Organisations will need one core competency to survive - innovation. To quote management guru Peter Drucker “Innovation is the instrument of entrepreneurship” and we are going to need a heck of a lot of that in the coming months and years. Leaders, managers and staff will need to switch mindsets to creatively thinking up new ways of doing things, and then doing them without letting the usual barriers and constraints get in the way of asking for more money. The new language will be characterised by questions like: “Where are our truly successful innovations? Who was responsible for them? How many new innovations in our field were delivered by us? Are our innovations in the areas of greatest opportunity? How many opportunities for innovation have we missed? Did we dismiss opportunities or just not spot them? Are we systematically investing in innovations that benefit patients and add value for the tax payer? Does our performance management system assess and measure innovative impact?”

Organisations that are skilled in innovation, like leading edge pharmaceutical companies or internet based companies, focus on a mixture of five things:

• The unexpected successes, failures or outside events. They learn quickly, and then ruthlessly shift their business models to competitive advantage.
• The incongruity between what is really happening and what is assumed or ought to be happening. Where incongruity exists they introduce clarity and focus, and get back on track.
• Processes that eliminate activities that add no value to the customer (patient) experience.
• Real time horizon scanning to be ahead of the field in flexing resources to meet new and unforeseen demands
• Applying new knowledge to improve outcomes.

I don’t want to want to become over-dramatic but it is probably true that there is now more than ever a need for entrepreneurship and innovation. From QIPP to quango, from HQ to the front line, we are going to need to focus on stopping what has always been done and start focusing on doing new things that might be excruciatingly painful to deliver, but ultimately better all round.

So back to the light bulb test: How many innovators does it take to change a light bulb?

Answer: None; we don’t use the light bulb anymore.