Trying to reduce the amount of people who die on the transplant list has been tough but it has helped us focus more clearly on our life saving mission, writes Lynda Hamlyn
“Transformational change sounds like constant churn,” said a non-executive director at one of my first board meetings as chief executive of NHS Blood and Transplant.
I knew his advice was well considered but I also knew from experience that incremental change alone often fails, and to make change happen and deliver benefits year on year it has to ambitious, well planned and sustained.
Equally importantly you need to bring everyone with you; not just your staff, but your customers, suppliers, supporters and, where possible, detractors.
Safety comes at a cost
I learnt this from my experience at the Greater London Council women’s committee. In the 1980s we had the challenge of trying to make London’s services more “women friendly”. But our biggest challenge was the attitudes and behaviours of staff and managers in our own organisation.
When I joined NHS Blood and Transplant in January 2008 it was the silent partner in the 24/7 NHS, focused on saving lives, partly through ensuring there was sufficient blood components of the right blood group available. Product safety was its absolute watchword.
‘Our programme of change is ambitious: we want to be the best organisation of our type in the world’
But safety came at a cost with steadily rising prices of both our products and our specialist patient services.
I rarely met a chief executive who knew the price of a bag of blood. In 2008-09 it was £140 per unit, having consistently increased from just over £110 in 2003-04. Today it is just under £122 and, with other prices reduced as well, we are now saving the NHS £50m a year.
These savings have been delivered as a result of an organisation wide transformational change programme.
We consolidated our blood manufacturing centres from 11 to five for processing and two for testing. We introduced lean techniques to eliminate waste and duplication from our processes.
We consolidated some of our offices and team bases and delivered major procurement savings. The increased productivity to match the best blood services in the world paid for the introduction of new safety measures.
The seven key elements which enabled us to do this were:
- a compelling vision of who we are and why we do what we do;
- a clear, evidence based strategy;
- a determined board and executive with both business acumen and public sector values;
- a tough but constructive partnership with staff and trade unions;
- a transformation fund supported by a well resourced programme and project management infrastructure and capability;
- a comprehensive staff development programme; and
- consistent messages reenforcing our aim to be the supplier of choice to our customers; globally respected by our peers; and a great place to work.
Our programme of change is ambitious in its scope: we want to be the best organisation of our type in the world.
We started with programmes largely within the control of individual directors so that we built skills and confidence.
We then moved on to the need for change across our internal supply chain to remove cross organisational handoffs, waste and duplication. We are currently part way through introducing industry standards in transport management and sales, and operational planning and we are using new IT capability to better network ourselves with hospitals.
The final stage is the hardest: to transform the NHS-wide patient blood management system. This will bring benefits for all, savings for hospitals and ensure greater patient safety.
Taking the first steps
The first steps have been to implement new hospital based ordering, requesting and reporting systems.
More ambitiously, we now have partnerships with a few hospitals where we are gradually taking responsibility for their blood stocks and ultimately we will be able to provide more integrated transfusion services to support the programme of pathology modernisation underway in many hospitals.
None of this can happen without a very good understanding of the ambition and current practice of our customers. We need staff and stakeholder support for NHS Blood and Transplant to be part of a new, more “whole systems” way of working.
These changes have been taking place alongside a very different situation in the rest of the organisation.
‘Change has been tough but it has helped us to focus more clearly on our life saving mission’
In January 2008, the report by the organ donation taskforce made NHS Blood and Transplant the organ donor organisation for the UK, with the target to help reduce the three people a day who currently die on the transplant waiting list.
The most important of these was to increase dwindling donations by 50 per cent over five years after a decade of stagnation and this was to be achieved across the whole NHS and four countries.
But that’s a transformation tale for another time.
So, has it been “constant churn”? Yes and it’s been tough at times, but it has also helped us do more with taxpayers’ money and most importantly it has helped us to focus even more clearly on our life saving mission.
Lynda Hamlyn is chief executive of NHS Blood and Transplant and the HSJ Awards 2013 chief executive of the year