Changing how we talk can help to bring about a change in culture, as one hospital's approach has demonstrated

Cash-releasing efficiency savings - or CRES for short - is the sort of phrase that makes the average clinician's skin crawl. Because it puts the focus on money, clinicians find it difficult to associate CRES with improving the quality of clinical care.

However, at Southend University Hospital foundation trust, CRES has taken on a new meaning. Here, it stands for "caring, reliable, effective and safe". Medical director Dr Grahame Tosh and chief executive John Gilham believe this reinterpretation will reinforce the focus on patient care, help to improve quality and patient satisfaction, and reduce costs.

"Southend University Hospital's motto, 'putting patients first', has been a catalyst for focusing on quality," says Dr Tosh. "On becoming a foundation trust last June, the board of directors reviewed its purpose and it agreed this was to 'achieve the best possible health outcomes for those people who choose Southend Hospital and to do so at a sustainable cost'."

On board

Focusing on quality has helped the hospital to re-engage clinicians, who felt that centrally imposed targets did not necessarily improve patient care. Certain measures of quality, such as waiting times and length of stay, were not well supported by clinicians.

To change this, Southend has developed a local set of clinical outcome measures for all specialties, such as low surgical complication rates and visual acuity following cataract surgery, which clinicians can relate to. When these measures are in the upper quartile, length of stay reduces, readmissions drop and, unsurprisingly, costs come down.

"As a chief executive, you have a duty of care and a duty to live within the resources available," says chief executive John Gilham. "You need a sustainable strategic approach to achieve this."

This approach is likely to be successful over the long term as clinicians can see the benefits and move away from the notion that cost reduction must mean reduced services.