Published: 11/12/2003, Volume II3, No. 5885 Page 18 19
If NHS modernisation is to succeed, the service must find ways to bridge the gaps between 'dry statistics'and the creation of a 'caring and healing environment'. And it is in the key areas of quality, workforce and IT that the crucial challenges lie
A number of years ago, when I was first appointed as a chief executive, my enthusiasm would get the better of me. I used to refer to every problem and challenge we faced as 'an opportunity'. One day, a manager came to me and said: 'Hey boss, I've got an insurmountable opportunity!' I learned to be more honest about the problems we encountered after that.
Nevertheless, the challenges we face in 2004 can be seized on as opportunities, and must be if modernisation is to move forward.
The Modernisation Agency has been working with a number of trusts, as well as hospitals in the US and elsewhere in Europe, as part of the Pursuing Perfection programme. This, as you might guess, is a US title. If it had been up to us Brits, we would probably have called it the 'perhaps we could do a little better programme'. Those taking part have committed themselves to developing a service in which there are no avoidable deaths, no unnecessary pain, no waste, no delays, and no feelings of helplessness.
Delivering such a vision will mean tackling three challenges in 2004; uality, workforce and new technology.
The quality challenge I spend a great deal of time on the road, meeting frontline NHS staff. One disconcerting feature of my conversations is when staff highlight what they see as a gap between 'government targets' and 'quality patient care'.
I understand how league tables and dry statistics can seem detached from a caring and healing environment, but it is essential we bridge that gap.
Good access is a vital part of a quality service - but it is not the only part.
Crossing the Quality Chasm, published by the Institute of Medicine in the US, identifies a number of dimensions of quality to set alongside timeliness.
These are: safety, effectiveness, patient centredness, efficiency and equity.
1Modernisation must tackle all of these dimensions if it is to succeed. As a consequence, modernisation and clinical governance must go hand in hand. In too many places, they are still seen as competing initiatives.
If modernisation is not improving the quality and safety of the patient's experience, then it is not doing the right things.
The Modernisation Agency intends to be more active in supporting the National Patient Safety Agency, the Commission for Healthcare Audit and Inspection and the NHS on these issues - for example, by tackling healthcare-acquired infections, medication errors, and compliance with evidencebased protocols.
Consider the work the agency is doing on improving patient flow through hospital systems, drawing on lessons from lean production thinking.
2Because it improves planning and coordination, and emphasises the effective transfer of information from one part of the system to another, it improves access and reduces lengths of stay, and reduces the scope for errors and unnecessary or harmful interventions. The aim of this work is to provide patients with 'better care without delay' - not only a quicker experience, but also a safer and better quality one.
Delivering on this will require serious attention to be paid to the second big priority for the coming year.
The workforce challenge
A good or bad experience at your GP surgery or local hospital is often down to the way you feel you have been treated.
During my time as a hospital chief executive, I was always pleased to receive letters of thanks from patients.However, what surprised me was how often these letters were prompted not by things going well, but because something unfortunate - a cancelled operation, for example - had been handled well by the staff involved.
We must not underestimate the power of a human relationship to turn a potentially bad experience into a good one, and vice versa. The creation of a caring and healing environment depends totally on the motivation, morale and energy levels of the staff involved.
Staff are often hard-pressed and over-busy, which can lead to exhaustion and exasperation.A major part of the workforce challenge is to create the headroom for them to refresh their skills and renew their energies. The various agency programmes - whether they are collaboratives and clinical governance programmes or leadership courses - aim to do just that.
We need to design jobs which allow staff to make the best use of all of their talents. The Changing Workforce programme has now piloted over 150 new job roles across the NHS. It is providing a framework for increasing the breadth and depth of jobs, resulting in more motivated staff and a more effective service.
Developments such as radiographers taking on trauma reporting, the creation of chronic disease practitioners or allowing home helps to administer medicines are better for staff and patients alike.We also have the opportunity provided by modernised pay and reward arrangements to ensure that staff are appropriately recompensed for what they do.
Agenda for Change, the consultant contract and the GP general medical services contract represent a demanding programme of work - particularly when seen alongside the need to implement the EU working-time directive. This will require strong human resources skills in trusts - but the work cannot be left to the HR department alone.We need to link these potentially radical changes in how people work and how they are rewarded, to providing a better quality and safer experience for patients.
The technology challenge
Our final challenge is daunting.
Nowhere can the many years of chronic under-investment in the NHS be seen more clearly than in the state of our IT systems, and our failure to use information to provide a modern service.
The national programme for IT is starting to put this right, but it will be a long and arduous process. The vision, however, is an exciting one.
Investment in the foundations of an electronic record, in the electronic transfer of prescriptions and in an e-booking system to allow greater certainty and choice for patients are progressing well. Connected to this is the continuing upgrade of local NHS systems to allow for electronic ordering and reporting of tests, drug prescribing and other treatments.
Developments in clinical technologies are now converging with those in IT - for example, the potential for the digital transfer of images to speed up diagnosis and to enable new patterns of service delivery. These developments are too important to be left solely to IT specialists.
Unless clinical staff at every level 'own' the changes, we will not realise the enormous potential IT can offer.
Modernisers at local and national level must be more actively engaged with the IT programme over the coming months.
So 2004 should be a year for connections. Chief executives and boards need to forge stronger links between clinical governance, modernisation, workforce issues and IT. Frontline staff need to make these connections a reality in their day-to-day working lives.
They need to find the time and energy to develop new ways of working, to co-ordinate care better with other clinical teams and departments, to learn and apply new IT skills and to focus all of this on the safety and wellbeing of patients.
A tall order, perhaps, but there are many places the length and breadth of the NHS rising to these challenges and where leaders at every level, from the ward and surgery to the boardroom, are making modernisation a reality.
Let's hope many more will join them in the coming year.
David Fillingham is director of the Modernisation Agency.
REFERENCES
1Committee on quality of health care in America. Crossing the quality chasm: a new health system for the 21st century. Institute of Medicine, 2001.
2Womack J and Jones D. Lean thinking. Free Press, 2003.
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