Nicola Mortali explores the concept of resilient organisations and how they work to reduce instability and variability across their wider health ecosystems
“Winter pressure”, the term indicating a seasonal increase in demand for health and social care services is misleading. As we know, “winter pressure” last year continued most of the year, through several seasons.
It doesn’t reflect the continued and sustained pressure that the health system is under, it is not just a period of stress between periods of otherwise calm, it is simply a period of significantly increased activity against an already stressed baseline.
Increasing demand and a lack of capacity to address potential issues, creates a hugely stressful environment and impacts on the quality of care patients receive.
This impact is evidenced by bed occupancy now running at 90 per cent on average across general and acute hospitals in England, and the ongoing struggle to meet the four-hour wait target.
It is also reflected in the high level of patient outliers and the excessive and unnecessary moves patients can experience during their stay in hospitals. For many providers, perhaps most tellingly, staff attrition, vacancy and absence rates are high and, in some cases, continuing to increase.
Patient flow issues are often looked at in isolation, but they reflect a wider organisational and health ecosystem where causes in one part have consequences across the whole
According to the 2018 Staff Survey, three out of five NHS staff report working extra unpaid hours, and just under 25 per cent report having unrealistic time pressures.
The health environment is hugely challenging, by its very nature outbreaks, emergencies and unforeseen situations are the reality. However, we can’t continue to rely on staff “going above and beyond”.
Patient flow issues are often looked at in isolation, but they reflect a wider organisational and health ecosystem where causes in one part have consequences across the whole.
Resilient organisations understand this and are focused on reducing instability and variability across their wider ecosystem, minimising risk or potential harm to an individual, group, community, or whole society.
They focus on understanding the risks and interdependencies that impact their business; empowering employees to do their job, safeguarding them and the organisation.
The challenge of delivering high-quality care and protecting patient experience in stressed environments would become significantly easier if that system were more resilient, and a more resilient health system can be achieved.
The key to improving performance and patient care, including patient flow, is to bring teams and organisations together and understand how they really do and should behave. It is difficult, however, particularly in the complex ecosystem that is the NHS.
The key to improving performance and patient care, including patient flow, is to bring teams and organisations together and understand how they really do and should behave
Systems with different elements, for example, clinical specialities or directorates, work best when they maximise the “shared space” between them. The shared space reflects how aligned the elements are on key aspects such as strategy, systems, people and process.
Misalignments across the system result in “friction” and create risk, reducing the ability to handle periods of prolonged stress. The greater the misalignment, the greater the potential issue and magnitude of consequences that result.
In such situations, typically staff end up trying to compensate for the lack of shared space through “heroic efforts.” In some cases, misalignments result in poor behaviour and perceived bullying.
Traditional approaches often simplify the complex ecosystem, don’t get to the root cause of flow issues, or don’t scale or sustain. Serco and its partners, including Experience Lab and Methods Analytics, have developed a Whole System framework and approach for considering flow in the context of developing organisational resilience.
The approach incorporates staff and patient engagement; deep analytics; process excellence and programme delivery.
With its partners, Serco works with organisations to build and deliver resilient organisations, seeking sustainable improvements in patient flow, care quality, care integration, financial stability, safety, and patient and staff experience: the combined effect of the collective effort within a whole system approach.