The NHS is a round the clock service that is open and available every day of the year. With longer life expectancy, increasing demands from service users, some high profile adverse publicity, financial challenges and advances in medicine there are a lot of issues to focus on.
From the outside looking in it is really easy to highlight what should be done to fix it all. Yet in reality we are talking about huge organisations offering a huge range of services where demand is extremely difficult to predict. The truth is there is no one thing that makes an NHS organisation high performing.
So what would I put on my list?
Key 1: A Strong Leadership Team At The Top
Now everyone has there own opinion as to what constitutes strong leadership. In my experience when a leadership team is clear about purpose, has a clear idea of what it wants to achieve and has the mix of skills and attributes to get others on board it has strong foundations to build on. Additionally it is vital to systematically review what is and what is not working, take decisions and then follow through on those decisions.
Key 2: A Strong People Focus
Just about everything the NHS does is people focused whether it is staff, patients or relatives. Ensuring that people have the support, the skills and resources to deliver to their potential is essential. This in my view is a lot more than merely providing training. It’s about ensuring that those not in frontline delivery are still really focused on serving those on the frontline.
Key 3: Focus On What Matters
Quality, safety, performance and user experience are all core. There will be many challenges and barriers to delivering on these different agendas. The key thing is to make sure that when addressing the challenges and barriers, the focus is on identifying root causes and doing something about them rather than being random.
Key 4: Processes That Function Like Clockwork
A lot of what is done can be set out in a very clear and precise way. By the same token there is often quite a difference between what should and what actually happens. When processes breakdown it is easy to forget the impact. Take something like theatre lists. If lists don’t start on time then some patients might end up not having their operation on the day. This impacts on income received and costs incurred as well as creating a lot of personal distress for the patient and relatives.
Key 5: Team Working
If a hospital is going to work well all the different professional disciplines and different specialities need to work together. It is easy to focus A&E because it is the front door for emergency treatment. However in any A&E department capacity is limited. Using the capacity effectively requires the ability to move patients to the next stage in the process.
If different parts of the organisation are operating in a vacuum, then it is going to have consequences for the very people everyone is trying their very best to serve – the patient.
Key 6: Realism
Change is spoken about a lot and a lot of change has taken place. While there may be a lot of demands to wave a magic wand and improve things overnight, this is just not realistic. Change, especially clinically focused change requires input from many and often not just a single organisation. All of this takes time. All of this has to be achieved while continuing to deliver the service day to day.
Key 7: Recognition
Most that have to access services, particularly hospital based services recognise the great care they receive. The trouble is this does not always get recognised and it is important that those leading make the time to acknowledge the effort and commitment.
Key 8: Feedback
One of the biggest challenges is engaging people and getting feedback. On the other hand armed with feedback you can start to look at ways of making small changes that make a big impact. Feedback is ultimately a catalyst for improvement.
Key 9: Communication
For me this falls into a number of areas. At one level it is about how we get the message across verbally. At another level it is about how to get the message across in writing. The third and often overlooked aspect of communication is about listening. Most will do a reasonable job on the first two areas but a lot fewer will excel at listening.
Key 10: Open Mindedness
Professional standards and safety must always be at the forefront. What’s important in my view is to ensure that this does not result in a closed mindset where there is only one way to achieve the outcomes. After all if we think about it all major breakthroughs have come from looking at different ways and challenging the boundaries of what’s possible.
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