10 Balancing act: supporting finance leaders to deliver on short- and long-term priorities
2. System and patient value
Overview Finance leaders recognised that long-term success relies on a focus on underlying value, and not just on cost. Working with multi-disciplinary teams is needed to understand the underlying value of decisions and behaviours and build a broader picture of service value that encapsulates the potential of new delivery models and the risk of failure demand, over and above short-term running costs. Finance leaders reflected that real progress has been made in partnership working and integration, with much more discussion of impacts in both health and social care. A system mindset is essential to success and while progress has been made in partnership working and integration, there is further room for improvement – an increase in transparency and openness between partners. Practical actions are set out at the end of the section and case studies are included in the appendices.
In order to understand the underlying value of decisions and behaviours, finance teams need to build a broader picture of service value that encapsulates the potential of new delivery models and the risk of failure demand, over and above short-term running costs. This requires working with multi- disciplinary teams (clinical, operations, and finance) to fully understand the operations of a service and setting an appropriate time horizon to define value and to assess the options available. Two examples referenced were the dependencies between complex discharges, intermediate care, and social care outcomes, or focusing on the total bed days required and improving this through admission avoidance and length of stay reduction, rather than just focusing on the cost per bed day. ‘The role of finance leaders has evolved – we are thinking more about delivering service efficiencies as a system and considering the welfare of all organisations within that, as opposed to savings within individual organisations.’
Finance leader reflections and experiences Focus on underlying value and not just on cost Finance leaders recognised that long-term success requires a focus on underlying value and not just cost. This will require better definition and assessment of value to make service improvement decisions. To do this, systems need to have a more sophisticated framework for measuring value across disciplines and organisations. Finance leaders reflected on their evolving role, the need for deep engagement with colleagues, and the wider skillset and mindset shifts required. ‘Are we doing the things we’ve always done and expecting different results?’ ‘We have to enter an era of doing better things.’ There was a general opinion that during times of financial challenge it is easy for finance teams to focus on the costs of how we currently deliver healthcare, rather than necessarily on the underlying value to the patient and the behaviours which drive inefficient use of resources. Participants discussed needing to take time to work with clinicians to understand not just unit cost, but the underlying value of activity, and the impact of failure demand when we don’t deliver the right care in the right place. ‘We understand unit costs, but the challenge is in the behaviours that determine what things cost.’
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