Healthcare & Wellbeing
CONTINUOUS IMPROVEMENT IMPROVING HEALTHCARE
M any NHS However, we cannot rely on improvement enthusiasts to lead this work. As David Fillingham, Chair of the NHS National Improvement Board, wrote: “We need staff at every level to see the benefits in their daily work.” One way to secure and sustain wider engagement is to demonstrate the benefits that continuous improvement can yield. However, measuring the value of continuous improvement in the NHS remains a challenge, as it does for leadership teams in other sectors. Continuous improvement, successfully implemented, can organisations are adopting a more collective approach to improvement. It might also improve productivity by freeing up resources, sometimes within the same organisation, but often in another part of the system. We can see this as the economic case for improvement. Leaders planning an improvement strategy need to balance these different cases. Yet they are seldom given equal prominence. Evidence shows that organisations are more likely to frame the benefits in terms of social value. Economic value and return on investment tend to be under-represented. Our evaluation of the five-year partnership between NHS trusts and the Virginia Mason Institute, aimed at advancing continuous improvement, found that delivering ‘value for money’ was deliberately excluded from the initial objectives for fear of alienating frontline workers. This poses a problem. Tensions may arise between these social and raise the quality and safety of care. We might see this as delivering social value.
Many happy returns
economic lenses and, if leaders focus too much on one to the detriment of the other, there are likely to be negative consequences. Focus too tightly on the social lens and there is a risk that costs will rise, as we don’t understand the economic impact of our choices and do not actively ‘harvest’ the value. Equally, if an organisation focuses excessively on economic measures, staff may become less motivated to participate as they perceive it to be a cost improvement programme. There is also evidence that even if the benefits to the system look compelling, leaders will only invest in improvement if they see a positive business case challenges, Warwick Business School and NHS Horizons convened two roundtable events in September 2023. These brought together 150 leaders from clinical, operational, finance, and improvement teams across the NHS. We asked for their own organisation. To better understand these
attendees three questions: However, many shared concerns that engaging clinical teams in discussions about economic value would be challenging because “clinicians switch off when money is mentioned” and frontline staff who were already “firefighting” had little time to discuss value-based care. There are several challenges when putting forward an economic case for continuous improvement: ■ The fact that most improvement projects are small ‘tests of change’ on a care pathway that contribute to larger step changes. ■ Tension between the pressure for short-term savings and the fact that the economic value of implementing continuous improvement takes longer to realise. ■ Commissioning levers lacking the nuance to recognise and reward continuous improvement. ■ The fact that the economic value is not always derived in the form of direct savings. More often it releases capacity in terms of beds, equipment, and clinical time. Overcoming these challenges may not be easy, but it can be rewarding. We analysed a ‘waste reduction’ programme developed by the Leeds Teaching Hospitals NHS Trust. The programme tracked improvements which reduced or eradicated activity that added no value, enabling the Trust to conduct additional work with the same resources. During 2019, the last year before the COVID-19 pandemic, the estimated return was £15.41 for every £1 the Trust invested in the project. This has significant implications. Some leaders at our roundtable event admitted that the lack of better methods to capture economic value made it difficult for them to
TO THE CORE
1. Continuous improvement in healthcare provides social value by raising the quality and safety of care. It can also provide economic value by increasing productivity and freeing up resources. 2. All areas of value should be recognised. Focus too heavily on social value and costs may rise. Concentrating excessively on economic value may demotivate staff. 3. Most healthcare leaders frame
the benefits only in terms of social value for fear of
alienating frontline staff. But other leaders may not adopt changes if they cannot see the economic benefits. 4. The NHS needs a standardised framework to capture and share the value of continuous improvement.
Demonstrating the value of continuous improvement by Helen Bevan & Bernard Crump
How can we make the economic case for continuous improvement as strongly as the social and business case? What approach could be developed to help organisations evidence the value of their continuous improvement activity through all three lenses? How can we demonstrate both the value and return on investment of continuous improvement in NHS operational currency?
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