NHS Quality conference - Paul Healy
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Decisions of Value How the NHS can balance quality and finance in decision-making Paul Healy 26 November 2014 NHS Quality Conference
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“Decisions of value – how the NHS can balance quality and finance in decision-making” NHS decision-makers have to balance the priorities of quality improvement and financial sustainability, in other words they have to deliver value. This balancing act is increasingly challenging as the demands on the NHS change and grow, with more expected within an ever tighter budget. Decisions of Value is a project commissioned by the Department of Health and led jointly by the Academy of Medical Royal Colleges and the NHS Confederation. It has spent six months studying what influences how decisions are made and brings together a large amount of research to show how factors such as relationships, behaviours and environment influence the value delivered, extending beyond Whitehall to the front line. The project’s findings have recently been published and emphasise the importance of the cultural, rather than structural, changes needed to move towards delivering better value and look at how they rely on having the right relationships, behaviours and environments in place. It presents insights into how people interact in the NHS and the crucial factors affecting how they operate within a particular context. In many cases, it indicates a ‘back to basics’ approach that involves a fundamental understanding of how humans interact and operate. As such, it doesn’t look to define good decisions, but rather gives an insight into the principles of good decision-making. For more information, please see: http://www.nhsconfed.org/decisions-of-value
Transcript of NHS Quality conference - Paul Healy
Decisions of Value
How the NHS can balance quality
and finance in decision-making
Paul Healy
26 November 2014
NHS Quality Conference
Content
• NHS Confederation
• Context
• Decisions of Value
• 2015 Challenge
NHS Confederation
• Membership body for all types of providers and commissioners
o NHS Trusts and FTs
o Acute, ambulance, community, independent and mental health providers
o CCGs and CSUs
o Wales, Northern Ireland and Europe
NHS Confederation
1. Speak on behalf of the NHS to Government, Parliament, policymakers and the public
2. Make sense of the whole system with policy research, analysis and information
3. Support members with expertise, insight and shared learning
Content
• NHS Confederation
• Context
• Decisions of Value
• 2015 Challenge
Context
• Sometimes believed improving outcomes will naturally cost more
• Also, reducing costs will come at the expense of outcomes
• Public polling – half of people do not think you can increase quality and reduce costs
Context
Context
• 68 per cent of senior NHS leaders said quality of care would stay the same or improve
• At the same time, 83 per cent of same leaders said financial pressures would increase
• Indicates that NHS organisations are expected to improve quality of care even as finances get worse
Context
• Finances and targets were often given priority without considering the impact on the quality of care - Robert Francis, 2013
• Rules, standards, regulations and enforcement have a place in the pursuit of quality, but they pale in potential compared to the power of pervasive and constant learning - Prof Don Berwick, 2013
Context
• We found that, while trusts in the main complied with quality and safety processes, they were slow in learning lessons when things go wrong and embedding that learning in improved ways of doing things - Prof Sir Bruce Keogh, 2013
• Post-Francis, senior managers, clinicians and boards will need sustained support as they grapple with the tensions of managing for both quality and productivity - Nuffield Trust, 2014
Content
• NHS Confederation
• Context
• Decisions of Value
• 2015 Challenge
Decisions of Value
• Project commissioned by the Department of Health
• Jointly led by the NHS Confederation and the Academy of Medical Royal Colleges
• Engage senior clinical and managerial stakeholders across the whole system
Decisions of Value - aims
• Understand the factors enabling good decision-making processes at a local level
• Not to suggest or define what good decisions look like
• Explore how NHS organisations might be supported to deliver greater value
Decisions of Value - methods
• Direct local engagement
• Wider national engagement
• Targeted expert and stakeholder engagement
Decisions of Value – what decisions?
Decisions of Value – main findings
• Biggest impact lies in cultural, rather than structural, shifts
• Behaviours and relationships more important than rules and standards
• Will take time to develop and system needs to focus on how to empower people to contribute to the decision-making
What the literature tells us
• The implications for policy of our analysis are that excessive reform, regulation and scrutiny runs the risk of crowding out innovative decision making in favour of response mode or risk-averse behaviour
• Without freedom and responsibility to take decisions it is impossible to adopt a ‘rational’ approach beyond mere adherence to national requirements and demands
Decisions of Value – factors in good decision-making
1. Stronger clinical and financial rapport
2. Greater patient involvement
3. Deeper values-based behaviour
4. Information-driven decision-making
5. Increasingly supportive environments
6. Larger networks of peer support
Stronger clinical and financial rapport
• Savings now required demand clinicians to be actively involved in current and future resource decisions with tougher trade-offs
• Balancing clinical priorities with financial duties can be difficult for clinicians moving into management
• Good communication is essential and working well requires multi-disciplined working across clinical and financial teams.
Stronger clinical and financial rapport
What the literature tells us
• Despite the limits of structural solutions there is some support for the notion of flatter organisational structures with more porous boundaries between units and groupings to enable sharing of learning and expertise
• Greater connectedness between finance and other functions would seem to be especially important in decisions of value
Greater patient involvement
• Decisions made with an impact on quality will need to consider the views of patients to understand this
• NHS organisations accept they can always be better at involving patient view and patients believe much more could be done to recognise their value
• Patient-reported feedback and complaints are invaluable ways to encourage involvement in changing and improving care
Greater patient involvement
What the literature tells us
• The wider literature on public engagement suggests that it can be achieved but needs to be well-resourced and conceived, and should avoid charges of tokenism
• The wider literature on patient involvement suggests that significant professional, cultural and organisational impediments need to be removed before meaningful engagement can be achieved
Increasingly supportive environments
• Environments have a big impact on how decisions are made and the ability people have to consider quality and finance in decision-making
• Most people feel they are making some or most of their decisions in a busy, distracting environment and while feeling stressed and physically tired
• Some of these environmental factors are natural, but more needs to be done to improve staff health and wellbeing to enhance decision-making
Increasingly supportive environments
What the literature tells us
• There is a body of literature on ‘dynamic decision-making’ – defined as having four characteristicso Series of decisions are neededo Decisions are not independento State of ‘the world’ changeso Decisions are made in real-time
• In these circumstances, the decision-maker cannot control when, or how often, they make decisions
Content
• NHS Confederation
• Context
• Decisions of Value
• Two Sides of the Same Coin
• 2015 Challenge
2015 Challenge
• Brings together health and care charities, local government, communities, staff and leaders to speak with one voice
• Sets out the better future we want to shape for health and care provision, and the steps needed to make this a reality
2015 Challenge - partners
2015 Challenge
• Put forward 15 things, including:
o Give public real say about services
o Continually improve quality and safety
o Equip staff to work in new ways
o Use finite resources efficiently, fairly and sustainably
Web address
http://www.nhsconfed.org/2015Challenge
Contact email
