As expectations of health care provision are driven increasingly higher, and levels of service in other parts of the economy rise, patients are demanding improvements in the quality, convenience and effectiveness of the services we receive. Terry Channell, of PA Consulting’s Management Group, who lead PA’s work in the health sector looks in the health sector looks at the issues for NI Medicine Today.
To make best use of available resources, providers in the health (HPSS) Northern Ireland have already made attempts at modernisation – developing new ways of working, utilising new technologies, streamlining and forming new alliances to manage care delivery. But, in overall terms, progress has been slow.
The successful implementation of improvements to patient services in the HPSS has been made difficult by a number of factors including:
- Old facilities: Some of our older hospitals were designed and built in the middle of the last century or before and are often not up to the challenge of delivering flexible joined up services. In addition, as a growing proportion of services are now being delivered within the primary, rather than secondary, care arena, the backlog in provision of appropriate GP premises is a major hurdle in modernisation.
- Fragmented organisations: Health and personal social services in NI are delivered by a large number of Trusts, each acting semi-autonomously, making the delivery of system-wide change more difficult.
- Under-developed IT: Many current IT systems were built around specific functions in hospitals and other care locations – these stand-alone systems are rarely able to talk to each other, require data to be entered more than once, and secure none of the benefits from being able to share and analyse information.
- Staff groupings: Staff in the health and personal social services are commonly organised into small departmental and/or professional teams, often with their own terminology, culture and so on, making cross-team working, collaboration and task sharing more difficult.
A key issue for providers is how to deliver major change programmes effectively in this environment. While there is no magic answer, our experience shows that successful change programmes have certain key characteristics.
Adopting a Patient-Centric View
Thinking on the direction and scale of change should be driven by its relevance to patients and its impact on their particular needs. The mapping of the patient-centred ideal (where individual agencies or the system as a whole wants to get to) to the current position, sets out the principles for future patient experiences and provides the basis for making each patient ‘transaction’ more effective.
Ensuring Appropriate Involvement of Staff
Every element of service in the HPSS is delivered by people. It is therefore essential that change programmes ensure appropriate involvement of staff, including clinicians, nurses PAMs and other care staff. It is they who have a unique perspective on the ‘patient experience’ and it is they who are best positioned to identify opportunities to improve that experience, and it is they who will be required to work within the new arrangements.
It is commonly the case that staff within organisations in the HPSS have neither the time (because of other competing pressures) nor the opportunity (because of the lack of any formal process to involve them in the ‘management’ of the service) to play any meaningful role in the development and implementation of change. Arrangements must therefore be introduced to ensure this involvement, both within individual agencies and across the HPSS as a whole.
Maximising the Use of Existing Infrastructure
Many change programmes will require developments in IT to allow them to be successfully implemented, particularly where the objective is to better integrate services within and between different care agencies. It is not always necessary to throw away the existing IT infrastructure to allow this integration to happen - instead, it may be possible to allow legacy systems within each agency to ’talk’ to each other. This approach, commonly referred to as ‘lite’ IT exploitation, uses internet technologies to give read and write access to systems residing in separate organisational units. New mobile and telemetric devices also allow for information to be captured or used at the point of care.
Lite-exploitation avoids the often expensive, slow and painful process of re-inventing large monolithic IT systems. More importantly, it recognises that there are increasingly more complex interactions between patients and healthcare providers. The end-to-end patient journey can only be delivered by integrating across the many different functions and services that make up the HPSS.
Supporting the information flows around the patient journey will also provide a rich source of information on patient trends – this will allow for better assessment of service effectiveness and improved resource management.
Conclusions
Change in the HPSS is both difficult and complex. However by taking a patient-centric view, ensuring appropriate involvement of staff and getting the most out of legacy systems, it should be possible to secure real improvements in performance. This approach to change will help to ensure that providers in the HPSS focus on those aspects of change that offer the potential for real improvements in the service provided to patients and that proposed change is implemented quickly and effectively.
