Tuesday, 6 April 2010

Perfect Alignment ... But we see a gap

In the summer of 2009 David Nicholson (Chief Executive of the NHS) sent a letter to all Chief Executives of PCTs, NHS Trusts and NHS Foundation Trusts in England regarding the implementation of Lord Darzi's Next Stage Review (NSR): The Quality and Productivity Challenge.

At the Same time we published our findings, from five years research working in the NHS, in the form of the book Making Hospitals Work. Whilst the two came from completely different sources the messages contained within both are remarkably similar.

David Nicholson asked for contributions about improving Quality, Innovation, Productivity and Prevention (QIPP) stating that this is the most important challenge facing the NHS for the foreseeable future. “The real changes we seek will be designed and delivered locally with the centre playing an enabling role. Meeting the challenge is central to the role of every NHS leader and every NHS board. In short this is your day job”

Within the four principles that he had set out to guide the implementation of the NSR, he goes on to mention the importance of:
  • Having the capacity and capability in terms of people with the right time, skills and support to properly support the scale and pace of change required.
  • Great clinical leadership, supported by managers who back good ideas.
  • Leadership behaviours, not necessarily the same as those during the period of growth.
  • Organisations having a clear narrative about what this challenge means

Interestingly the House of Commons Health Committee: NHS Next Stage Review (First Report of Session 2008–09), a ‘review of the review’ if you like, echoes the need for the above points but voices concerns regarding the general lack of analytical and planning skills and that the quality of management is very variable, stating that “It is widely recognised that the quality of leadership in the NHS must improve”. It also expresses concerns about whether NHS institutions and staff were capable of delivering the proposals made in the NSR.
Anyone who has read Making Hospitals Work or follows the Lean Enterprise Academy’s healthcare articles and blogs will see a very clear alignment between these messages and ours. You will also be aware that we insist that all this should be the part of the day job, that clinical leadership is definitely the way forward and that leadership behaviours will need to change to face the challenges ahead.
However working daily, at many sites, gravitating (up and down) constantly between the frontline, middle management and executive level our concern about a clear narrative is that until healthcare organisations, at this local level, are capable of distilling and prioritising their objectives, to address the vital few problems facing them, then staff will neither be given or have the time (capacity) to develop their skills (capability) to enable them to deliver.
We share the House of Commons Health Committee’s concerns regarding implementation, but herein, we believe, lies the gap. The staff at the local level have not (yet) been shown how to do this, thereby enabling them to practice and become skilled at doing it, then they must be left alone, uninterrupted, to get on with doing it.

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