Comment

Remember to breathe

Suzie Bailey from NHS Improvement, and former development director at Monitor, explains what NHS trusts can expect from the new regulator.

Nowadays, it seems as if the NHS is rarely out of the news with a dizzying amount of debate on whether it’s in good or bad shape, and what the solutions might be. So much so, that you find yourself wishing it would all stop for a moment – so you can catch your breath. 

However, the truth, as with any large and complex public service, is that the NHS is somewhere in the middle. In many respects, the NHS continues to offer a good quality service, free at the point of access yet we clearly face some deep challenges. These challenges include: unwarranted variations in quality, increasing pressures on limited resources and significant staffing challenges. 

I’d argue that the trick for the NHS, to paraphrase Kipling, is to treat…“both success and challenges as imposters, just the same”. And, instead, focus on the issue of improvement. 

However, how, in challenging times, can NHS organisations be expected to concentrate on improvement? I would argue that this doesn’t require a giant leap, as improving the quality of care unites both patients and staff. Up and down the country provider organisations and local systems are getting on with the everyday business of improving care. In these systems, staff are valued and trusted to do the right things and patients are treated as true partners in their care. 

Improvement is everyone’s responsibility 

From 1 April 2016, a new national organisation – NHS Improvement – went live with a remit of helping providers to create the conditions for real and lasting positive change. Its ethos is to stand shoulder-to-shoulder with the NHS as the sector strives to place continuous improvement at its heart. This will involve a range of support offers as the NHS seeks to change and improve to meet the needs of its patients, and will include helping the system get a grip on its financial situation to ensure greater stability. 

Improvement is everyone’s responsibility, at all levels of the health and care system. As leaders, it’s our job to do everything possible to value the 1.4 million staff across the NHS to enable them to do their very best work every day. The Berwick Report echoed this: “Culture change and continual improvement comes from what leaders do, through their commitment, encouragement, compassion and modelling of appropriate behaviours.” 

Partnership working is also essential to successful improvement and transformation. Finding solutions on how to improve care and reduce costs requires cultures where the workforce are encouraged to work differently, test ideas and continually improve what they do.  

Last year’s Smith Review looked into leadership development and improvement support, and NHS Improvement and others will help to implement its recommendations – helping to strengthen the NHS’s ability to deliver effective transformation and improvement, identifying existing and future talent, and developing highly capable leaders. 

Continuous learning 

NHS Improvement also intends to support the growing improvement movement in the NHS and learn from teams across the UK, overseas systems and other sectors. Therefore, we are developing a new expert improvement faculty which includes Lord Ara Darzi and Professor Don Berwick, and will be seeking to develop stronger clinical networks through the system. 

Steven Spear from the Massachusetts Institute of Technology’s Sloan School of Management suggests that the difference between an organisation being great and being average is having the knowledge to be great. He describes how in these organisations leaders see their critical capabilities as including coaching, encouraging, and harnessing the capabilities to: (1) see problems; (2) solve problems; and (3) spread discoveries. Such high-velocity learning capabilities can ensure that issues encountered on Monday are addressed on Tuesday, so by Wednesday new approaches are being tested and tried. 

From my experience working in the NHS, I’m confident that this capability can be developed in the system. However, we need to help providers to see, solve and share – see the problems, understand them, then solve them by testing solutions and help to share the results. In this way, the staff of the NHS, working in increasing partnerships and networks, can help to develop the NHS as a learning organisation. 

Therefore, despite our challenges, we need to remember to breathe. Our patients and staff are counting on it.

Tell us what you think – have your say below or email [email protected]