“First, do no harm.” The spirit of the doctors’ oath should be the spirit that guides NHS trusts in transforming. Getting Sustainability and Transformation Plans to actively drive improvements is a key part of meeting that requirement, but it feels like some trusts may be caught up in old and unhelpful behaviours. Why do I say this? There are regions that are making STPs work, and there are others for which the “STP” acronym seems to mean “Seriously Tricky Plans” – there is huge diversity in how effective the regions have been. So – how to scale best practice across regions?
STPs aren’t negotiable, and neither is success
The ones that make it work take decisions that reflect regional, rather than local priorities. They have managed to solve the challenges of a complex funding environment, at least in part, by taking an altruistic approach, and realising that the greater long-term good may require that some organisations within the region earn less revenue to meet overall strategic goals.
The challenge isn’t mysterious, nor is it limited to the UK. In order to make healthcare sustainable globally, health analytics and the prevention of acute episodes would lower costs and move care away from hospitals to focus on prevention rather than cure. However, hospitals that are funded on the basis of patient throughput would lose budget if they receive fewer patients – so meeting patient needs is in direct conflict with maintaining local hospital budgets.
To add to the challenge, public healthcare ecosystems are notoriously difficult environments in which to deliver change. Multiple organisations with distinct accountability, autonomy and different approaches to investments and technology are hard to coordinate around a single objective and approach.
Regional versus local priorities
When Primary Care Trusts and Strategic Health Authorities were stripped out of regional NHS structures, some of the ability to co-ordinate and control regional strategy from a central point was lost. Independent leadership in individual organisations became increasingly focused on the bottom line, and competition between these organisations meant that keeping local control was important. Yet the NHS needs to collaborate at regional level to move more care into patients’ homes and the community health setting. So how do health authorities overcome these sometimes conflicting priorities? The Accenture Health CIO survey has revealed three key points to consider:
Maintaining control in distributed ecosystems – this is tricky where there are several autonomous groups or organisations tackling transformation opportunities, with intersecting and overlapping initiatives and priorities. CIOs talk of two different issues here: lack of coordination, where multiple different pathway redesign efforts for different disorders result in duplication (the age-old silo problem, don’t reinvent the wheel); and a lack of architecture skills, where some clinical design groups lack the vision (to know what technology could do for their pathway) and / or the understanding of technology challenges (“don’t pay for the curtains when you still need to dig the foundations”).
Co-creation is key – all CIOs underline the importance of the role of Chief Clinical Information Officer in larger NHS organisations, and the need to involve doctors in creation of Digital strategies and solutions. There is a strong feeling that greater harmony between the technology and clinical domains results in more relevant solutions and greater ownership (and thus faster adoption) by the clinical community. The cautionary point here is that proper technology support and involvement early in the discovery phase can avoid the proliferation of apps and vendors from creating, rather than solving, confusion.
Digital best practice is being created in pockets, where funding is available - Like the vanguard programme or more recently the digital exemplars, CIOs within other organisations are keen to get access to this best practice and the associated investments.
What does this mean specifically for Hospital Trust leadership? Instead of hospitals being cost centres, we need them to become the platforms for organisational change. Regional actions, not local actions, are the primary success factor for STPs, so by extension, regional decision making power should increase.
Hippocrates had it right – the needs of the patient, not the behaviours of individual organisations, must be the primary factor when taking decisions about the transformation of the NHS. Failing in this regard is not an option.