One of the key drivers in setting up NewCourse was my belief that there was a better way to deliver the help and support healthcare organisations across the world need to improve. Consultancy, in all its various guises, is an expensive commodity and we are passionate about enabling people to access the help they need and making sure that our help represents good value for money.
In this series of articles, I hope to, in some way, hold up a mirror and reflect on some common challenges or conceptions about consultancy; thinking about how it is commissioned and how it is delivered, linking back to my area of interest in healthcare quality, and reflecting on how these challenges might be overcome.
This week’s post will look at why quality improvement is important and some of the benefits of seeking expert advice, as well as what happens if we choose the wrong partner. In the next post, we will drill down into a few more specifics about the challenges of delivering improvement and engaging with consultants, for example measuring return on investment (ROI) and dealing with resistance to change. In the final piece, we will bring all these elements together and think about how best to deliver effective, measurable and sustainable improvement.
Let’s start at the beginning. Whatever our drivers, and today is not to debate them, we should all be able to agree that healthcare needs to continually evolve, improve and develop in order to deliver the best possible outcomes for patients.
Quality improvement should focus on improving outcomes for patients and enhancing the patient experience throughout the healthcare journey. Of course, this is an oversimplification of the complexity of delivering ‘quality’ in healthcare services; and in many cases meeting legislative requirements might be a simpler, unifying goal amongst healthcare organisations the world over!
But measuring quality is not easy. First of all it is hard enough to define quality, but measuring it can be just as difficult. Healthcare organisations are incredibly complex, with multiple sites, convoluted hierarchies, and various intertwined processes and pathways governing the delivery of care. The standard of care can vary considerably between organisations and even between departments within the same organisation.
If how to identify measures of quality within such a complex framework presents quality improvement professionals and hospital management with the first problem, measuring the success of any improvement can be even more problematic. And then you need to sustain and build upon the improvements made. Often it is a bit of a lottery, in which the quality of the data we extract is only ever a reflection of the quality of the data that we put in: part of the reason why it’s so important to take the time to plan for measurement from the outset.
We have casually bypassed getting leadership and staff engaged and involved in improvement. Engaging in quality improvement can help to create a positive environment for both patients and staff. But only if it’s done properly. Staff can rapidly become disengaged if they feel marginalised by improvement work and many, quite legitimately, suffer from initiative-itis. Resistance to change has many drivers but it is fair to say that the arrival of smartly dressed outsiders with immaculate powerpoints does not always help!
In high pressured environments, and healthcare is certainly that, staff often struggle to find the capacity to focus on improvement. All too often, it is seen as a nice-to-have add on rather than part of the job. We also find an intriguing balance between confidence and knowledge to structure improvement (because there is a bit of science to it) sometimes resulting in a situation in which anyone with some knowledge or training in improvement gets thrown everything that is going wrong and told to fix it.
All of this creates a challenge, when we know that well planned and implemented improvement programmes can drive safer and more effective healthcare services, enhancing patient and staff experience, as well as reducing costs that our finance colleagues love.
I fundamentally feel that if you need help you should ask for it and there are some really key things that outside eyes, and legs, can help with (if done right):
Specialist expertise – significant experience that helps guide you towards the desired results, helping you define the right goals, and helping balance the evidence base with your local circumstances
Training and coaching - not only helping to train staff on new processes or teaching them new skills, but mentoring them with new responsibilities and providing the coaching to improve collaboration, engagement and development
Overcoming organisational barriers – external eyes often have the headspace your staff don’t, enabling them to see the path to improvement more clearly, and it’s easier for them to overcome internal barriers to change brought about by organisational structure and culture
Capacity - in the majority of organisations, existing staff members simply do not have the capacity to absorb anything else into their workload. As a short-term solution, this can get programmes up and running
Quick wins - consultants can often deliver immediate results in order to demonstrate the effectiveness of an improvement. This can improve staff engagement, particularly if workload is noticeably reduced as a direct result. Management support can be more easily gained if they see progress or early cost benefits of QI measures
Infrastructure – the experience to build the appropriate infrastructure from which to manage and govern change moving forward. This can include helping to identify the right skills, building a reporting structure and improving communications. All with the aim of making sure the setup is fit-for-purpose
A step in a positive direction - organisations flourish when they are moving forwards, embracing change and improving. The same goes for individual staff members. An effective QI programme which is well-planned, tailor-made to meet an organisation’s individual needs and well implemented can bring tangible results, quickly.
In reality, not all consultancy is good consultancy. Despite the numerous benefits that can be gained from seeking help, it is amazing to find examples where obvious mistakes are made which have a negative impact both in the short and longer term. It is important to find the right partner to work with your teams. The right partner will want to build a positive and mutually beneficial relationship with you. Indicators of this can include:
Spending time understanding you, your challenges, your culture and ethos
Adapting solutions to meet your aim and objectives, rather than delivering out-of-the-box solutions that might have worked somewhere else
Understanding your priorities and competing agendas, focusing in on the specific strengths and weaknesses that drive your performance
Building capability and confidence with existing staff, helping turn their ideas into action and ensuring a legacy to the improvement work
Focusing on developing the infrastructure to maintain and build on the work undertaken
Allowing you and your teams to take the limelight, and removing the frustration many feel when their ideas are not recognised
Focusing on action rather than discussion and presentation.
This list is far from exhaustive, but it underlines some of the elements consultants, myself included, can all too easily get wrong, and which impact the improvement process. Getting this partnership right from the start and setting up improvement in the right way is going to contribute to a more positive, more cost effective and - most importantly - sustainable improvement in the long term.
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