Dalton: Time for new mindsets on standards and governance

In December 2014 I delivered my review of NHS providers to the health secretary.

It is, I hope, now stimulating discussions about how NHS providers can pursue models of care consistent with the NHS Five Year Forward View that meet required standards and develop governance arrangements to allow them to deliver these standards reliably.

This will require a new strategic mindset, so leaders can act as architects of the future and not passive stewards of their organisations, who defend them regardless of how alternatives could provide benefits to the people and communities they serve.

New models and governance arrangements will be required to deliver local, integrated services and also shared services across hospitals to serve wider geographies and populations.

One of the five themes I proposed was for ambitious organisations with a proven track record to be encouraged to expand their reach and have a greater impact across the sector.

• Private sector with public spirit: a Swiss alternative to Hinchingbrooke
• Pearson: Follow the tides of change to achieve new models of care
• Read more in this series about delivering lasting change within the NHS

Clear model of care

The interview with Axel Paeger explores how an organisation with a clear model of care has implemented this and is able to demonstrate a track record that has a positive impact.

Evidence gathered as part of my review last year showed that many healthcare organisations in other countries have an enterprise strategy, and a mindset for change, growth and development.

‘I proposed for ambitious organisations with a proven track record to be encouraged to expand their reach’

These are not as evident in our NHS, hence the struggle to be clear on strategies that improve standards of care reliably and for governance structures that require organisations to collaborate effectively to achieve goals.

By contrast, across Europe and beyond, larger healthcare groups are finding new ways to assure high standards. They appear to place a greater emphasis on strategic planning and standardisation, as well as effective local operational management of each operating entity.

“Many healthcare organisations in other countries have an enterprise strategy, and a mindset for change, growth and development”

They have a clearer focus on standardisation – initially of back office functions and of procurement – to assure high quality of products and greater financial discounts.

They pursue standardisation of care pathways, and they pursue innovation to enable new technology and devices to be deployed at scale across different sites.

They also standardise their improvement methodology, so ideas can be tested in several locations before they adopt and spread to all locations. Their strategic approach to standardisation is to improve care quality, and bring service reliability and significant opportunities to improve productivity and efficiency.

Processes must reinforce

The story of AMEOS is one of a relentless drive for high reliability, to minimise operational variability. In the UK it is assumed that staff will contribute to the board’s strategy and values, yet rarely do formal processes assess and reinforce this.

European hospital groups are more likely to adopt recognition and reward programmes, to align performance and behaviour with organisational goals, and to make clinicians and staff fully accountable for their contribution to those goals and values.

“Hospitals must also break out of the outmoded “single hospital” mindset”

There are lessons to be learned from our European counterparts. Collaboration should be viewed in terms of what is best for the patient, rather than its impact on organisational or individual status.

Too many hospital leaders see collaborative working, partnerships and mergers as either a failure to offer a full range of services, or an opportunity to extend their power base.

Often they are inclined to preserve their organisation, rather than trying to find alternative value adding solutions. Hospitals must also break out of the outmoded “single hospital” mindset, where a single organisation is expected to provide every service from one site.

Leaders of our NHS organisations must now enjoin their talent and capability with the opportunities that are presented by the forward view, so that they can design vibrant, high quality and sustainable models of care.

New ambitions and a social entrepreneurial flair should create the governance and organisational forms to enable their delivery. These are exciting times.

Sir David Dalton is chief executive of Salford Royal Hospital Foundation Trust