Seven steps to creating a sucessful social enterprise

Bromley Healthcare is an NHS “spin out” social enterprise, established just over two years ago, which provides community services in Bromley. It is gradually winning business in other areas but has made very significant improvements in performance since it was set up.

‘Organisations like ours are not weighed down by a hospital, with its daily demands and ravenous need for money’

Leg ulcer healing rates have reduced from 21 weeks to five weeks; chronic obstructive pulmonary disease readmissions have fallen from 20 a month to zero; the amount of patients not attending appointments at clinics has dropped from 13 per cent to 5 per cent; and population sickness has dropped to only 2.5 per cent.

Only 1 per cent of the staff group would not recommend the services to friends and family and productivity has increased by 15 per cent; we expect it to increase by a further 7 per cent this year.

We have only just started our improvement programme − the facts are good but they will be a lot better. So, you might be wondering, how did we do this and what role did being a social enterprise have in it?

Spin out success

Our methodology is formed of seven points.

• We have tried to keep our objective very simple − no more and no less than making sure everything we do improves care for our patients. We have made this the defining philosophy for everyone in the organisation. You don’t need endless corporate statements to achieve this.
• The next point isn’t rocket science either − we have let go of the bad things about the public sector and held on to the good. This seems easier to do in a new organisation that does not come with any predefined expectations about how it should work. Social enterprises in health do not come with a rule book; public sector organisations (whether explicitly or subconsciously) probably do.
• There are clearly things to be learned from all sectors. This is obvious to anyone who has worked in different types of organisations. Charities, mutuals, social enterprises, private companies and the public sector all have things to learn from each other. We have brought in people from different sectors and backgrounds, and not just at the top of the organisation; we want to take what is good about the private sector but, as a not for profit organisation, we’re not held to short term ransom by the need to generate profits for shareholders.
• We have delegated control of services to staff and given them true responsibility for them. They know their patients better than anyone else and are best placed to improve services without having to wait for management to approve anything. But with delegation comes responsibility, so we monitor the performance of services closely − and we manage performance in a way that it has not been in the past. Why? Because if staff don’t do their jobs well, patients suffer − and our patients have to come first.
• By creating a common story − we have no guarantee of survival − we do not live with that complacency. We stand and fall by our performance and everyone needs to know that we if we are not producing better services than anyone else, we won’t be providing any services.
• We also really do look at best practice across the country, compare that against our own and put plans in place to get our services to the standard of the best that is out there. There is a lot of talk about sharing best practice − at the very least service leads should know how what they are doing compared with the best that is out there, and have a plan for being at least as good.
• Lastly, we have the mixed blessing of being small, at least by health service standards. Organisations like ours are not weighed down by a hospital, with its daily demands, ravenous need for money and the huge burden of central government control. This is a massive competitive advantage because it allows us to plan calmly for the future and concentrate only on the fundamentals of looking after patients better and more efficiently.

The leading health organisations of the future may not be the large hospitals of today; they may be health management organisations that organise care around individuals’ needs, led by the community and human in scale and scope.

These organisations will want to focus on keeping patients well, not keeping hospitals solvent − they will want someone else to do that.

All of this is obvious of course, but it’s easier when you start something new with an utter determination to do it differently.

There is a lot of theory about different organisational forms and the role of competition, but a 15 per cent improvement in productivity is not theory. If this was replicated across every community provider in the land, our health service would do better where it matters most; resulting in improved health for the people we serve.

Jonathan Lewis is chief executive officer at Bromley Healthcare