Spring In-Brief 2019 - Flipbook - Page 4
Continued from previous page.
Putting good governance at the very heart of corporate
spending is a very different mind-set for how resources
are deployed to support clinical delivery of services in
many organisations.
The great woolly mammoth
… and the evolution of specialist services
Organisations are now challenged to work outside of
‘form’, urging close collaboration with neighbouring and
similar hospitals to improve efficiency and reduce costs.
Working in this way requires an enhanced skill-set and
strategic thinking needs to be bold, courageous and
underpinned by the drive to understand how non-clinical
resource can be most effectively deployed without the
necessity to “own it”.
Providers simply cannot do everything themselves and
should meaningfully collaborate with other organisations
to share services, particularly back-office services. Trusts
that will prosper in this environment will show leadership
in the spirit of co-operation and give ICSs answers rather
than problems.
While Model Hospital started as a process to help
providers to be more efficient it is not a panacea. Trusts
still need to continue to transform services so they are
more responsive to patient needs and do so in an
increasingly efficient way. Accountability is evolving to
encourage providers to streamline the delivery of services
along a pathway and make decisions to improve services
and reduce costs at incremental points. Boards who have
grasped the Model Hospital agenda are ahead of the
curve and those that are actively aiming for the ‘sweetspot’ of joining up use of non-clinical resource, improving
governance and reducing harm are leading the curve.
Key questions for your Board:
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Where does your organisation stand on key areas of
expenditure, notably buildings and the cost of running
them? Where are the potential synergies with
neighbours?
How do your services that support the delivery of
clinical services such as human resources, risk,
governance and finance benchmark with other
providers, and do your outcomes measure up?
How does your discretionary spend add-up on
communications, research and development and how
does this contribute to reducing risk and improving
safety?
Does your Board have the skills to think differently
enough in support of greater integration and does your
Board development programme reflect this change?
Is the ICS doing enough to promote trust between
providers? Do you have a panoramic understanding of
each other’s key risks? How are these risks being
mitigated and shared across the ICS?
Mark Hindle, Associate Partner - Niche.
4
“It is not the strongest of the species that survives,
nor the most intelligent that survives. It is the one
that is most adaptable to change”
This quote is often falsely attributed to the father of
evolutionary biology, Charles Darwin (although there is no
substantive evidence of this being something that he ever
said or wrote). However, it very succinctly encapsulates a
concept at the core of his most famous work “On the
Origin of Species”; the book which laid the foundation for
modern evolutionary biology.
Whilst working on a simulation modelling project for a
mental health trust recently, I found myself explaining the
issues surrounding specialisation of services within
healthcare systems and how the subtle ‘evolution’ of
these can have adverse impacts on services’ ability to
deal with changing demand.
Specialisation of services may represent a clinical ideal of
perfectly tailored clinical intervention, optimised for a very
specific cohort of patients (the strongest, most intelligent
service). But when we sub-divide services, we also make
them much less resilient to change. Smaller populations
of patients have much higher relative variation in demand.
Specialisation may refer to clinical practice, but splitting
services by gender, age and locality are all different types
of specialisation. Dividing services, either clinically or
otherwise, may be the right decision and absolutely
necessary.
However, it is worth fully understanding the impact this
will have on the resilience of services to cater for everchanging levels of demand; both in terms of short-term
variance and long-term demographic and epidemiological
change.
The woolly mammoth was perfectly suited to the ice age
that it lived; with its insulating coat, long tusks for digging
through snow and ice for food and small ears to prevent
radiation of vital body-heat.