Four principles of successful system-level transformation in healthcare

There are four key principles healthcare leaders should follow to embed and embrace system level transformation, writes the healthcare experts at PA Consulting

Optimising healthcare can be a complex challenge for any transformation and advice for those involved can sometimes feel contradictory, and offer incomplete or changing requirements. For example, how do you provide an individualised service of the highest quality to an ageing and expanding population while cutting costs year on year?

In the UK, the NHS has undergone multiple reorganisations since its inception. At local, regional and national levels, leaders have repeatedly tried to solve the cyclical challenge of volume, cost and quality. The latest change calls for health and care organisations to come together to form Integrated Care Systems (ICSs). Legislation is to enforce these ICSs from April 2022 as NHS leaders try to drive collaboration in a bid to efficiently and effectively answer both short- and long-term population health priorities such as the patient backlog and shortages in workforce across the system.

If ICSs are to be successful and truly transform healthcare services, our experience has taught us there are four key principles healthcare leaders should follow to embed and embrace system level transformation:

Think beyond organisational boundaries
System-level transformation requires organisations to work collaboratively to deliver the bigger picture. They’ll need to share insight, resources and risks to build and maintain the relationships required to deliver complex change across a diverse range of stakeholders. These relationships are crucial aspects of any system-level transformation as leaders will find themselves having to make decisions in the best interest of the system, even if they’re detrimental to their own organisation. Healthcare leaders need to ensure they carefully consider how to manage this continual balance of short-term risk and long-term reward, ensuring organisations aren’t penalised for doing the right thing for the system.

In the Black Country, we brought together four NHS trusts to redesign IT systems that would let their shared pathology service better provide for the region’s 1.4 million patients. By working beyond traditional organisational boundaries to collaborate on the new system, we’ve been able to free capacity by reducing over testing and reduce costs by £52 million over 10 years, all of which will improve services for both patients and staff across the region.

Empower organisations and teams
It can seem counter-intuitive, but creating rigid and wide-reaching governance structures to oversee, manage and drive system-level transformation is more likely to hinder than help. System-level transformation requires a partnership built on trust, where organisations and teams can take decisions quickly as everyone understands they’re working towards a clear goal. Simplifying governance structures and modelling them around the outcomes required, rather than an arbitrary governance mechanism for reporting or assurance, will allow transformation teams to respond quickly and focus on delivering value.

Adopting such an agile approach offers many benefits when working on complex, system wide programmes. Consider the national responses to the Covid-19 pandemic, such as the UK Ventilator Challenge. Responding to the call from the UK Government in March 2020,  quickly mobilised and coordinated a national programme to produce enough ventilators to meet unprecedented demand within the NHS, bringing together organisations across the public and private sectors. It was vital to align these disparate stakeholders around a shared mission so each could make effective decisions at pace to stay on track to achieve the ambitious goal.

Stay true to the overarching vision and outcomes
Transformation at a system level can quickly become overcomplicated, causing the programme to drift from the initial objectives. Leadership teams must establish a clear vision from the outset to unify collaborating organisations and teams. Maintaining a relentless focus on a vision throughout a transformation programme will help manage the natural evolution that happens as you overcome obstacles and find new opportunities. It’s also an important stabiliser to sustain system-level partnerships, ensuring all organisations remain aligned even when competing priorities threaten to derail the transformation.

In South East London, for example, transforming the pathology services to fit a new ‘hub and spoke’ model had the opportunity to improve diagnosis and treatment for millions of people across the ICS. By maintaining a clear and consistent vision across the primary and secondary care providers involved, we were able to agree a 15-year contract that should save the ICS more than £100 million while improving access to services.

Design for simplicity and build to evolve
System-level transformation requires an approach that’s adaptive, flexible, iterative and reflective by its very nature. Continuous evolution needs to be at the core of its design, especially when competing against other programmes and projects for time, energy and resources. Creating a complicated and detailed project plan can be time consuming, and latter stages are often out of date by the time teams come to implement them.

Complement high-level roadmaps and a clear vision of the required outcomes with shorter horizons that focus on incremental goals. Breaking down the transformation into smaller, more attainable milestones means the transformation team can effectively manage and prioritise the critical path, often achieving the transformational aspirations sooner than expected. And celebrating each incremental milestone keeps the teams motivated, organisations enthused, and transformation on track.

This is what PA did with the North Central London Cancer Alliance, a partnership of NHS organisations, as they strived to reduce waiting times in the wake of the Covid-19 pandemic. By creating a vision for more efficient, sustainable endoscopy services, we were able to prioritise the most valuable projects, delivering them in parallel where possible, and launched them as they were ready. This simple system of constant evolution let the Alliance hit its goal four weeks ahead of schedule.

Healthcare can undergo successful system-level transformation
Successful system-level transformation will require ingenuity, strong leadership and a willingness to listen, learn and adapt. Keeping the structures, processes and governance simple, agile and responsive are key ingredients to maintaining and sustaining collaboration across organisational boundaries. Combined with a relentless focus on the overarching vision and outcomes, optimising the provision of healthcare to meet both short- and long-term health priorities is possible.

By Ashley MacNaughton, Oliver Excell and Nina Stanley, healthcare experts at PA Consulting.