Part 4 Segmentation Strategy

The third aspect of work­ing smarter is to seg­ment patients accord­ing to their spe­cific needs and pref­er­ences. Seg­men­ta­tion iden­ti­fies patients with sim­i­lar needs and/or pref­er­ences, and groups them together so that a spe­cific path­way can be designed for them and spe­cific resources can be allo­cated to them.

An exam­ple is a strat­egy for peo­ple with long term con­di­tions such as dia­betes and asthma. Rather than hav­ing a ‘one size fits all’ sup­port strat­egy for peo­ple with long term con­di­tions, we can group or seg­ment patients by their level of risk. So a per­son with mild dis­ease could be offered one to one case man­age­ment sup­port in the com­mu­nity to avoid cri­sis and pre­vent hos­pi­tal admission.

Seg­men­ta­tion also means design­ing the sys­tem to meet the needs of each group, so that vari­a­tion is reduced and capac­ity matches demand at every stage in their jour­ney. An exam­ple is the seg­men­ta­tion of patients who attend the emer­gency depart­ment. They can be grouped or streamed accord­ing to whether they have ‘major’ or ‘minor’ needs. A sep­a­rate process flow is estab­lished for each stream of patients with ded­i­cated clin­i­cal staff for each stream. In this way, arti­fi­cial vari­a­tion is avoided because staff are not being con­stantly moved between minor and major patient streams. In addi­tion, the needs of all patients are met.

A focus on reduc­ing vari­a­tion and waste in health­care processes is a key pri­or­ity in improv­ing health­care per­for­mance, both cost and quality

By work­ing out the detailed resources required by each patient group, the flow of patients through the whole sys­tem is improved and vari­a­tion, queues and sub­se­quent delays are avoided. Patients are safer, there is less waste in the sys­tem, sat­is­fac­tion rates are higher and the poten­tial for effec­tive out­comes is enhanced.

The new per­for­mance per­spec­tive means new roles and skills for NHS finance lead­ers. Tra­di­tion­ally, we view the finance direc­tor as the voice of finan­cial con­straint. We value his or her abil­ity to ‘bal­ance the book’ at the end of the year. Often the role needs to look back­wards; seek­ing the dif­fer­ences, dis­crep­an­cies and expec­ta­tions to bal­ance off, rather than think­ing how to move things forward.

Next to follow: The new Finance Director

Writ­ten by Helen Bevan  (Direc­tor of Ser­vice Trans­for­ma­tion) and Micheal Caw­ley (Direc­tor of Finance and Busi­ness Ser­vices at the NHS Insti­tute for Inno­va­tion and Improvement).

Related posts:

1. Working smarter not harder
2. Reducing costs and improving quality in the NHS!
3. Demand management fails as trusts soak up PCT cash