In every National Heart Service (NHS) organisation, the finance team should be champions of quality improvement. Why? Because clinical processes represent more than 80% of the costs in a typical NHS setting. Actions that we can take to improve quality (reducing errors and unnecessary variation in clinical processes) are also some of the most powerful and sustainable ways to reduce costs.
Yet too often, we see costs and quality as competing goals or trade-offs. Finance leaders may regard them selves as protecting the bottom line against the poor cost control and excess expenditure of clinicians. Clinicians may regard themselves as defenders of quality, protecting patients and professional standards against the demands of the finance team. Too often, non-clinical leaders use methods of financial scrutiny and cost reduction that appear heavy-handed and inappropriate to clinicians.
Looking at things from the point of view of both the finance team and the clinicians the picture may appear very different. However, they just have different perspectives on the same problem: systems that are poorly designed.
Many of the performance problems of health care organisations are the result of problems in the way that processes are organised and delivered across the health care system. Problems such as variation in clinical outcomes, excessive patient waiting times, high costs of care, even needless deaths in hospital can be tracked back to issues around healthcare processes and the flow of patients through the healthcare system. A focus on reducing variation and waste in health care processes is a key priority in improving health care performance, both cost and quality.
In the past, a variety of methods for process improvement from manufacturing and service operations have been switched to health care.
These methods include:
1. Lean thinking, which seeks to eliminate activities or process steps which do not add value to customers
2. The theory of constraints, which seeks to eliminate bottlenecks in processes
3. Six sigma, which aims to reduce variation and create defect free services
We find that these industrial approaches, based on many years of improvement knowledge in other sectors, can make a significant contribution to cost and quality improvement in healthcare. However, these techniques need to be translated for a clinical and managerial leaders can relate to, providing specific clinical examples and case studies and creating clinical champions for the application of these techniques.
As these process improvement methods become more commonplace in healthcare and their benefits are demonstrated, they contribute to a new perspective amongst healthcare leaders about where the real problems are in the system and how to systematically improve care. In future, the skills connected to this new way of thinking will be an essential capability for every finance leader.
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).
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