The other morning, I came across an article in the Financial Times about Andy Burnham wanting to move the NHS from 'good to great' despite, say the Financial Times, the billions of pounds in savings the service will have to make.
The FT went on to argue that those levels of cost savings would require a 'major re-engineering of services'. The word 're-engineering' caught my eye because, before coming to The King's Fund last year, I spent many years teaching software engineering to budding engineers. Much of what I taught was technical, and a large portion of it concerned system efficiency and optimisation.
Efficiency and optimisation aren't everything in engineering, but they count for a lot.
These days, I often think about the hard leadership skills – can we call them skills to re-engineer? – that clinicians need if they are to improve clinical quality and patient experience with reduced financial resources. This is more than simply making the best use of resources because then the key evaluative measure is how well resources were used. Instead, the key challenge is aligning resources to improve outcomes.
Richard Bohmer and Tom Lee recently wrote that 'outcomes-oriented' health care organisations (where effectiveness is measured by outcomes rather than by the number of services delivered) will need to look at the 'optimum configuration' of human and technical resources, and the processes linking them to clinical outcomes.
The question is, who optimises the system?
Like Lord Darzi, Bohmer and Lee see this as a job for doctors, nurses, and those who work closely with them. Clinicians understand the nature of the work and together have the most comprehensive and complex view of their organisations. And they have patients' best interests at heart.
Clinicians are best placed to know which processes result in good clinical outcomes, and how they can be used most effectively. They will need to define which elements of clinical data are most useful to improving outcomes, how to interpret them, and how to apply them to get results. Clinicians' input will be needed to align decisions across the entire system.
This line of argument suggest that the core skills needed in a cold climate are close to those of an engineer concerned with efficiency. But while efficiency and optimisation count for a lot, they don't capture everything. You don't optimise a system in a vacuum – the process is laden with trade-offs that you have to make daily, as an individual and with your colleagues. How do you make those trade-offs? And, more importantly, how do you get your colleagues and staff on board?
We are conducting an online survey of both medical and clinical directors to get their views on the leadership skills needed during a cold resource climate, to feed in to the content and design of our clinical leadership programmes. We're also hoping to discover new thinking through your comments on this blog. Which leadership skills do you think are needed for a cold climate?
I would be very interested in hearing more as I doing some work for the Scottish Government to explore the role of clinical leaders (mainly nurses and midwives) as guardians of quality within wards and department.