Improving productivity in the UK has become a national priority. Health care delivery is not immune to this challenge although those of us working in the sector may have lost sight of the amount of waste there is. The public definitely haven’t. Wastefulness is one of the most common criticisms of the NHS.
Within the NHS, we need to talk about productivity whether we are clinicians and/or managers. We have a responsibility to provide quality care as efficiently as possible. One of the challenges is that addressing this requires clinicians and managers to work together. This happens every day but isn’t always easy because the mindsets and approaches to a problem can be so different.
When I think back to when I was a clinician, I wanted to be as certain as possible about the diagnosis, treatment and likely prognosis for a patient. Clinicians aim – as far as is possible – for certainty and will pursue it relentlessly. They can do this, not just because of their skills and knowledge, but because they also have easy access to more data and information (such as ECGs and x-rays) than a manager could ever dream of.
When I became a manager, I realised I had to think differently: if I had been aiming for the same certainty as a manager that I looked for as a clinician I would never have been able to provide advice or take a decision. This situation – clinicians wanting all the evidence possible and managers working on a ‘good enough’ basis – can create tensions, which, I think, can potentially be even more difficult if the manager has a clinical background. As a manager, I have always tried never to pull the ‘I am a clinician too card’, although wouldn’t claim I have always succeeded.
The essential ingredient for success in improving productivity is a shared vision of what needs to be achieved with shared ownership of both the work and the outcome. Building a relationship is the first step to building trust on both sides. The manager and the clinician also need to be confident they have local/service autonomy to make the necessary changes within appropriate frameworks. The manager needs to be well prepared and clear about what he/she is asking of the clinician, so time is not wasted. (I think that managers often waste clinicians’ time discussing things which have little or no chance of happening. We shouldn’t do that.)
To challenge the waste and productivity gap in health care we also need to work with patients and the public. They can see inefficiency better than any of us. Having worked with patients and the public for many years I am amazed how rarely we ask them about what is important to them. An example is visits to outpatients – for a 10-minute appointment a patient may be spending a whole day waiting for transport to and from hospital at significant cost (to the patient and the health service) only to be asked to come back in three or four or six months to do the same again. As well as cost, this shows a lack of respect for patients’ time. They might not feel they need follow up at all but put up with our way of working because of worrying they won’t be able to get back into the ’system’.
Putting our efforts into non-value-added activities or wasting resources reduces our productivity, whether we are a manager or a clinician. Some clinical variation may be appropriate but often there is no rationale for it, other than custom and practice. There are many examples of this, including decisions about how best to manage the same condition or the use of different orthopaedic prostheses for the same clinical problem, often costing the NHS more.
We need to ask ourselves whether our behaviour, as much as limited resources, impacts on our individual productivity. How can we become more efficient? This is a subject that I and others will be discussing at the Fund's Annual Conference later this month when we’ll consider questions such as ‘How can organisations and individuals continuously learn and improve as part of a wider health care system?’, ‘How can we harness the power of clinical and financial staff to deliver better value’ and ‘Where do patients and communities fit into this?’
Improving productivity can imply criticism of staff for not working hard enough, although this is rarely the case in the NHS. And a single individual is unlikely to become more productive on their own, however much we tell them they must be. A productive workplace is a more constructive and engaging way for us to address this issue in health care, built on teamwork and a shared vision of where a business, in our case health care, is heading. This may be a better way to approach productivity in health care.