It's tough in the NHS. Until recently as the chair of North Bristol NHS Trust (NBT) much of our board time was spent on the competing challenges of demand, performance and money, with no magic wand but increasingly the promise of continuous improvement as a potential way to unlock productivity. Productivity has become the new catch phrase but by itself, it is not surprising that staff suspect it is just a different word for doing more with less, and there isn't much support for that.
I am a fan of continuous improvement. I spent two decades of my professional life working to embed it in different organisations. Done well, it harnesses the wisdom and common sense of the people who actually do the job, which in time delivers real performance and productivity gain. Done badly it is just another "management scheme" which may deliver something, but little that actually sticks. In my previous media roles, there was fierce push back against anything that curtailed the individual choices or creativity of staff and pushing for consistency, value for money and improved process was a hard sell. The trick is to persuade staff to own and improve "their way" for the right outcomes. Fortunately, the motivation to do the "right thing" is usually not an issue in the NHS.
There are many improvement methodologies; at NBT we opted for Patient First which came from the Virginia Mason Institute and proved so successful at trusts in Leeds and Sussex. It is important to look at what others like you do and how they make it work, but I think the most successful improvement messages are to be found further afield and in unlikely places.
As NBT was beginning to get to grips with Patient First, I asked an improvement contact who he thought was world class in improvement. The surprising answer was Baxter, the maker of the drug and saline bags that are so much a part of hospital care. Baxter is a global manufacturer, with an exemplary site on the west coast of Ireland.
My visit there with our chief executive and chief operations officer was inspirational. They use the Kaisen methodology for everything they do. Their production lines work with it, their investment teams use it when preparing business cases, and their research teams use it to improve their work. Everyone speaks improvement, everyone, from the forklift truck driver to the managing director lives it. Their dedication to improvement meant that when Covid-19 struck, and they had to triple production they didn't even break their stride. So, what do they do that is so impressive?
The improvement message is everywhere in bright, fun infographics on walls across the site, including the staff canteen, displaying how they embrace improvement. They recognise individual and group achievements, and they celebrate their improvement journey.
Everyone can describe what 'improvement' is. There is no question about the leadership team's commitment, the executive team who were the first to be trained, now train others and know that their visible commitment sets the tone of the whole programme.
Every idea is welcomed. Suggestions are reviewed and ideas that are chosen are rewarded with something simple like a parking space for a month right outside the main entrance.
The most inspirational story from my Baxter visit was how they motivated their staff. Before they began their improvement journey improvement was just another word for productivity, aka making more bags. The leaders knew that a culture of improvement was rooted in a sense of ownership and pride, in doing something that mattered. They gave staff a sheet of A3 and asked them to illustrate how a Baxter product had helped someone they cared about. Back came pictures of friends and family who at some point had depended on a Baxter product. They shared these across the staff and then asked them "what do we do at Baxter?" The resounding answer from the staff was "we save lives". When Covid-19 struck and they needed to make more bags, they were saving lives – not increasing productivity.
I might therefore argue the NHS has a head start. We do save lives, we are motivated to do it, sometimes in the most traumatic and difficult circumstances. But much of what we do is also routine, tested, straight-forward. So how do we motivate our people to really own and deliver improvement, how do we build it into the DNA of the NHS? I would suggest the word 'productivity' isn't the answer. It is easy to set up delivery teams and trainers, but much more difficult to free up the right people from their already full days to be trained and to lead and embed improvement work. My experience tells me that the people who see the opportunities and have the knowledge to grab them are almost always the ones on the frontline. We can provide support and resource, but the right answers come from those really invested in making it better.
About the author
