Developing an organisation that successfully organises health care.
Giving the public a direct saying in calling out waste
Two distinct but linked issues here.
In a wide range of life experiences we have become used to services that work. Having goods bought via the internet delivered the next day has become the norm. Organising whole parts of our lives remotely has become normal. We expect things to work first time and we expect all of it to be organised.
As consumers we don’t need to know about the logistics behind all of this. It’s just there and when, as in May 2018, this doesn’t work (on the railways) we are shocked and angry. Someone saying that timetabling trains is a bit hard just won’t do. We expect organisations to quietly get on with organising quite complex activities without really bothering us with what they do and how they do it.
If that’s the case in 2018 think what it will be like after another 10 years of organisational tightening up.
And then there is the health service.
A very small example from a chemo suite.
Some of the highest qualified and most capable nurses in the world decide you need some vitamin D. But they can’t prescribe it. So they have to wait for a doctor whose sole purpose, when they appear, is to write the prescription which the nurses dictate. A copy of that prescription is then given to the patient and another copy is faxed to the pharmacy downstairs. The patient then takes the prescription in their own hands down to that pharmacy to get their vitamin D.
It’s not just that it’s wasteful, a bit crazy, and of course perfectly normal in our health services, but unlike nearly every other organisation from which we receive services we can see the organisation as it organises. It’s right there bumbling along in front of our eyes operated by very highly trained and capable people doing very odd things. It’s like when we did maths at school – the ‘working out’ is written down ahead of the sums and is there for all to see. Often patients are pretty ill at the time so just go along with it, but that doesn’t make it any the less odd or any the less public. And any less wasteful.
In this blog I have often talked about the work done by National Voices in 2013 which concentrated on identifying what the public wanted from coordinated, person-centred care and how that’s a better language to use than the internal one of integration. The public wanted very straightforward things.
“I would like to tell my story once” The seeming endless repetition of symptoms and lifestyle to different doctors and nurses and social care staff is wearing for patients.
“When I move between services and settings there is a plan in place for what happens next”. Wouldn’t it save a lot of time if, when they transferred a patient, services also clearly said what happens next – rather than the duplication that now takes place.
“I can plan my care with people who work together to understand me and my carers, allow me control, and bring together services to achieve the outcomes important to me.” Putting me at the centre of what is going on will save a lot of time energy and waste because after all I am really here at the centre of my life.
Over the last 5 years I have taken these aims and these statements and discussed them with thousands of staff and patients and they ring very true. Most of those discussions have been about the tiring waste for the patient and their carers that comes from repetition and duplication, and yes that is the main reason for tackling them.
And yet over the years there remains a mirror image of this duplication and waste. Not just for the patient and carer but for the staff in the NHS and social care. Telling my story 10 times is tiring for me and my carer but it also means that 10 different people are taking it down and for 9 of them it’s a waste of their time and effort.
If insufficient knowledge is passing with me between care settings it’s a pain (and a danger) for me but it’s also a complete waste of staff time in the new setting to have to carry out diagnoses and tests that have already been done elsewhere.
Over and over again we see that what is a waste for the patient is also a waste for the NHS and social care. And this isn’t a little thing. Added together it’s enormous.
But we’ve sort of got used to it. The chemo nurses know that they wait for a doctor and go to the fax machine at work. The moment they leave the hospital they get their mobile phones out and organise their lives for the evening. And they do this only once – not 10 overlapping and duplicating times (or by fax)
And this is where my opening thoughts intersect.
The National Voices work tells us that every day hundreds of thousands of patients experience duplication and waste. Their main experience is confusing and puzzling for themselves, but they also see the waste in the NHS. All the time. Every day.
Let’s empower their experience of what they see. Every trust could have a six monthly report from Healthwatch outlining the waste experienced by patients that comes from a failure to apply logistics. It’s not the job of the patients to come up with a modern organisation. That’s the job of the people who run the organisation.
But it is the job of patients to call out the waste that they see every day and to compare that with other services they experience.
If we fail to improve how NHS and social care organisations actually organise themselves in their dealings with the public over the next 10 years, those institutions will collapse under the burden of waste.