NHS Reset: Learning from COVID-19
NHS Reset is an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic. Here, Dr Alan Willson, senior research officer for the Life Science Hub Wales, takes us through six key process innovations learnt as a result of the pandemic.
Thank you for the tweets and direct replies to my last blog: The habit of innovation. They confirm that we at Life Sciences Hub Wales are far from being the only ones wanting to use the COVID-19 disruption to learn about ourselves and our system.
On a personal note, like many people, I have been using technology that has been around a while to have much more focused meetings that avoid travel. I have also had the same £60 in my wallet for four months as I have suddenly gone cashless in all transactions. Innovation? For me, yes. It has also been a useful way of helping me differentiate between product innovation (meetings software and contact-less payment) and process innovation (changing what I actually do).
But what is COVID-19 teaching us about the NHS and its partners as innovators?
In a nutshell, the problem we have had is to get huge amounts of kit to lots of people. At the start, that was about existing suppliers and existing users. But the levels of use mushroomed, existing supplies were exceeded (sometimes very quickly) and new users appeared. That has meant bringing new suppliers into the market - often with no experience of healthcare. At that level, parallels with innovation are limited to working at new pace, wider spread and more agencies. But the health service quickly realised it needed to solve new problems - testing for a new disease at scale. Also, suppliers have come with new designs for existing kit. How do we balance need with prudent risk taking?
Following my last blog, I have had many conversations with colleagues about the learning. They are important conversations because we must not forget useful experience. I have picked out six themes. They are all about process innovation - our actions. I will start with the obvious ones.
1. Connection and collaboration
A good market depends on buyers and sellers interacting frequently and intelligently. When people don’t know one another and don’t speak to one another, they don’t understand one another and may hold naive views about what the other party does or believes. Also, as the Nuffield Trust report suggests, poor connections happen in large organisations and structures, not just between sectors.
2. Pace
Like all production lines, NHS processes for getting a product to its user or for building new resources have many steps and many handoffs. During the pandemic, staff in NHS organisations in Wales often had to respond and work a lot more quickly than usual. As Suzie Bailey and Michael West say, this has partly been achieved through the resourcefulness of talented and committed staff: COVID-19: Why compassionate leadership matters in a crisis. But those staff have needed a mandate for pace and changes to processes.
3. Risk
The Parliamentary Review of the NHS in Wales signalled a need for a new approach to risk. That was very prescient. Arguably, Covid-19 has made the risk of not doing something greater than the risk of doing something. Security and speed of delivery became more important than cost. Certain checks and tests were fast-tracked to deliver PPE to its users.
4. Evaluation
There is a tendency to front load our risk management by building in specifications and checks at the procurement stage. This excludes untried and untested products and suppliers. The rigidity of current risk management was also reflected when some services found themselves without any viable suppliers of certified and appropriate PPE.
Innovation involves prudent risk-taking. That in turn requires trial and learning. Our risk management must follow processes and implementation rather than be fully front loaded.
5. Centralisation
So many of our systems use centralisation as a way of achieving efficiency and reducing risk. We measure efficiency in terms of unit cost of ingredients and do not look at value across whole processes, including factors such as speed and security of supply. How much longer does it take to send a test to a big central laboratory? How any extra steps? How many extra errors? Just-in-time supply systems have also been found wanting. National and international standards and specifications may be too rigid, detailed or anachronistic. Unfortunately, centralisation also separates users from suppliers; problems from problem-solvers.
6. Leadership
Dr Freddie Johannson’s thoughtful blog for the Q community: What has happened to make change happen so quickly? suggested several reasons for the changed mindsets that have driven progress during the Covid-19 emergency. Positive reasons (shared purpose, focus on patients) have combined with a removal of usual constraints (especially the burden of governance and assurance) to drive change at remarkable pace and scale. While the acceleration may have been driven by fear and anxiety, it needs to be driven by sustainable forces in future. Leadership must be clear about purpose and value and less focussed on checks and balances.
What lessons do you know that we have learned?
Dr Alan Willson is a senior research officer for the Life Sciences Hub Wales. Follow the hub on Twitter @Ishubwales.
