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Technology plays an increasingly important role in our health and care system. It allows us to consult specialists and receive care from home, order medications using our phones, and receive new digital treatments. This shift towards technology can, and should, be positive; technology can drive change, facilitating better patient outcomes and experiences. However, NHS patients struggle with aspects of digital health care, such as having multiple apps with siloed records, fragmented digitalisation, a lack of digital options, and insufficient accessibility features.  This study from the King's Fund aimed to understand the skills, knowledge and capabilities needed for health and care systems to do this well. 

Leeds Teaching Hospitals NHS Trust discovered a significant budget shortfall and had to act fast. The financial picture would only get worse unless they reduced spending. The Trust mounted an unprecedented response in record time, rallying 800 staff to come up with solutions in a massive, coordinated improvement workshop. The results were phenomenal — saving millions of pounds with a variety of updates to staffing and scheduling practices. And the Trust proved it was up to any challenge, no matter how large. “Our people, our culture and our methods came through for us in the most impressive and inspiring ways. When you invest in those components completely, it pays off a thousandfold,” — Professor Phil Wood, Chief Executive at the Trust.

A new government has come into office facing public services in dire straits and a tough financial climate. Inevitably, finding ways to boost public sector productivity has come to the fore. This paper, authored by Alex Fox and Chris Fox, argues that traditional approaches to improving public sector productivity, such as adopting private sector practices, technology-driven reforms, and tighter management, have failed to address the complex and evolving needs of public service users. It proposes a shift towards a strengths-based, person-led model, where public services are co-produced with individuals, families, and communities.

Identifying high and poorly performing organisations is common practice in healthcare. Often this is done within a frequentist inferential framework where statistical techniques are used that acknowledge that observed performance is an imperfect measure of underlying quality. Various methods are employed for this purpose, but the influence of chance on the degree of misclassification is often underappreciated. Using simulations, this study shows that the distribution of underlying performance of organisations flagged as the worst performers, using current best practices, was highly dependent on the reliability of the performance measure. When reliability was low, flagged organisations were likely to have an underlying performance that was near the population average. Reliability needs to reach at least 0.7 for 50% of flagged organisations to be correctly flagged and 0.9 to nearly eliminate incorrectly flagging organisations close to the overall mean. The authors conclude that despite their widespread use, techniques for identifying the best and worst performing organisations do not necessarily identify truly good and bad performers and even with the best techniques, reliable data are required.

 The NHS Oversight Framework (NOF) outlines NHS England’s national approach to oversight of integrated care board (ICBs) and trusts, and how it monitors performance against key NHS commitments. The Recovery Support Programme (RSP), working with regional and national NHS England teams, provides focused intensive support and oversight to ICBs and NHS trusts/foundation trusts that are in segment 4 of the NHS Oversight Framework. The RSP has been in place since July 2021 and replaced the previous special measures’ programmes. There are currently 20 NHS providers and 3 ICBs enrolled in the RSP and the list of organisations is published on the NHS England website. Organisations in the RSP receive support (for example, financially and through the provision of additional resource) for a time-limited period with exit criteria agreed that will demonstrate sustainable improvement and recovery. The RSP approach can be applied to an individual NHS organisation, or across a whole system, comprising the ICB and constituent NHS providers. This paper outlines the current RSP approach and describes the work underway to update NHS England’s approach to improve performance in the most challenged organisations.

The Patient Safety Authority (PSA) has published its ambitious new strategic plan, Reimagine Patient Safety 2029, with PSA’s vision of “safe healthcare for all patients” central to the plan’s three core goals summarised below: Push the boundaries of information science: Harness existing and cutting-edge information science to identify and understand patient safety issues. Leverage relationships: Collaborate with key stakeholders to implement impactful changes that improve patient safety. Maintain a strong organisational culture: Prioritize people and continuous organisational improvement.

As the NHS is approaching its 75th birthday, this report from the Tony Blair Institute for Global Change proposes how the NHS needs to transform if it is to survive. The paper propose six areas for reform where radical-but-practical policy action will begin to transform the future of the NHS and deliver better patient care: 1. Put patients in control of their own health: First, the government must provide every person with a digital Personal Health Account (PHA) that offers a simple, single digital front door to the NHS and wider health-care services. It will become the portal through which people interact with the NHS, allowing patients to have direct access to services, including general practitioner (GP) appointments, at-home diagnostic services and even opportunities to participate in clinical trials. Most importantly, it will give people direct access to and ownership of their health data, including information provided by third-party providers or wearable technologies. 2. Create new access routes for services and providers: The range and availability of health-care services must increase to reflect citizens’ demands and their increasingly complex needs. Pharmacies, gyms, supermarkets, workplaces and other spaces should all be able to provide or facilitate the provision of health care, bringing services closer to patients and reducing demands on general practice. Most importantly, the PHA will create a new marketplace for services. This should focus on high-volume, low-complexity services – for instance dermatology – to make them directly available to patients. Introducing multiple providers, including third parties, will offer patients greater choice through the ability to balance outcomes, waiting times and costs. 3. Harness the power of genomics and other “omics” platforms to personalise care: The NHS Genomic Medicine Service should be made accessible to more patients for a greater range of conditions to improve early diagnosis, prevention and treatment. Specifically, universal clinical whole-genome sequencing should be offered to all patients upon disease diagnosis, all newborns and all healthy populations with known risk factors, including a family history of disease. As science progresses, other omics disciplines such as proteomics and metabolomics, should be integrated into routine clinical care, to improve the prevention, management and treatment of disease. 4. Create a locally led and self-improving system: There must be a new deal for accountability and autonomy between Whitehall and the Integrated Care Systems (ICSs). This must allow local leaders to operate with much greater freedom and hold them to account for delivering a set of clear and transparent outcomes focused on creating and improving health, rather than simply treating sickness and delivering against activity targets. ICSs should also be given multi-year budgets that are adjusted for the needs of their local population. And they should be allowed to keep and redeploy savings from innovating and improving care. Finally, quality and care outcomes should be made transparent and available to patients to empower them to make an informed choice between GPs and secondary care providers within an ICS. 5. Invest in new and more efficient infrastructure to deliver better care: NHS productivity and efficiency must be transformed through investment in basic technology as well as increasingly powerful AI, and by enhancing existing infrastructure. This will require upfront investment but will be offset, at least in part, through increased automation of processes and by finally tackling wastage across the system. The future operating model we are setting out in this paper will be much more capital intense, much more efficient and much less reliant on labour. 6. Energise and modernise the NHS workforce: The new NHS Long Term Workforce Plan is welcome and will provide much-needed investment to help create a pipeline of future talent, increase long-term capacity and provide new training routes to increase workforce diversity across the NHS. However, the NHS is facing an immediate workforce crisis with concerns over staffing pressures and pay that must be resolved. In addition, putting more staff into an outdated and unproductive delivery model is not sustainable and much greater focus is needed on harnessing the potential for technology to improve the efficiency of services, help to reduce the demands on frontline services and improve outcomes for patients. In addition, a comparable commitment and long-term plan is needed for social care and public health to create fully supported health and care services.

The government has published its mandate to NHS England. This mandate is intended to apply from 15 June 2023 until a new mandate is published. NHS England has a duty to seek to achieve the objectives in the mandate. The Secretary of State keeps progress against the mandate under review, setting out his views in an annual assessment which is laid in Parliament and published. The government will agree with NHS England how it should report on overall progress against the mandate to support the Secretary of State in keeping this under review. This will include reporting at agreed intervals on other delivery expectations listed beneath the objectives. Mandate objectives Priority 1: cut NHS waiting lists and recover performance. Priority 2: support the workforce through training, retention and modernising the way staff work. Priority 3: deliver recovery through the use of data and technology. Continue work to deliver the NHS Long Term Plan to transform services and improve outcomes.

The publication of a new single, shared improvement approach, ‘NHS Impact’, is an exciting milestone. It reflects recognition, at the highest level in the English NHS, that improvement principles need to be part of the mainstream approach to the challenges facing the sector. Penny Pereira, Q’s Managing Director, considers the new approach, its potential impact and what it means for members and others working to improve health and care in England and beyond.

Does your manufacturing facility experience an undesirable frequency of costly product losses? Are recurring operational issues impacting productivity and morale? Do people believe the causes of these production issues are ‘human error’? Do Quality Differently will show you: How to take a systems-based risk management approach to create more operational success. Practical examples to guide improvement in your operations. Ways to apply comprehensive approaches that reveal and address the combination of factors that influence performance outcomes. The lessons in this book were gathered while integrating human and organisational performance principles and practices at multiple biopharmaceutical companies and manufacturing sites—real-time experiences with frontline workers, support staff, and leaders. Do Quality Differently offers practical guidance for biopharmaceutical manufacturing plants and beyond—anywhere managing risk is paramount. Clifford Berry and Amy Wilson share a recent presentation that summarise key points from the book: HOP Integration - Berry Wilson.pdf

Hospitals can significantly elevate patient satisfaction and enhance the delivery of healthcare services by incorporating best practices from adjacent and non-adjacent sectors. Chetan Trivedi explores several solutions, from multiple sectors, that can serve as a blueprint for hospitals across every key step of the patient journey, spanning from admission to discharge.

The NHS is at a critical juncture in its 75-year history. With finances as tight as they have ever been, and a workforce stretched to breaking point due in part to spiralling demand from an older and sicker population and a shrinking labour pool, it is clear that things cannot carry on as they are. The time has come to think and act differently – at every level of the health and social care system – and to do so at pace. This long read describes five guiding principles that should inform implementing the NHS Impact approach to improvement at provider, ICS and national level to maximise the chances of success in the current climate. We also present recommendations for provider organisation, system and national leaders on the steps needed to translate these principles into sustained improvements across ICSs.

This factsheet explains more about how the new independent Health Service Safety Investigations Body (HSSIB) will function

Imperial College Healthcare share a poster on their strategic goals and their values and behaviours.

MIT Sloan experts offer a systematic approach to organisational resilience that can help leaders manage risk and rebound rapidly when catastrophic events strike. In their executive education course, “Building Organizational Resilience: A System Approach to Mitigating Risk and Uncertainty,” Carrier and Levi lay out a playbook for improving organisational resilience. They advocate for an approach that leans on systems thinking and continuous improvement to help organisations identify problems before they occur. They also detail how to identify the right intervention points in operations and the supply chain to help an organisation stop or recover from an evolving critical situation before its impact turns catastrophic. In this article they summarise the key advice from their resilience framework. "It starts at the top with C-suite executives who are fully committed to understanding what’s happening on the front lines so they can ask the right questions and be open to the right recommendations and actions."

Human Factors and ergonomics (HFE) expertise continues to have difficulty integrating its experts into healthcare. This persistent disconnect is compounded by unique aspects of healthcare as an institution, industry and work system. Clinically embedded HFE practitioners, a new HFE sub-specialty, are a conduit for addressing substantive mismatches between the two domains. Greater HFE penetration will require a fundamental change in stance for both domains, however, the burden will lie with HFE to be the more adaptive of the two. Learning more about the in situ work of this sub-specialty will provide insights for more nuanced approaches to bridging domain specific mismatches and obstacles.

Workforce burnout and resilience in the NHS and social care report describes the causes and effects of burnout among staff working within the National Health Service as well as the impact of Covid-19 on burnout.