Focus Prioritisation Performance and Results

Anyone who works or has worked in the NHS will tell you it is hard work, challenging and rewarding.  Chances are they will also talk about the frustrations of feeling that no matter how hard they run or work, it can feel at times as if they are wading through treacle and getting nowhere fast.


When you are on the outside looking in it can all seem so simple.  Yet often this assessment is based on limited understanding of the size and scale of the organisations, the politics and and the very fragmented nature of things.


During 2014 we have seen more and more organisations struggling to balance the books.  We hear that a huge number require improvement or are inadequate in terms of safety.  Access, particularly for planned operations is becoming a problem, requiring significant investment in extra capacity. Emergency departments are having to deal with more and more activity.  Use of agency and locum staff is on the up.


We all know that every organisation faces challenges.  Dealing with these challenges requires appropriate focus.  Decisions about what is priority and what is not need to be taken.  Problems need to be looked at and solutions found.


As someone who worked in the NHS for 15 years at the bottom and at board level as an FD I understand that any kind of change takes time.  There really is no quick fix.


What worries me is that most of the challenges we are seeing in 2014 are exactly the same challenges that existed when I was last working in the NHS at Board level 10 years ago.


Perhaps this is an indicator that at all levels and all parts of the NHS, leadership focus needs to change.  Maybe by taking 4 or 5 big impact areas and focusing attention on them, some progress can be made.  Everything is connected.


Demand for services determines the resources you need to deliver services safely.


Demand for services determines the amount of capacity you need.


How you deal with that demand impacts on capacity.  High levels of bed occupancy mean that you have to have really slick processes around discharge.  It means that you have to have good cross working between different providers of health and social care if you are going to avoid significant numbers of delayed discharges.


Now I am pretty sure anyone who works in health gets all of this 100%.


The challenge is as I see it to move from managing the problem to focusing on finding long term, sustainable ways of dealing with the issues so that in 10 years time we are not talking once again about the same issues.  To enable this to happen will require among other things:

  1. Board level teams focus on moving organisations forward.
  2. Top quality management both clinical and non clinical so that all the day to day operational activity runs well.
  3. A willingness for different parts of the health and social care sector to work together.
  4. Honest and open debate.
  5. Facts, figures and evidence rather than hearsay.
  6. Mutual respect for what each party brings to the NHS.
  7. Action focus.
  8. A willingness to learn from other sectors which have had to make significant change.

What’s your views?


Duncan Brodie is Managing Director of Goals and Achievements and works with healthcare organisations to help them to improve their leadership and management capabilities.  Learn more here.