Technology and system design key to NHS doing more with less

A new report has recommended the NHS invests in responding to patients as “customers”, as spending cuts, an ageing population and rising obesity place the institution under more strain than ever before.

Researchers at a British headquartered consultancy have warned that a range of converging crises are placing the National Health Service under greater pressure than ever before. In their annual Barometer on Change publication, the analysts of Moorhouse claimed that the number of people waiting longer than 26 weeks for an appointment has more than doubled since 2013, sky-rocketing from 45,000 to 92,000 in just three years.

Since 2012, Moorhouse has conducted an annual survey of senior leaders across both public and private sectors on the challenges they face in implementing change. Their findings draw together views from over 200 board members and the senior leaders that work most closely with them, from organisations across private and public sectors. Across all sectors, the 2017 Barometer found that leaders remained aggressively self-confident regarding their organisations growth expectations, with the number of respondents experiencing growth climbing by 26% from last year to hit 85%, in spite of the political and economic volatility in 2016. Meanwhile 79% of leaders cited their organisations as ‘change embracing’, showing that transformation is increasingly viewed as a necessary vehicle for growth.

One of the roots of this readiness across businesses to go through processes of continuous self-evaluation and regeneration was found to be the ever shape-shifting demands of the customer. 71% of leaders interviewed named customer demand as the most significant driver of changes to their organisations’ products or services – with 80% of companies believing due to their innovative approaches, they deliver good customer service. Problematically, only 8% of customers surveyed meanwhile felt they received the service they expected. This perception gap is a growing concern for profit-oriented businesses particularly, given that 47% of customers also indicated they took their business to a competitor within a day of experiencing poor service.

However, public services do not have this mechanism for understanding public perception – and with a rapidly changing user-base, many captains of the public sector are finding it increasingly difficult to deliver the standard of service people would expect as customers, not just citizens. Particularly, the NHS is struggling to meet the expectations of a growing, ageing and increasingly demanding population, a predicament not aided by the announcement in January that the UK government will cut the Service’s budget per person in real terms next year. Numbers released by ministers show NHS England will face a sharp reduction of 0.6% per head in the financial year 2018-19.

This latest round of funding cuts comes at a time when an ageing population recently saw dementia and Alzheimer’s disease become the top causes of death in the UK for the first time, while almost 3 million people suffering from diabetes, linked to an increase in obesity of over 10% in both sexes. The UK also saw a staggering 16 million hospital admissions in 2014/15 alone, an increase of almost 4 million over the preceding decade, and The British Red Cross has meanwhile warned of a “humanitarian crisis” regarding waiting times at hospitals in particular, condemning current practices following the deaths of two patients after long waits on trolleys in hospital corridors of Worcestershire Royal in early 2017. These seismic shifts in patient demography mean NHS funds are likely to be spread thinner than ever before in the future, while the institution’s leadership struggle to find new ways to do more with less.

As a result, the conclusions of Moorhouse’s report particularly focus on advising public services, with special prominence afforded to the NHS, on how to respond to growing pressures within the public sector. The report states that, so dire is the current state of affairs, that for many leaders in public service provision, only a radical approach will be able to tackle the increasingly demanding patients of the health sector.

Broadly, researchers state three fields through which to frame all institutional strategies for both public and private organisations. Innovation, through which organisations can leverage game-changing products and services to create a customer-centric experience. Secondly organisational leaders should be ready to collaborate, in order to best implement these innovations. Finally, organisations are advised to engage with staff and customers in order to gear these changes toward the people who they will most directly impact. In the case of health care providers, Moorhouse recommend applying these three pillars to system design, value creation and the use of technology.

Through designing services as a system, researchers believe leaders in the sector can rebalance resources while restructuring health care to cope with new issues, for example, focusing on campaigns of prevention to help stabilise existing services in the long-term by reducing future demand – particularly in the realms of the aforementioned obesity epidemic, or integrating proactive health-checks into other areas of business, such as housing associations to catch outbreaks of disease early, minimising the strain they can thereby put on the NHS. Once space has been freed in this manner, emboldened system designs tactics can look into tailoring services to match services to different patient segments in order to address the disparate needs and expectations of an increasingly diverse age-range of patients.

While it will probably not be intuitive for a not-for-profit state service like the NHS, another potential avenue for leaders in the sector to consider is making “value” part of the equation. By ensuring hospitals make staff and patients aware of what services cost, while drawing staff around key issues that may involve those figures, leaders in the sector could open themselves up to valuable input on how to save costs according to localised patient analysis, while improving engagement from their employees.

Above all else though, the use of technology is at the heart of health solutions that match patient demand and customer expectations. The legacy computing infrastructure of the NHS recently came under fire after patient records were compromised by the global WannaCry hacks earlier in 2017, however the need for digital innovation to cope with growing demand goes much further. According to Mustafa Suleyman, founder of Deep Mind, a firm specialising in apps to organise patients medical records, who is cited in the report, “Doctors and nurses in the NHS do a phenomenal job caring for patients, but they’re being badly let down by technology. Pagers, fax machines and paper records are still standard in most NHS hospitals.”

By properly harnessing new technology, hospitals could harness the ‘big data’ and the power of population health analytics, and use the information to project where resources are most needed, or even where prevention would be most effective, lightening the load on the medical infrastructure by decreasing patient numbers. The NHS reportedly spent £640 million on consultants in 2014 alone, in a ‘cost saving’ exercise as the institution bid to access such analysis on where resources were best used, however the appropriate use of technology in this instance could all but eliminate such a cost.

According to the authors of the report, “This year’s Barometer on Change has exposed a growing need to meet increasing customer expectations in a challenging business environment. Customers expect more. And firms are struggling to access the skills and capabilities to meet their demands. For many, only a radical shift in their business models will create the environment to compete in this customer driven market. Therefore, whether tackling increasingly demanding patients in the health sector or responding to disgruntled passengers in a crowded transport sector a bold approach is required.”