One challenge I heard to the fab description of using the Vanguard approach to improvement in a GP consortium (shared in our Zoom last week)  was that it seemed to look at the 40%-70% of ‘failure demand’ found in the system at an individual level, rather than looking at how you can use an understanding at an individual level to redesign a service. It could end up looking as if it’s just person-centred care and asking someone what matters to them, one person wondered.

Below,  one of the speakers, Kristian, responds with a really helpful deeper description and clarification (nb slides/video from the Zoom coming soon!):
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Thank you for giving us the opportunity to clarify the point in question from the participant. 

In answering the question I think it’s important to remember the definition of failure demand as ‘demand caused by a failure to do something or do something right for the customer’. This means that failure demand indeed does arise on an individual level, as a consequence of the system not being able to respond to the individual in a manner that matches the individual’s need or ‘what matters’.

Aggregating demand in a demand analysis, where you gain insight in Type and Frequency of demand, tells you whether the problem of failure demand is systemic. If the proportion of failure demand is very high it thus means that the system is not very good at handling the variation in patients’ need and ‘what matters’ as a whole. 

By studying a sample of patients’ end-to-end experiences with the entire NHS system, we learned that the proportion of failure demand and waste was high, and we learned about the causes, which I outlined in the first part of the presentation. In other words, we learned that many demands placed on the system could have been prevented, had the patient been understood and helped differently.

With the intent to develop an approach to patient care for the frail elderly, which prevented future failure demands, we started an experiment. We knew that the experiment would not be fully systemic to start with, because we didn’t have engagement from all parts of the system, but we believed that a lot could be achieved by applying our systemic learning in an experiment close to the patients in their locality. 

What we did subsequently was to let Liz work outside the ’normal system conditions’. Equipped with the knowledge of which system conditions hinder patient experience and a method to understand the individual patient, Liz was free to do what she felt needed done to help the individual patient in relation the patient’s need and ‘what matters’. (This set up was very different than for anyone else, who works in the NHS and tries to achieve a person centred approach). This meant that she sometimes initiated clinical and sometimes non-clinical solutions and sometimes she engaged in different communications with the wider NHS system.

What we presented on the webinar was the surprisingly impactful positive consequences of doing just that. It showed that for the frail elderly, a huge part of the failure demand on the wider system can be prevented by following this method. 

As we mentioned, we have not redesigned the whole system. We have understood the whole system and its problems and causes from the patients’ point of view. We have then implemented this knowledge in a preventative and practical method, by which we can help the frail elderly better. This is something the current system is not capable of doing (otherwise we wouldn’t have achieved the results, which we did). The model is still in the prototyping phase, but as Darren mentioned, we are currently planning to roll the new roles, measures and work design in to the other GP surgeries under K2 Healthcare. 

We have thus created a prototype for helping frail elderly patients in a way that is demonstrably better than the current approach, without intervening in the wider system. However, it’s a method which reduces a lot of demands on the wider system. And it’s a method, which is very much person-centred.

The key, though, is to understand that it is not person-centred from a functional specialist perspective (only being person-centred about that part of the individual that we see through our specialist lens) but from a patient perspective. Furthermore, we have identified a long range of possibilities for improvement in the wider system, which will help us impact the wider system positively in the future. But for now the task at hand is to roll-in the method in K2 Healthcare GP’s.

I hope this helps to clarify the point in question. It’s near impossible to explain our process in detail on a 45 min call, so we really appreciate being able to answer any queries that emerge. 🙂