What are the priorities for the NHS right now?

The NHS operational planning guidance sets out the priorities for the year ahead. These include:

• investing in our workforce
• responding to COVID-19
• increasing activity to tackle the elective backlog
• improving the responsiveness of urgent and emergency care.

Most immediately, NHS health care leaders have been asked to focus on delivering urgent and emergency care, which includes ambulance handovers and hospital discharges, and providing more routine elective and cancer tests and treatments.

How are these priorities related?

Each of these priorites is interdependent and related to system wide flow across the local health and social care economy.

For example, ambulance handovers present at the entry point to hospital but are related to constraints within the system such as bed availability and staffing. Similarly, delays to hospital discharges present at the exit from hospital but are related to constraints in the wider system – including pressure and capacity in social care.

Furthermore, elective backlogs which developed during the response to the COVID-19 pandemic can present in any part of the healthcare system such as primary care, mental health, outpatients, diagnostics and surgery. Clearing these backlogs and bringing demand and capacity into balance is recognised as a longer term challenge related to constraints in workforce capacity and staffing.

What these examples show is that demand in one part of the health care system can meet constraints in another leading to delays and backlogs. We need approaches that help us consider health and social care as a whole system.

How can we tackle system-wide problems?

The scale of the problem may seem daunting and feel too big for any individual to tackle, but there are things that can be done.

Taking a large-scale, relational change view can help identify the interdependent nature of the different problems we are tackling and the multiple organisations and stakeholders involved.

Using the complex systems lens of ‘structures, processes and patterns of behaviour’ can help us to focus on potential improvements that may be within reach.

Some problems we need to address are structural. This means they relate to organisations, policies and regulatory guidance, or perhaps physical space, equipment and resources. Examples include the need to address the NHS workforce vacancy gap; the cost-of-living crisis and its potential to impact on health and pension taxation rules and their consequences for NHS workforce flexibility, recruitment and retention.

Some problems are behavioural and relate to the ways we act based on our experiences. Others are primarily processual, meaning they involve the routines and other activities through which health care services are delivered and relate to patient journeys, pathways, procedures, and the flows of people, equipment supplies and information.

Large structural changes may be tied to longer term policy, strategy and funding decisions. Process and behaviour changes may be more readily achievable – for example, we’ve written previously on the Q blog about process changes to support elective recovery.

How can the Q community help?

The Q community is a group of people skilled in improvement. As a large and growing network, Q is experienced in bringing stakeholders together across organisation boundaries to work on complex problems. One way in which stakeholders can do this at scale is through online collaboration.

Online collaboration is an effective means of sourcing process improvement ideas. Right now, colleagues across the NHS are sharing via the #SolvingTogether platform ideas to boost elective capacity and improve processes. But what else can be done to support implementation?

Technology enhanced learning techniques and massive-online collaboration are effective and efficient means of supporting improvement activity at-scale.

NHS England’s Improvement Capability Building and Delivery Team offer several massive-online programmes that Q community members can use to collaborate on large-scale change, process improvement and micro-system improvement.

What can we do with massive-online improvement and collaboration?

Getting Started with Large Scale Change provides a structure for planning improvement programmes to tackle large scale, system challenges such as ambulance handovers, elective backlogs, and hospital discharges.

Through collaborative learning, this massive-online programme can support Q members to:

• establish a local vision for their change and build commitment to a shared purpose
• develop a narrative to connect with the core values and motivations of stakeholders
• create a high-level improvement strategy connecting specific, actionable changes to the overall vision and goal
• create momentum by coalescing activity around 30, 60, and 90-day cycles of change.

Supported by Q members, local teams can then take forward the specific changes identified in high-level improvement strategies and 90 day plans via process improvement and micro-system improvement massive-online programmes.

How to enrol and get started

Getting Started with Large Scale Change is enrolling now and opens on Monday 27 June.

Lean Fundamentals focusses on process improvement. The next cohort opens on Monday 5 September.

Improvement Fundamentals focusses on micro-system improvement and runs throughout the year.