Demand is often treated in an undifferentiated, transactional way but closer analysis finds there are two key types: value demand (responding to what the patient needs) and failure demand (ie demand caused by a failure to do something, or to do something right for the patient).
Demand analysis will often reveal that levels of ‘failure demand’ in the system can be up to 70% or more, and turning it off has an immediate positive effect on capacity.
A 16-practice GPs consortia in Lincolnshire used this Vanguard method to understand the nature of patient demand around frailty and drive down the failure demand by taking action on its root causes. This improved the service for patients, reduced costs radically and waiting lists too.
In this session, Vanguard and two members of the GP consortium share an overview of the method and details of their journey of system change in Lincolnshire. They’ll also discuss how this approach can be replicated in other areas of health care.
‘Creating capacity, eradicating failure demand and failure work, turbo-charging staff engagement & morale, transforming the outcomes/lives of patients for the better and significantly improving the systemic economics. Sounds impossible…?’
‘Well, a small team within a 16 GP consortium in Lincolnshire have actually delivered all of the above’.
– Project team member
Two health practitioners from the GP Consortium talk through:
- the key changes made;
- the performance impact that resulted;
- how systemic economics can be understood.
The case studies are representative of patient experiences from acute hospital care to adult social care, as well as core GP services.
Vanguard founder John Seddon explains: ‘it is our belief in targets, procedures and controlling people that creates waste in the flow, constraining the capability of the system from the [patient’s] point of view and generating large quantities of failure demand’.
Speakers bios
Darren Altus is Managing Director at K2 Healthcare, which constitutes a 16 GP practice federation with 132,000 town and rural capitation. He applies systems change and service design, with a focus on building Neighbourhood Teams that integrate work across health, social care and the community.
Elizabeth Reader has been nursing for 30 years, starting at Addenbrookes Hospital Cambridge and currently working as Practice Care Co-ordinator Lincolnshire with a passion for treating frailty in community. Awarded Queens Nurse Title 2018, in recognition of her commitment to high standards of patient care and continually improving practice.
Kristian Astrup Nielsen has in the past 15 years been helping leaders in the UK and Scandinavia apply (the Vanguard Method) a systems perspective on design and management of their service organisations. Recently he has been involved with transforming health services in the NHS.
This session was organised by Q’s Primary Care Special Interest group and facilitated by Sheffield-based GP Ben Allen.