Improving productivity: resources from Q

If not already high on your objectives, 2024 is set to bring calls to increase productivity. This is layered on top of the quality and recovery challenges we have been grappling with since the pandemic. 

It’s easy to feel deflated by the resource pressures and the picture of declining productivity in the health sector as the backdrop for our improvement efforts. 

Yet, those of us with improvement skills have a crucial role to play both in achieving change and bringing perspectives that galvanize others. 

This piece shares resources from Q that give me inspiration. 

Rather than get our heads down and push on with ​‘driving productivity’ in the face of staff resistance, learning and sharing how to bring people with us may be the most important way we can help each other and the health sector.

The contribution of improvement to productivity that comes most immediately to mind are the methods to understand systems and reduce waste. 

While well established for decades, as Steve Black has argued and we’ve summarised in a recent Health Foundation briefing, there’s still a long way to go before they are used routinely. 

As Jim Mackey reminded us last year in relation to elective recovery, there’s lots we can achieve through doing the basics of improving processes well. 

Across the work of Q members, there will be many examples of people taking out non-value adding steps and reducing errors in care pathways in ways that free up the time and resources of service users and clinical teams. 

The 62% reduction in process lead times achieved collectively by the trusts participating in the Virginia Mason Initiative provides one example.

As our learning from the Q community shows, we are now as often challenging ourselves to take a broader systemic view as improving services provided by individual teams. 

While it’s crucial we continue action on specific service challenges, this wider systemic view is a critical strength of an improvement lens on the productivity challenge.

When organisations are looking to make cost improvements, or target staff time and scarce capital resources, often these choices are made without the system analysis that makes sure we’re targeting the real issues. 

And we need to get better at introducing changes – whether that’s tech or new roles – in ways that will embed effectively in care pathways and proactively address any new quality and safety challenges, otherwise we may well end up changing staff numbers and costs without getting better outcomes. 

Health needs cross organisational boundaries, and the gaps between services can be a source of inefficiency as well as harm and frustration for staff and patients. 

Many of the pressures we face may be caused or exacerbated by not addressing population needs when they occur – so called ​‘failure demand’. 

For many reasons it’s important we take a system view of both of our measures for success and implementation approaches, even if that can make change more complex. 

The Health Foundation’s recent guide to making the case for improvement provides examples of the benefits associated with improvement, from a population, staff, organisation and system lens. 

I’d encourage you to use this guide to think holistically about the benefits you’re seeking to achieve and demonstrate with any piece of improvement work. 

Rather than having ​‘safety projects’, ​‘clinical effectiveness projects’ and ​‘cost improvement projects’, a more mainstream approach designs change to achieve multiple organisational goals. 

That can help staff see the potential to hit productivity alongside other objectives, manage any trade-offs and help get the level of senior support that work will need to be sustained, particularly in a context of extreme budget constraints.

While the focus when talking about productivity is understandably on care delivery and high cost back-office activity, it’s worth applying this lens to work in all areas. There’s plenty we can learn from each other in Q as we do. The act of sharing itself reduces one of the most pervasive wastes: duplication due to our failure to adopt and adapt what we can from others. To name two recent examples from Q that I found inspiring: 

1. We funded work to establish the first online patient experience library, mapping the mountains of evidence already collected. This means that we can target our efforts and the time of the patients we engage – focusing on gaps in knowledge or populations reached. Find out more. 
2. Members from 24 organisations have been collaborating over several years to develop a quality coach development programme, that is free to adapt and adopt, meaning you can focus on delivery, confident in the design and development of the content. Access the programme. 

What else have you seen that’s helped save time and helped good ideas spread further?

While the productivity agenda brings into focus the technical issues of balancing resources and reducing waste. 

At least as critical is the contribution of improvement to understanding how people work together in systems to enable outcomes and how to engage staff well in change. 

The productivity challenge is a people challenge: staff costs make up over 45% of the NHS budget. 

Recruitment challenges mean staff capacity is set to be an increasingly constrained resource. The nature of health care means that resource decisions are made by thousands of people every day, rather than being controlled from the top of organisations, as Professor Sir Chris Ham notes in his recent opinion piece for the BMJ.

It’s also a people challenge because, when we work within organisations and processes that are so frequently wasteful and poorly designed, we’re eroding the ability of teams to bring their best. 

And only with people who receive and deliver services can we improve productivity sustainably. 

On a recent Q Visit, I found the work of Leeds Healthcare NHS Trust inspiring for many reasons. 

The way in which they describe waste really struck me: reminding us that the different forms of waste all have the potential to undermine human potential and skills. 

The interaction between the more technical process and human view of waste is critical. And addressing waste allows us to make the most of the human potential all around us in the health sector. 

The health sector runs on discretionary effort. 

If we further alienate people often exhausted by the pressures on the system, we could make retention, overall staff engagement and productivity worse. 

There is a pressing need to focus on engaging people effectively in productivity discussions. 

While there’s no easy route through this, the skills I see in our community make us well placed to help. And we have resources and connections to draw on, including 10 principles to support the engagement of staff in major organisational and system change.  

This recent Q insight project saw 300 people helping to distil these principles. 

As David Fillingham, the chair of England’s new National Improvement Board put it when speaking with me on a Health Foundation webinar last year, we need to inspire rather than direct improvement. 

That’s as true when our goal includes increased productivity. And it includes both the work we do with staff in health services and the time we take to inspire each other with the examples and stories that can keep us going and on track.