Planning for Value

by Niamh Lennox-Chhugani

How do we realise the ambition of delivering better value healthcare systems through the Sustainability and Transformation Plans?

The Sustainability and Transformation Plans (STPs) have been submitted. There will have been collective sighs of relief around the 44 footprints across England. Unlike many other strategic plans submitted in the past, there is an expectation that this is only a start of a journey. Momentum is expected to be maintained and evidence of early delivery will need to be seen at the next checkpoint in September or October of this year.

STP footprints are at different points in their journeys.  None are at an advanced stage of transformed sustainable healthcare that effectively manages population health risk through prevention and person-centred right care. “Person-centred” and “population-based” are seen by some as potentially in conflict.  I contend that you cannot sustainably realise one without the other. Professor Sir Muir Gray (@muirgray) highlights this in a recent joint Better Value Healthcare – Optimity Advisors webcast.

Assuming you collectively share an understanding of population risk management that delivers person-centred care for value, where do you start? STP priorities will have been identified for 2016/17 and 2017/18 but what do we know about the relative impact that these will have on value? And how can we accelerate this impact?

There are three things that the health and care systems in England has not historically done well which STPs are addressing:

  1. Managing population health risk proactively through a greater focus on prevention. This is about much more that having great analytics although this is a critical enabler, but is about a mind-set change for the population as a whole as well as health and care workers.
  2. Using digital technology to deliver coordinated, flexible services in entirely new ways and then monitoring the performance of these services in real-time.
  3. Contracting with and reimburse providers in new ways to incentivise the delivery of personal, technical and allocative value.

All of these are necessary conditions to realise the triple aims of the STPs but none of them are sufficient on their own.

Just as importantly, STPs will be thinking about how they deliver these transformational changes quickly based on the evidence. There will be no room for delay in benefits realisation. Based on our experience with STPs and past transformation programmes, we have three pieces of advice here:

  1. Work out the critical path in your implementation plan. This may be time consuming in these large and complex plans but the time spent at this point in ensuring that you understand dependencies and the critical path will only be spent 10 times over later if you do not do it at the outset.
  2. Harness the collective intelligence of your population, not just health care staff, in the design and delivery of new models of care that are based on evidence about what works and what delivers personal, technical and allocative value. This means taking a broader view than just “patient activation” but a new mind set in collaborative practice and shared decision-making which digital technology can be a real enabler of.
  3. Set up an agile or wiki-Programme Management Office, one that models the kind of collaborative, rapid cycle learning behaviours you are trying to embed across the health system. A core group of experienced change managers can be deployed flexibly across the system to work alongside people in designing and delivering services in new ways. They are deployed for short defined periods of time and don’t “backfill” business as usual but do help people to reprioritise their own work and release time to transform which in turn releases more time to invest (if it doesn’t then you haven’t been transforming the right thing in the first place).

If this was easy we would all have done it by now, but STPs will only work if stakeholders recognise they are here to stay, have to happen and then makes a personal commitment to contribute to their success.

If you would like to know more about our thoughts in this area, please visit our website for our webinars on transformation including real-world evaluation of transformation Optimity Advisors Healthcare Webinars 2016

Niamh Lennox-Chhugani

English

Niamh has 25 years of experience at senior levels in health provision, commissioning, policy making and research internationally and is the firm’s lead advisor for NHS and local government transformation. Niamh specializes in strategic delivery of innovative models of care across organisational boundaries and real-world implementation of public sector policies using rapid evaluation and learning cycle methods to inform implementation and provide real time feedback to decision-makers, frontline staff and service users.