Managing Change to Improve Clinical Outcomes

Throughout my career, like other health professionals I have focused on trying to achieve the best outcome for each patient. I have kept abreast of new evidence and endeavoured to apply that in my clinical practice. As Connect Health has grown and I have ceased my clinical role, I have encouraged and supported other clinicians to do the same. As a result, our clinical outcomes have steadily improved. Over the last few years, we have invested in systems and a data warehouse, which has given us timely information about our clinical outcomes at organisation, service and individual levels. This has accelerated our improvement in terms of outcomes demonstrating that visibility of performance enables transformational change.

Technology is changing every aspect of our lives. The benefits provided by new digital approaches are having a huge impact on our societies. However, one of the greatest business challenges is not about the devices, software or solutions – it is about how we manage the process of cultural change, particularly in health and care, which have historically been slow to embrace new technologies. Almost everyone accepts that technology has the potential to improve the delivery of healthcare and its impact. Therefore, the management of change is critical in its implementation. We have introduced Artificial Intelligence (AI) to enhance patient care. This has resulted in streamlined processes which frees up time for colleagues to focus on the patient, rather than on certain administrative tasks. Our communication with colleagues has been key in this, sparking significant levels of interest, curiosity and ideas.

An organisation as large as the NHS inevitably has significant variation both in terms of its behaviour and practice. There are numerous examples of innovation and excellent practice and impact. However, in some areas there are conflicting incentives and drivers. Where focus is on patients and taxpayers, but also a good deal for staff, then there is a better chance of optimising care.

We remain determined to work with the NHS to raise the quality and efficiency of MSK, rheumatology and pain community service provision across whole systems.

Our services are wholly designed to focus on the patient experience and what really makes a difference to them – being seen in the right place, at the right time, by the right clinician.

Part of our clinical philosophy is to reduce the barriers for patients (and commissioners) to accessing care. We have found that the earlier a patient presents, the less pain, stiffness and weakness has developed therefore achieving an optimal outcome requires less input by the clinician or the patient. The investment in our infrastructure and referral management centre is key to reducing those barriers.

Our approach is highly collaborative with other providers and stakeholders in the system. The primary focus is on efficient implementation and delivery of community clinical and therapy services.

Our investment in infrastructure for community service delivery and our development of a unique change methodology, which transitions services onto our platform demonstrably improving their effectiveness and productivity, are transferable to other clinical service areas.

Our data is helping us to make better decisions earlier in the broader MSK Pathway with regard to what can be managed successfully conservatively and what we need to accelerate on to more specialist and/or surgical interventions. We consistently reduce the demand for surgical outpatient appointments (and associated diagnostics) and in some cases are reducing the surgical demand. Our biopsychosocial approach combined with improving lifestyle (promoting exercise, increasing confidence and social engagement, improving diet, etc) is improving peoples’ ability to live longer with moderate to severe hip and knee arthritis. Working with our surgical colleagues helps to optimise decision-making in this regard.

Connect Health was founded by myself and other clinical colleagues in 1989 and we spent over 20 years slowly building the foundations with a clear focus on the patient. We believed that optimal care would be achieved by attracting the best clinicians and investing in their clinical development – but the supporting infrastructure was relatively neglected. This changed when, a few years ago, I visited a manufacturer of heat exchangers for cars, which was in the supply chain for a large car manufacturer, and realised the importance of a broader approach to efficient and effective delivery in a market where annual reductions in price were normal. Counterintuitvely, this was driving investment in innovation and improvement and the manufacturing business was thriving. I sought to bring the same approach to community healthcare service delivery.

From a personal point of view, learning from mistakes (my own and observing others) has been important in developing a successful business in our sector. Even better is to surround oneself with a management team that have made their mistakes and done their learning on other businesses before joining ours.

Be resilient: there is an optimal pace for change.