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July 2019
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Organisational development in the NHS

It is doubtful whether any industry has seen more change in recent years than healthcare. Arif Ahmed, Managing Director of ikonami, examines the impact of these changes and how HR and Learning & Development (L&D) professionals in the NHS can better manage organisational development.

A report in 2009 estimated that there would be a £15bn contraction in NHS finances in the five years from 2011. However, the demand for healthcare will only increase during the same period. Better healthcare and treatments have led to people living longer with terminal or multiple chronic health conditions. Our ageing population is increasing; the proportion of -old, old, many of whom have multiple health conditions that are more complex and difficult to treat, is now 7% of the UK population (up from 4.5% in 1971). In addition, the recession means that people who once had private health insurance or sufficient disposable income are being forced to turn to the NHS.

At the same time, the regulatory mechanism for healthcare providers is more stringent than ever before. The Care Quality Commission (CQC) has a wider range of responsibilities and sanctions than did the Healthcare Commission. Additionally the Clinical Negligence Scheme for Trusts (CNST) requires NHS organisations to prove compliance across a number of areas. These schemes can have a direct financial impact. Failure to meet CNST targets will lead to higher insurance premiums, whereas the CQC can impose financial penalties – or even close the organisation. One proposal currently under consideration is that a proportion of each organisation’s budget will be dependent upon patient satisfaction. So how can healthcare providers raise standards, prove compliance and maximise the availability and use of budgets?

Initiatives are not enough

In its first 40 years, the NHS focused on the treatment of disease; then the Griffiths report in 1983 heralded a new emphasis on optimal resource allocation. By 1989, the -Working for Patients white paper introduced the concept of health authorities and GPs purchasing services for their patients at the best price. Yet while these changes improved management and budgeting within the NHS, it was at the expense of clinical quality. -The New NHS Modern, Dependable in 1997 and -Quality in the New NHS – in 1998 put clinical standards on a par with governance for the first time, and led to the establishment of compliance programmes like the CQC. Yet while successive initiatives have sought to improve the efficiency of the NHS and safeguard patient care, we still hear about clinical negligence, poor hygiene standards or lax care of vulnerable patients. Measurement and reporting is undoubtedly valuable, but it is clear that tick boxes cannot guarantee patient safety. What is needed is whole-scale culture change.

Focus on competence

The NHS needs to focus on competence – studies have proven that this is critical for delivering better quality care. Yet organisations are more complex because of the service commissioner-provider split. The first challenge is to accept that external staff are an equal risk or benefit as internal NHS employees, so they must be included in the organisation’s training programmes, development plans and reporting systems.

The second challenge is to adopt a framework to measure the competence of each employee in their job role. Tools are already available for this. The Knowledge and Skills Framework (KSF) sets out the qualifications, skills and experience necessary for every job in the NHS. The associated information management tool – the (Electronic) e-KSF – makes it easy to measure employees against the relevant criteria, identify development needs and track progress. When used across the organisation, this framework can identify the true training and development needs, enabling learning and development programmes to be prioritised, developed and deployed in the most time and cost efficient way. However, it is important to consider the organisation’s current and future needs.

Better workforce modelling

With constrained budgets, healthcare providers will need to become more effective in workforce planning. HR professionals should use models of anticipated patient needs across a five year timeframe to identify the number and type of staff required to deliver patient care. Then they should focus on identifying the number of people with the appropriate skills, abilities and levels of competence necessary to meet those needs, rather than a certain number of staff at each grade. Integrating the e-KSF with a good learning management system can provide managers with a wealth of information upon which robust decisions and plans may be made. This can highlight the gap between current competencies and future needs, making it possible to develop existing staff in a timely way and reduce the need to increase headcount. Focusing on competence rather than set staff -grades also enables the organisation to be more flexible about offering training and development opportunities to the most appropriate employees.

Back to the start

When the NHS was founded, it was thought that improved disease management would decrease healthcare costs over time as people became healthier. While that did not happen, the NHS is going to have to become more efficient without impacting patient care. That can only come from instilling a quality culture from the very top of the organisation, ensuring the learning and development strategy supports that vision, and having effective workforce planning and support systems in place. From the chief executive to the porter, every individual should be competent enough to act in a way that safeguards patient safety and utilises scarce resources effectively.

Arif Ahmed is the co-founder & Director of ikonami He has seven years experience in providing bespoke learning solutions for the private and private sector. ikonami is a provider of bespoke learning software systems for government, independent healthcare and other organisations seeking learning and development efficiency. The company was founded in 1999 and originally provided project management consultancy to help organisations exploit the benefits of technology. In response to client demand, ikonami evolved into a full-service technology company that combines its specialised software offerings with a variety of service capabilities, including full Learning Process Outsourcing (LPO).

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