Clinical Engagement

Gaining front-line and clinical engagement for change

How do you make change happen? If the staff don't feel engaged, very often they are the stumbling block. On the other hand with the staff engaged projects race forwards under their own momentum. Read more about techniques and workshops here . . .

Transforming Community Services (TCS) – 3. Managing Performance


Transforming Community ServicesFor TCS 3. (this discussion) I'm going to assume that you are ready to procure your new service, and now you want to make sure it delivers better care, better use of resources, and delivers your part of the Nicholson Challenge (find £20billion in savings to prepare for the changing demographics).

Key areas to consider

  • Access to care 
  • Clinical Decision-Making
  • Managing Performance

Transforming Community Services (TCS) – 2. Specification and Commissioning


Second in our three-part series, we reflect on lessons learnt whilst developing new pathways for patient care.

Balanced Scorecard - Benefits of Transforming Community Services
  Internal External

Staff Satisfaction

  • Retention & recruitment
  • Sickness/ Absence
  • Staff survey

Patient Experience

  • Patient satisfaction survey
  • Friends and family referrals
  • Choice, usage, DNA

Financial and effectiveness

  • quantities and critical mass
  • impact on other pathways in the system
  • reduced bed days and further care

Clinical Outcomes

  • capacity
  • better health => less need of other services
  • better recovery => lower costs


Getting GPs involved in Clinical Commissioning Groups (CCG)

Most healthcare providers, in UK the same as everywhere else, get paid for each activity they do.  If someone needs care, they get paid.  If someone is well, they don’t.  So there isn’t much incentive (for the healthcare provider) to keep people well, even though it is much better for the person, much better for the nation, and much lower cost. Ltd is working with one CCG to generate enthusiasm and involvement, and the results are fairly successful….

Getting GPs involved in GP Commissioning

Clinical Commissioning Groups (CCG)GPs know the most about the patients registered with them, and have the biggest incentives to innovate and to commission better services. So why aren't they embracing Clinical Commissioning and using it to improve healthcare right across the country?

It could be any of a number of reasons, and we believe it's about understanding.  What's more, with our experience of doing exactly this (supporting GPs to get engaged), we can demonstrate how we've made a difference, and how it could work for other CCGs.

The Politics of CCGs


Clinical Commissioning Groups (CCG), the organisations that will commission  healthcare for nearly 60million people across England at a value of around £70billion, are beginning to take shape.

They come in essentially three types, and if you want to supply healthcare to these CCGs, even if you are an established provider of healthcare, you need to understand what you are dealing with

Primary Care and GP Engagement

Nuffield Trust prepared reportThe NHS budget is protected from cuts under the new government. But the rise in Emergency Admissions over the last few years threatens to use up all of the protection and more. And yet, until we invest in care outside of hospital, we can’t change this rise.
I have to declare an interest – well two actually.

Not motivational - inspirational

Deepak Chopra once described Jack Canfield and Victor Hansen's "Chicken Soup for the Soul" books as 'Not Motivational' 1
Motivation is something imposed from outside, the traditional 'rocket up the backside', the manager or change agent pushing people with threats and bribes to change the way they work.
Of course motivation can help an organisation to improve, to cut costs, to increase output and trading surplus, but it's hard work.  The Minney approach to change in services for the public good is rather different.

Clinical Quality vs. Profit

They say another key difference between clinicians and managers is that managers are only interested in what will make money, whereas clinicians are only interested in delivering the highest quality. I don't know if you've studied Lean methodology in any detail? It's a series of techniques for improving the delivery of services and products, and NHS Institute for Innovation and Improvement has released a number of guides of its Productive series, Productive Ward, etc. This is about getting people to question the way we do things round here, to see if there's a better way.

Why - the Manager/ Clinician divide

There seems to be an enormous gulf, in healthcare, between those that care for patients, and those that administer. Neither side seems to trust the other – clinicians accuse managers of thinking only of costs, and in return managers complain of a refusal to recognise limited resources. This applies in other environments, eg social care, where care professionals and management also seem to struggle to bridge the communication gulf.


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