Workforce is probably the single biggest expenditure of any healthcare organisation, and especially so in NHS (after all, all care is delivered by humans - it works better that way).
Because of this, when efficiencies need to be made, workforce expenditure comes under the spotlight.
Techniques such as Lean, and programmes such as NHS Institute's Productive Series look at ways to shave pennies off each activity. But what about activities that aren't actually necessary, but that organisations hold on to because the individuals fear for their continued employment?
We already know that under Payment by Results, a secondary provider (hospital) can increase their income by increasing their throughput (eg improving quality to the point where length of stay is reduced, which frees up beds, which allows more people to come in for operations). But is this value for money? Does the extra income generated cover the additional cost of driving up quality?
We looked at this with the boards and front-line (clinical and support) staff of an acute teaching hospital, and a care trust. We generated profiles of the staffing currently in place, and the staffing models that the staff themselves thought would deliver best care. We examined cost per unit of activity and quality outcomes, and compared this with the avowed aims of the Trust.
Most importantly, we compared the profiles for similar departments and functions, which generated passionate discussion and soul-searching.
The staff themselves agreed potential new staffing profiles, taking into account resources (cash) available and the tariff under payment by results.
Managers, workforce planners and clinicians used the profiles generated to plan and implement projects to deliver the changes and realise the benefits.
In a busy and turbulent world, it's almost impossible for the Directors to mandate every change and every conclusion, and it leads to resentment and de-motivation. The above process engages people, helps them to feel part of the organisation in which they work, to see the bigger picture, to work for the greater good. That's when quality improves at the same time as unit costs reducing.