by Linda Hutchinson |
What do the following have in common?.
Each one of these is a complex operation requiring co-ordination of staff, equipment, premises. They all have customers and interested parties. They all have financial considerations. They all have unknowns.
I find it difficult to understand how, in this country, we can host one of the most successful Olympics to date, have a world leader in logistics and yet fall so woefully short when it comes to operations management in the NHS. How did we get to a point that the amount spent on management and administration in the NHS is constantly moaned about by politicians and the media and yet the NHS is, frankly, grossly under managed.
I’m going to use the example of the film industry to illustrate my point. I am very familiar with it as my husband is a film producer. Before a film is ‘green lit’ there are endless discussions, negotiations, twists and turns about each and every line in the budget. It does not matter if the total budget is £200,000 or £20 million, every line has to be justified and is argued over, beaten down and agreed.
Once the film is in pre-production, there is an amazing sequence of events. A line producer and production co-ordinator swing into action. An office is set up and equipped within days, recruitment of full production team completed, payroll, accountancy systems set up. All the heads of departments and functions – cinematography, sound, set design, etc also recruit. Actors are confirmed.
Most importantly, the planning begins. By the time the shoot starts, every minute of every day of the 6-10 week shoot will have been mapped out. Every day of the shoot, there is a ‘call sheet’ which lists what will happen the following day. It is several pages long and contains every bit of information needed – names, contact numbers, pick up times, transport arrangements, health and safety and other important matters, then each scene and who is needed, timings.
This is all done through excellent planning. Each team does their own and then they come together, again and again, to work through in advance. Once live, every day there are production meetings, director meetings, communication between everyone.
It would have been the same for the Olympics. I am sure there is an overall template built up with all the learning from previous Olympics. It is a huge logistical exercise and meticulous planning and frequent communication and co-ordination between all parts would have been taking place continuously.
How does this compare with the NHS. Health services run all day every day, they are not one off events. There are excellent examples of good operational management in the NHS, however it rarely feels fully joined up and in control. I don’t mean between organisations, just within one, or even within one department. We see co-ordination and management as a weekly event, not a daily or multiple daily one. The ward round or the handover is the closest we get and even then, the doctors do theirs separately from nurses. In the community, the first virtual wards used to have daily ‘rounds’ by phone. More recent ones meet with a GP practice monthly. Ambulance staff can now use software that tells them the available capacity in hospitals and other health care facilities so they can best decide where to take people. The wonder is that it is only a recent development.
How on earth can we justify the cottage industry approach to health care that still takes place? How can we have integrated care that does not involve the organisations and teams involved not talking or communicating with each other daily or, if needed, several times a day? There were 7.4 million visitors who attended the Olympic Games in 3 weeks. The NHS sees 1 million every 36 hours.
I was recently at an event attended by consultants and GPs from a local area . It was remarked how unusual it was to meet each other and, by the end of the morning, many ideas of what they could do together had been aired. Some are being taken forward with no additional resources, no additional money. Nothing special took place, they just connected and communicated. Imagine what could happen if those same consultants and GPs, or at least a few of them, were expected to have that meeting – by phone or face to face – every week, even every day. No time, I hear you cry. We are all too busy. It raises the question about whether we are too busy dealing with the fallout of not communicating and not planning together in the first place.