The previous article (Oct. 2009) on this topic highlighted the significant opportunities and challenges faced by the present-day National Health Service (NHS) in the UK.
Author: Zaf Gandhi, Managing Consultant & Partner

This follow-on article assesses the recent upheaval and political turmoil affecting the NHS, and provides a number of high-level pointers for ensuring a harmonious transformation of the NHS, and modernising it to deliver a patient-centric service fit for the 21st Century.

To be a Chrysalis, or not to be a Butterfly?

It is a well-known observation that most organisations and human beings find change a challenging experience. Charles Darwin also encapsulated the critical role that change, and adaptability to change, plays in the successful evolution and survival of all species. And so it must also be for the NHS: change or have change enforced upon you!

Whilst there is no denying the fact that the scale of the challenge currently facing the NHS is of a highly complex, multi-dimensional, multi-organisational, multi-stakeholder and multi-regional nature, the goal itself is well defined: Empower the real customer – i.e. the patient.

Notwithstanding, it is the change process along with the engagement protocols and implementation (i.e. what form, when, who, how much, etc) that currently appear to be the major sticking points.

The Guiding Principles for the 21st Century NHS

History tells us that whenever leaders are confronted with difficult decisions or choices, they tend to rely on a set of "guiding principles". When correctly applied, and combined with the necessary foresight, these guiding principles often result in desired and successful outcomes.

The following considerations must therefore be included in generating the guiding principles, and any subsequent strategy and stakeholder agreement, for transforming the NHS:

• It [NHS] must exist to serve the patients to the best of its abilities, maximising resource efficiencies without compromising the patients' well-being and health.
• Its financial and budgetary system† must be self-regulating and must provide the necessary checks and balances and "safety valves", regardless of the management structure in place. Such a system must also permit the recipients of treatment (i.e. patients), providers of treatment (i.e. hospitals, health trusts, health centres, etc) and prescribers or influencers of treatment (i.e. GPs, specialists) to ensure a six-sigma (i.e. 99.9997%) level guarantee that the patients' interest WILL always come first.
• It must ensure ongoing excellence in the field of medicine and medical sciences through continuous improvement, knowledge creation and research and development activities to ensure the UK's leadership position, today and in the future.
• It must engrain a professional, positive and talented workforce necessary to deliver a world-class service that nurtures diversity, meritocracy and fairness.
• The proposed new arrangement for the disbursement of the NHS funding must not only be capable of achieving a greater level of operational and administrative efficacy, it must be at least an order of magnitude simpler to manage than the current scheme, and be flexible, transparent, and provide increased accountability for utilising public funds.

Mission Critical and 'Safe Fail' Change

When leaders have to realise change that is mission critical as well as highly complex, with a significant number of indeterminable or unknown parameters, then it is usually more prudent and practical to avoid the 'big bang' type of approach. Instead, a piloting strategy should be adopted, even if there are compelling reasons (e.g. rapid cost cutting or reducing management hierarchies) that merit the former (big bang) approach.

Proposed changes that can lead to large-scale disruption, conflicts of interest, safety/security breaches, or even democratic dissent should normally be trialed on a representative kernel scale to unravel the unknowns, to solicit real-life feedback from all stakeholders, and to provide sufficient proof of fidelity, reliability and robustness.

Moreover, mission critical systems in many highly complex industrial applications (e.g. aerospace and nuclear) already recognise the prohibitively high costs associated with ensuring a 'fail safe' approach. Therefore a 'safe fail' philosophy is adopted, instead.

A 'safe fail' system is designed in such a way as to ensure built-in redundancy and multiple failure paths. This approach allows the system to continue functioning in a satisfactory and relatively safe manner even if some of the critical parts fail during normal operation, or under abnormal conditions or unforeseen situations.

Therefore, it is important to consider the mission-critical aspects of the NHS from both the process and management perspectives, and to build-in a 'safe fail' philosophy into its day-to-day operations. This should also provide a more pragmatic approach to implementing and risk-managing the wide-scale transformation of the NHS.

Read Part 1 of this series of articles »

Read Part 3: The Deputy Prime Minister Nick Clegg's response to the proposed modernisation plans for the NHS »

† Denotes system in a wider context to include process, people, quality and risk management and technology systems.