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Can small steps amount to achieving massive results?

Thursday 7 February 2019 Data Insight & Analytics

By Nader Koder

Government austerity has had a huge impact on public services spending. The austerity programme had a direct impact on the NHS, according to False economy (May 2018), the latest report on NHS finance from The Health Foundation, in 2012 there was an overall NHS surplus of £600m. By 2016 this had become a deficit of £2.5bn.
The Sustainability and Transformation Fund was introduced to help improve financial stability – but NHS trusts still posted a deficit of £806m in 2016/17. The Health Foundation reports that at Q3 2017/18, the total deficit for NHS trusts stood at £1.3bn, against a plan of £916m.
It’s clear that the long-term financial pressures on trusts are mounting. Closing the deficit is still a tall order. Statutory restrictions on trusts make it hard for them to identify trade-offs that could help them manage their fiscal challenges.
If you have been following the news lately, none of the above should surprise you. However, one important question remains. What’s causing it?

There are many factors. The False economy report lists a large growth in spending on agency staff, growing demand for emergency care and falling consultant productivity. It also reports a correlation between financial distress and quality of care provided to patients.
On top of this, infrastructure upgrades, therapeutic and technology advancements and generally increasing patient demand all strain trusts’ limited resources. Deloitte’s 2018 Global Health Care Outlook reports that trusts are pursuing new cost reduction measures, including:

  • Alternative staffing models
  • Shifting patients to outpatient services (alternative care settings)
  • Reducing admin and supply costs
  • Consolidation/M&A
  • Alliances/Partnerships
  • Care and operational networks

These are all big and expensive developments. In this context, how can trusts make drastic improvements without breaking the bank in a timely manner, as well as maintaining a satisfactory level of patient service?

But need these improvements be drastic? I got to thinking about Dave Brailsford and his work with the Great Britain cycling team. Since 1908 GB had won one single gold medal at the Olympic games. Performance was so bad that even one of Europe’s top bike manufacturers refused to sell bikes to the team as they were afraid that it would hurt sales if other professionals saw the brits using their gear!

Dave was brought in as the performance director. In 2003 he applied a philosophy called the aggregation of marginal gains. The principle is that if you broke down everything you can think of that goes into riding a bike, and then improve it by 1%, you will get a significant increase when you put them all together.

He started with quick wins, like redesigning bike seats for comfort, rubbing alcohol on tyres for a better grip and switching to lighter indoor racing suits. Then he dug deeper, testing different types of massage gels, getting surgeons to teach the best way of washing hands to reduce the chances of catching a cold, painting the team truck white to help spot little bits of dust that can degrade the performance of the bike.

So, what happened? As these hundreds of small improvements accumulated, the GB cycling team famously won 60% of the gold medals in 2008. Four years later in the Olympic Games in London, they set nine Olympic records and seven world records.

Good story, but what can healthcare organisations learn from it?

There’s a paradigm that massive success needs massive action. It’s too easy to overestimate the importance of one defining moment and underestimate the value of making small improvements.

To make these kinds of gains you need very accurate and reliable data. You need to interrogate it in a timely and sophisticated way to discover the small issues and variables that give you an opportunity to improve. You need to record the effect of changing them so you can improve and track outcomes.

We know that trusts are already making strides with simple, quick win improvements where possible. Could more accurate data and agile data sources further improve their visibility and help make good decisions? Through our many years working in healthcare, we’ve learned that understanding your data empowers you to take the small steps needed to accomplish massive results. Aggregating small but definite improvements in every area of your business and contributing to a big change in the whole service.

Sometimes many small, targeted changes can bring about a revolution

Can small steps amount to achieving massive results?