As part of our ‘What If’ series on change in the NHS, we spoke to Programme Director, Peter Bullivant and asked him: “Putting all politics aside, if you could change one thing about the NHS, what would it be?”
If I could change one thing…
I would change the financial incentives so that all organisations are rewarded for the achievement of patient-determined outcomes.
This would facilitate the design of healthcare as a value-based system and not archipelagos of isolated organisations with competing priorities, driven through perverse incentives. Organisations do not deliver healthcare, people deliver healthcare and we do not currently work together as a system.
Aligning incentives would enable application of systems theory used in other sectors such as that espoused by Senge and Nonaka. We could develop systems that operate across organisations to promote feedback and communication around common goals; we need to change how we support people and populations not just where.
The shift in incentives would create an environment where everyone, including CFOs, are focused on patient outcomes to ensure support that is high value at both the personal and population level. It is also achievable.
Having worked with many clinicians in developing optimal designs, there are two central tenets that emerge on nearly every occasion once we are able to de-tribalise their thinking and enable them to focus on their common goal: supporting the people they see every day.
The first is the lack of communication between clinicians throughout the patient journey that leads to silo thinking and creates a culture of blame.
The second is the opportunity of increased non-clinical support for patients, to educate and coach, to create shared understanding and shared decision making that reflect patient preferences. This shift ensures that resources are focused on what really matters and we reduce all low value activity that exists today. This requires a change in thinking and behaviours from both patients and clinicians, which system thinking with common incentives can enable. This shift in culture is key to a sustainable health service that uses the resources available to provide the best outcomes for patients.
Peter is an enabler and leader with experience of facilitating, developing and delivering change in many systems within the NHS. He has a particular passion and ability to turn data into pathway and behaviour change through working across professions and organisations using effective programme management.
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