The new vanguard sites announced this week may be the first steps toward a genuine shift in NHS thinking, but it is crucially important that, upon completion of the vanguard pilots, the bottom up approach to transformation must not be allowed to flip 180 degrees and become another top down imposition of change.
On Tuesday NHS England unveiled its twenty nine 'vanguard' areas established to pilot new models of care. Simon Stevens believes that they will act as the catalyst needed to bring about change in the NHS "from the bottom up, led by frontline NHS staff."
The NHS isn’t typically synonymous with enabling those at the front line to lead on its transformation. Yet the word “vanguard”, defined as [a group of people leading the way in new developments or ideas] feels like an appropriate starting point to establish a cohesive shift in NHS thinking.
In a recent interview on Radio 4’s World at One show Simon Stevens was quizzed on the vanguard approach. The interviewer, Shaun Ley, was sensibly asking if post the pilots the next step was to “impose” the new ways of working on the rest of the NHS. Understandably given the brevity of the interview Simon Steven’s didn’t get drawn into a discussion about the “what next”, but the line of enquiry was sound; that upon completion of the pilots the bottom up approach to transformation must not be allowed to flip 180 degrees and become another top down imposition of change.
When Unipart began its journey of transformation out of the remnants of British Leyland we realised how vital it would be for us to learn from the best organisations in their fields and then find our own way of working. This same philosophy should be applied to the vanguard areas. It is unlikely to be a coincidence that a significant proportion of the twenty nine selected areas are already doing many things well. Whilst the (hopefully positive) outcomes that the vanguard pilots generate will be important, their ultimate success will be determined by how well the NHS learns from these pioneers and applies the new models of care within other health economies. The NHS is therefore about to embark on arguably its biggest test yet in how capable it is at managing knowledge.
Fundamental to the success of this initiative is the role of leadership. The endeavour may be a clinically led “bottom up” approach, but it will require those at the top of NHS England to maintain the courage of their conviction and foster a culture within the twenty nine areas that nurtures new and innovative thinking. A key characteristic of a learning organisation is one that ensures employees do not fear being belittled or marginalised if they ask the naïve question, or if they make a mistake. Historically the NHS hasn’t been a pioneer in nurturing employees in this way, often finding it quicker and easier to point the blame.
The opportunity to prove or dis-prove the efficacy of the new models of care will, of course, be very important to their subsequent adoption and rollout to other areas. This will require a clear baseline of current performance to be defined at the outset. It also requires the vanguard areas and NHS England to work collaboratively in defining and agreeing the quantifiable measures of success. This helps to guarantee that these measures are meaningful to each stakeholder, and that ownership of achieving them is taken in partnership. Without a clear objective, how will the vanguard know they have succeeded?
The vanguard areas must be allowed to try things without fear of recrimination - perfection is rarely obtained on the first attempt. Their achievement or failure can then be studied and communicated transparently so that all who follow the vanguard can act on what has been learned. The NHS does this fantastically well when developing thousands of medical students year after year, each of whom leave University equipped with modern and innovative skills with which to treat their patients. However, when applied to a wider system that is seeking to help prevent people being hospitalised in the first place, this meticulous approach to learning and managing knowledge begins to be eroded.
The vanguard areas may not just represent a significant shift in how care is delivered, they may also act as the first steps toward a genuine shift in NHS thinking, whereby a learning culture is pervasively fostered and encouraged irrespective of the Trust or care setting in which people are employed.