A new approach to delivering and sustaining high quality healthcare
For many healthcare organisations, the challenge of balancing service demand, high quality care and limited resources continues to grow. This year, these challenges have been amplified and accelerated by the economic pressure caused by the COVID-19 pandemic, and have heightened focus on how our health system supports and delivers care to the community.
In recent months, we have seen many health services undertake radical transformation out of necessity, enabled by rapid legislative and funding model changes. This swift response broke down traditional silos and created synergies more effectively than ever before. Healthcare payers and providers are embracing virtual health to support new models of care, while there is also closer collaboration between hospital departments, governing bodies and community health providers. These changes are resulting in greater improvements to patient flow, a focus on keeping patients out of the hospital and improved partnering with GPs and allied health professionals.
As we navigate this global crisis, many healthcare organisations are now embarking on a recovery and rebuild phase, establishing their ‘new normal’ for how they will operate into the future. However, there is a risk that as health services emerge from this ‘pandemic environment’ they will revert to old ways of working, overlooking the opportunities that exist to embed improvements long term, and to rethink and reconfigure healthcare around patients and the clinicians who care for them.
Many health services have embarked on significant transformation activities to deliver services more effectively and efficiently, such as cost reduction, process improvement and technology implementation. These changes are often designed to flow seamlessly across hospital services and functions - through theatres, wards, emergency departments and back office. But unfortunately in many cases, their benefits have either been unrealised or unsustainable, with the health service returning to baseline performance and old ways of working.
It is clear now more than ever that meeting these challenges in a sustainable way requires a fundamental shift in how we plan for and deliver healthcare services. In reimagining how our clients can deliver transformation change differently into the future, we have spent time exploring and validating the challenges health services face to break down their root causes.
Achieving ‘Board to Ward’ alignment on the health services strategic direction
Asking a frontline clinician to articulate the strategic focus or vision of their health service often illustrates a disconnect between ‘Board to Ward’. This is because a strategic plan is commonly developed at an executive level with limited input or validation from frontline staff, missing a key opportunity to create ownership or buy-in to support long-term changes.
Agreeing expectations and performance targets supported by appropriate governance and accountability structures
In the complex environments that health services operate, there is often a struggle to agree expectations and performance targets across the entire organisation. This problem is further exacerbated where appropriate governance and accountability structures aren’t established, and do not truly hold staff and the executive to account.
Prioritising the right transformation and improvement initiatives within a fiscally constrained environment
The strategic planning process provides a range of options and choices for the direction of the organisation, but health services often find it challenging to prioritise the right transformation and improvement initiatives across people, process and technology. As a result, they often take on too many projects and aren’t able to deliver on all their benefits as planned.
Ensuring staff have access to the right tools, technologies, equipment and information to deliver high quality and safe care
The enablers that support frontline clinicians to deliver the best outcomes for their patients can be difficult to introduce and embed across a health service, particularly when significant change management is required to ensure success. Implementation of new technologies, models of care and access to the right information at the right time can be a challenge, and an uphill battle if not supported by careful planning and early, regular engagement with stakeholders.
Creating a health service culture that promotes high performance, collaboration and care
We commonly see and hear that culture is identified as a critical problem impeding a health service’s high performance, but also a challenge that creates staff fatigue and burnout. Even if endeavouring to implement the best technology or the best new processes, until the culture of an organisation is healthy, the mindset and behaviours of their workforce will not support successful, sustainable change.
Fostering the right skills and capabilities to empower clinicians to be greater leaders
Across many health services, we find that areas of the workforce can struggle with developing, attracting and retaining talent, meaning that they don’t always have the right skills and capabilities in place. In some cases, staff can be recruited or promoted through a clinical pathway and suddenly find themselves needing to manage a large workforce, cost centres and finances. In rural and remote areas, attracting talent can be a challenge in itself.
Using data and information in a way that creates meaningful insights to deliver high quality outcomes
As with many other industries, the last five years has seen health services having to increase their exposure to data. While many health services have a clinical information team established to manage, interpret and leverage available data, their level of sophistication and capability varies greatly between health services and state health departments. One common theme though, is a clear gap between turning the data and information available into meaningful insights to drive performance improvement.
Delivering what patients value by linking technology, to clinician experience and patient experience
The final, but perhaps most critical, challenge that we see health services struggle with is translating the impact of their clinicians’ experience with the experience of their patients to deliver on what patients value. This centres on innovative use of technology, genuine engagement and establishing mechanisms to ensure continuous improvement.
In an environment of limited resources, we commonly see clients approach change in a piecemeal or targeted approach. Where scope is not clearly defined, or perhaps the underlying purpose of the initiative is not clear, we quickly realise that the problem we are there to help solve isn’t necessarily the one which will deliver them the highest value.
We believe sustaining high performance requires a new approach: one that is human centred, insight driven and digitally enabled, resulting in a dramatically improved experience for all, particularly clinicians and their patients.
Based on extensive research and experience, PwC has designed a framework to bring this new approach to our clients, known as High Performing Healthcare.
The High Performing Healthcare framework works holistically to explore all aspects of a health service’s operations and performance, to focus on delivering improved experiences and outcomes for staff & clinicians, and the patients and communities which they serve.
The High Performing Healthcare framework has four key elements: focus on strategy to maximise impact; align your operations to deliver strong results; enable your people to inspire better outcomes; and drive patient-led transformation to deliver for patients.
Threaded through each of these elements are two key enablers - digital health, and the consideration of governance, risk and compliance. In today’s environment, digital healthcare should no longer be seen as a separate silo or department, but rather as fundamental to improved service delivery and better patient outcomes. This can be seen in every facet of a health service from the way information is captured, stored and used, through to the way that new, innovative models of care are designed and delivered. At the same time, ensuring that governance, risk and compliance frameworks support service delivery needs and meet organisational objectives are a fundamental part of assuring long-term, sustainable change.
Success stems from having a clear and compelling identity, designed with clinicians, understood by all staff, and aligned to the current and future needs of the community. To support local ownership, this identity needs to include a strategy, vision and objectives that are representative of the health service’s clinicians, staff and the community. The strategic planning that follows must be clinically-led and designed collaboratively to inform technology and operational options that future-proof the delivery of 'right care, right place, right time'.
Craft an ambitious & compelling strategy - a unique, compelling vision and strategy act as the heartbeat of your health service, balancing current and future needs of your organisation and its community, with statewide system considerations. Your end-to-end strategic planning process should be human centred (i.e. collaboratively developed from Board to Ward) and insight driven (i.e. informed by population modelling, demand analysis, master and clinical service planning).
Optimise the service profile - the choices and investment decisions your health service makes from its strategic planning process are critical to ensure the strategy can be effectively executed. These can include decisions regarding infrastructure, digital enablement, workforce and service improvement. Considering these holistically requires a balance of flexibility throughout the end-to-end strategic planning cycle with a focus on prioritisation and a clearly defined transformation agenda. This process should encompass research, engagement and development phases, with the opportunity to review progress annually.
When your leaders and staff are empowered to make decisions based on accessible, relevant and timely data insights, they are enabled to work at the highest scope of practice. Governance, accountability and effective ways of working connects your teams to ensure a collective balance between meeting operational objectives aligned to your health system's strategic direction.
In a High Performing Healthcare organisation, strategically aligned and ‘fit for purpose’ operations have to address two critical considerations.
Create shared governance and accountability - aligning your operations to create a high performing organisation requires a focus on providing the right information to decision makers, establishing and enabling shared governance and accountability, and building workforce capability. This model should measure performance and agree standards and expectations to achieve your health service’s objectives.
Deliver clinical and business outcomes - with the right governance model and access to information and insights, health services are enabled to better understand the opportunities that exist to continually improve patient, performance and financial outcomes. To deliver these outcomes and a step change improvement in performance, the right behaviours must be driven, along with standardised ways of working and empowerment of frontline staff to solve problems.
To deliver exceptional patient experience, it is essential that your teams and individuals are empowered to continuously innovate and improve, while accepting accountability for achieving objectives. This is managed through clearly defined roles; a collaborative and psychologically safe culture; and, investment in the right capabilities across people, process and technology to achieve success.
Support a capable & engaged workforce - the key to unlocking your health service’s potential is through its people. To do this you need to drive positive change through leadership, engagement, skills and behaviours. These critical focus areas unlock the potential of your workforce as a whole, from senior leaders through to genuine engagement with frontline clinicians.
Enable a motivated and collaborative culture - at all levels, high performance is grounded in enabling and supporting the right skills and behaviours in your health service. This capability and the culture it creates are critical to driving adoption and sustaining a successful transformation agenda.
True transformation in healthcare means putting quality patient experience and outcomes at the heart of everything you do, to meet the expectations of the modern consumer. There are growing opportunities to leverage technology like wearables, electronic records and the Internet of Things to deliver what matters most to the patient and improve the experience and care they receive.
Driving patient experience and outcomes - identifying and delivering on what your patients value the most will result in improved outcomes and experiences. This should include:
Developing a structured approach to measure experience - in order to successfully achieve patient-centred transformation, your organisation needs to leverage closed loop feedback to continuously improve patient care delivery. This should monitor and evaluate insights through a tiered approach, from a strategic perspective, an episodic perspective and a tactical perspective, and where possible, linking the clinician experience to the patient experience.
Now more than ever before, it’s clear that the health service of the future needs to meet growing expectations of a dynamic, digitally enabled and more efficient and effective healthcare experience. This requires strong organisational alignment, and greater focus on experience and engagement to enable high performance in service delivery.
To explore how your organisation rates against the High Performing Healthcare framework, we have developed a short and interactive self-assessment. This survey is based around the four key elements of High Performing Healthcare, and aims to identify the challenges and opportunities your health service is facing now and into the future.
We encourage you to share this survey with your teams for a more fulsome picture of your organisation's position and as a critical conversation starter amongst your leadership. Talk to us today about how you can access the survey, or to find out more about PwC’s High Performing Healthcare framework.
Contributors: Chris Rogan, Tricia Tebbutt, Jayram Vasudevan, Jacqueline Curran, Kate Payne, Michael Kastrissios, Patrick Gorenac-Walsh, Angi Bissell, Leo Oyama, Emma Woodberry and Dr. Helen Vickery
NSW Government Leader, PwC Australia
Tel: +61 2 8266 5091
National Health & Wellbeing Leader, PwC Australia
Tel: +61 2 8266 0990