What the UK NHS can teach the rest of us
One week in January 2016, for the first time in my life, I was a patient in a hospital. I won’t bore you with the details but after a quick trip in an ambulance and a brief sojourn in Wexham Park Hospital ITU (Intensive Therapy Unit) I’m back home and well on the
road to recovery.
Given the generally negative narrative around the NHS in the UK my preconceptions ahead of my visit were of dedicated staff probably doing their best given challenging circumstances.
What I was surprised and delighted to find at Wexham Park ITU was a high performing team using state of the art approaches to deliver amazing outcomes.
Wexham Park ITU has chosen to work based upon self-organised cross-functional teams, real time dashboards, virtual hierarchies, agile-like rituals, and a culture of empowerment and accountability.
At Wexham Park ITU patient care appears to be organised physically and logically around what I will call “pods”. Each patient has a bed space at the end of which is the nurse’s station. The nurse’s station has a PC, keyboard, screen and phone and is adjustable for sit-down or stand-up use.
The nurses seem generally to be allocated 1:1 to patients although it looks possible for a nurse to float between patients 1:2 if the pods are adjacent.
This nurse:patient 1:1 relationship is the foundation of the operating model used so successfully at Wexham Park ITU. The nurse’s responsibilities are simple and clear – they are there to care for this one specific patient.
They feel total ownership and accountability for achieving positive outcomes and are supported rather than constrained by all other processes and activities in the ward.
During quieter periods nurses self study the conditions affecting their patient – further improving their knowledge, capabilities and effectiveness. (The nurses told me that this more “technical” style of nursing tends to attract more male nurses which only helps create a stronger and more diverse team).
The nurses use the terminal in the pod to read and update patient KPI data in real time into what would be called a “dashboard” in other contexts. Charts/graphs were available in real time and information was presented in a very clear and accessible way. Blood tests results took 1-2 hours before being available on the “dashboard”.
This real time people-technology relationship is critical to how the unit wants to work and I think they would struggle with the old “clip board at the end of the bed” approach (they went paperless three years ago).
The unit’s approach to cleaning also spoke volumes to me. Needless to say the ward was spotless and that was because it was continually being cleaned. They didn’t batch cleaning up to be done after more “important” activities were finished but integrated cleaning into and alongside all other activities…continuously. (An analogy with QA as part of software development is illustrative..good software development teams integrate testing so well that it’s hard to spot it. Other teams throw software “over the fence” at the end of the sprint to QA).
During the twice daily doctor’s rounds the “dashboard” is used to get everyone up to speed on patient status and collaboratively discuss and record next steps. The respectful way the doctors interacted with the nurses made it very clear that they were valued members of the team whose opinion was sought and listened to. The doctors also took the time to explain their reasoning – further improving the contribution the nurses will be able to make to their teams in the future.
I saw very little evidence of any hierarchies at Wexham Park ITU…talented people were organised into cross functional teams with common goals and clear roles and responsibilities.
Morale was high and people laughed and smiled their way through what must have been some very tough situations. They were self-aware and took time to help develop each others knowledge and experience for the collective good.
I think Wexham Park’s ITU shows that high performance can be achieved pretty much in any context by great people working in great ways.
I for one am very grateful that Wexham Park’s ITU have set themselves the challenge of operating at the level they have and consultants like Omar Touna and Clare Stapleton are role models for the rest of us in terms of their passion, ability and positive impact they have on other people’s lives.
We need too avoid so much negativity whenever the NHS is mentioned in the UK. Of course what it does is so important that we need to hold it, and ourselves, to account but we also need to celebrate success and recognise world class performance when we see it.
Congratulations and thanks Wexham Park ITU..you guys are leading the way.