Helen Bevan
Director of Service Transformation
National Health Service Institute for Innovation and Improvement, England
"Our job is to support the whole of the National Health Service and to make better change, faster." (1:19)
I’m Helen Bevan and I work as Director of Service Transformation at the National Health Service Institute for Innovation and Improvement in England. The NHS Institute is a national body that exists as part of the National Health Service in England at a national level, and our job is to support the whole of the National Health Service and to make better change and to make faster change. And what we do is we focus on some of the areas of the biggest challenges. So how do we take the delays out of the system? How do we very significantly reduce the instance of health care-acquired infection? How do we deliver value and quality? How do we make a significant shift for people with long-term conditions from hospital care to much more responsive, effective, primary community-based health services?
If you look at what’s happened to the NHS over the past few years, the change process has been really amazing. Just even four or five years ago it wasn’t unusual for people to wait for a year for a routine cataract surgery or routine hip replacements. Or it certainly happened that thousands of patients would wait in an emergency room on a — we call it a trolley; you call it a gurney — for 12 hours or 18 hours because there weren’t any hospital beds available.
"You get to a stage where you have to flip from very top-down leadership-driven programs to how you can better support local improvers." (1:16)
Trying to change a whole system is I think a huge challenge. I mean, 1.3 million staff. We’re the second biggest employer in the world and an annual budget of 110 billion dollars. And it’s just this enormous organization, and I think one of the key issues strategically is what can we do at national level to support change and what has to be done at local level. And the system is constantly changing.
I mean, I’ve been working at a national level in health care improvement for seven or eight years now. And when I first went to work at national level we ran whole series of national improvements programs because in a sense the capability and the knowledge for improvement weren’t really there locally in the system. And then you get to a stage where national programs aren’t the right model anymore. I mean, first of all because the capability of local leaders is growing so significantly. And secondly, I think you can only get so far with programs. And I can remember going to talk to one hospital chief exec and he said to me, “The national programs are great Helen, but, you know, we’ve got 17 different national programs in our organization that don’t connect with each other and I’d much rather have the money and support to do the things I want to do locally.”
So you kind of get to a stage where you have to flip from very top-down leadership-driven programs to actually how you can better support local improvers — clinical and managerial leaders and teams — to do it for themselves.
"I really learned about needing to be ambitious. Not putting up with, you know, two percent, three percent increment improvements but really seeking out ambitious change." (1:51)
When I first graduated I worked in local government, in welfare, and I worked in education. I’ve always worked in improvement; I led I think what was the first total quality management project in British education in 1987 or ’88, and so I kind of know how to do improvement.
And I actually didn’t intend to work in health, but in 1991 I saw a scheme that was advertised in the Sunday Times saying, “Do you want to be a future leader of the National Health Service?” And it was for people that were senior leaders in other sectors to come into health on a two-year fast track program. And I think that the kind of people they thought that they would get would be accountants from Woolworth’s. I don’t think I was quite what they had in mind. But, I don’t know, somehow I kind of got into the NHS.
So I just went into hospitals and I was given a job in a particular hospital and I was told to sort out outpatients. So I just did what I always do, which is just went in and just watched what was going on and worked with the staff and started to map the care processes. And the first ever care process that I worked on with a team was in ear, nose, and throat and we mapped a kind of standard outpatient process and all the stages for the patients. And I got invited afterwards to the hospital board meeting and we rolled out this great sheet of wallpaper and what it showed was that from when a patient got referred by their family physician to when they actually completed a very routine outpatient appointment took nine months in our system, and then in that nine months we actually undertook 21 minutes of active work for that patient of which 12 minutes was clinical. And you know the big question is, “Why is it taking us nine months to provide 12 minutes of clinical care?”
I ended up working at a particular hospital leading this huge multi-million pound pilot reengineering project. But what I really learned through that project and that program was about needing to be ambitious. Not putting up with, you know, two percent, three percent increment improvements but really seeking out ambitious change.
"I’m a tempered radical…somebody who can rock the boat and yet stay in it." (1:05)
The world I operate in is one at a national level in a very large complex government organization trying to create transformational change. And what I’d say is that actually it creates tremendous opportunity for leverage. To be able to be influencing, and to be supported to influence, a whole health care system and the opportunity to really make a difference in millions of patients.
So, you know, in that sense it’s an amazing place to be. But also it’s difficult. It’s government; it can be bureaucratic. We’re constantly being structurally reorganized. And one of the things I read that kind of really helped me understand is Debra Meyerson, who is assistant professor at Harvard, she wrote this really great book and it’s about being a tempered radical. Somebody who’s kind of very radical in their thought process that kind of wants to change the world; that challenges the status quo but does it in a way that enables them to stay inside organizations. Somebody who can rock the boat and yet stay in it. Somebody who walks the fine line between difference and fit, and I think I’m that kind of person.
"If you look at the very best improvement projects the staffs are full of energy, they’re liberated, and they’re just going the extra mile." (1:08)
There’s a very significant body of evidence that says that if you’re in an organization where the staff feel that they’re doing work which is absolutely congruent with their own values; they’re working in environments where they feel part of a community; they feel that their leaders are trusted, and are working in their own interests; what you’re seeing is 30 to 40 percent more effort than in organizations with a different kind of leadership.
And I mean, it’s interesting. If you look at the very best improvement projects, and when I think about the very best improvement projects I’ve worked on, you know, what’s special about them? It’s that the staffs are full of energy, they’re liberated, they’re just going the extra mile, you know, to make it happen. And how do we enable that? And I think if we think about this in the context of productivity, you know, like across America, all across England, you know our health care organizations are striving for greater productivity and, you know, how are we doing that? We’re analyzing our baseline, we’re looking at processes, we’re taking out the non-value-added activity. Very rational, yeah. And if you actually think about how do we create the emotional engagement using these social movement ideas. We’ve got to potentially massively increase productivity. So, I’m not saying we stop doing the rational stuff, but the rational stuff is not enough.
12/15/2006
