Reducing bureaucracy and empowering staff can result in continuous improvement of public services and cost-effective delivery
Being asked to write this blog reminded me of one edition of the regular newsletter we sent out to staff in preparation for spinning out of the NHS. I used an old Chinese proverb – “when the winds of change blow, some build walls, others build windmills”.
It grabbed people’s attention at the time and reading it again, nearly four years on, it is a true reminder of the start of the exciting journey we took to become a public service mutual and one that we are still taking as the organisation develops.
Anglian Community Enterprise (ACE) is a successful community interest company, employing over 1,100 staff and is completely employee owned. We provide a wide range of NHS Community Services and generate an income approaching £50m.
Formally part of the North East Essex Primary Care Trust, we ‘spun out’ of the NHS on 1 January 2011.
Before spinning out, I had worked in the NHS for many years and seen a lot of changes – too many of which focussed on the structure of organisations and not it seemed on real change where it matters, in our direct work – with users of the services that we provide.
It was not difficult to argue however that all the disruption and uncertainty was worthwhile if we could make a real difference to the health outcomes and experience of people using our services.
Becoming a public service mutual was about being bold and not being side tracked by those who found it difficult to see the real opportunities that the change could bring. We have experienced many changes in the last two years as a public service mutual, one of which is harnessing staff innovation.
Becoming a mutual has helped harness staff innovation, as we have been able to make decisions more quickly and have the flexibility to put these ideas to the test. As the culture of the organisation is changing, staff are reporting that they feel more empowered and have a real ability to influence key decisions. Previously, the decision making process could take a long time, which could be de-motivational for staff. Now, freed from a lot of bureaucracy, employees across the business are able to take responsibility and act with speed, improving the efficiency and effectiveness of our services.
Some ACE staff innovation has gained national recognition through awards. An example of this is the Dementia Doorway Project which assesses all patients admitted to the community hospital wards over the age of 75 for early signs of Dementia illness, ensuring timely and appropriate referral and diagnosis. In the period August 2012 to January 2013, 34 referrals were made. The project aims to enable patients who have positive signs of Dementia to commence on the correct referral and treatment pathways, ensuring that they and their families are supported through their journey. It was developed to encourage engagement from all levels of staff to improve the experience that they are able to offer to patients, regardless of the reason for admission. The success of this project has been a clearly defined process, an individual identity, enthusiastic and committed staff and an innovative approach to providing quality improvement.
Another example is the patient held Urinary Catheter Passport. Urinary tract infections (UTI’s) made up the second largest single group of healthcare-associated infections in the United Kingdom and 80% of those were related to indwelling urinary catheters (National Audit Office 2009). Recognising this, the patient held Urinary Catheter Passport was developed as a joint initiative between ACE and the local acute foundation trust to support reduction in catheter associated urinary infection and improve the care of catheterised patients. The initiative has improved the communication between the hospital and the community as the patient holds the record and it is quick and easy for staff to locate key information which supports timely removal for the patient; decisions to catheterise are questioned more easily and checking takes place that alternative methods of management have been considered, in addition, it is proving to save staff time. The first three months of the initiative showed a 5.3% reduction of catheterised patients on District Nurses’ caseloads.
There is little doubt that the NHS, along with the rest of the economy, faces some huge challenges. Patient and service user expectations are high, the focus is on delivering high quality and continually improving services and all of this must happen whilst achieving significant improvements in productivity. As a public service mutual we are meeting these challenges head on through the ability to reduce bureaucracy and empower staff to innovate, resulting in continuous improvement of services and cost effective delivery.
So now I ask the question of you – do we build walls or do we build windmills?
Lynne Woodcock is managing director at Anglian Community Enterprise