How do we create effective engagement?

Dr Mahmood Adil asks how clinicians and finance managers can engage and work together more effectively.

Clinicians and finance managers usually hear different music and dance to different tunes –  patient outcomes vs. bottom line, disease management vs. episode costs.

An average financial analyst might have to Google ‘decubitus ulcer’ (bed sore!) to participate in discussions about reducing harm rates in hospitals. By the same token, the typical clinician may glaze over at the mention of productivity measures and costing.

However, if we can help these two dedicated group of professionals to share their knowledge in driving common outcome i.e. improving quality and efficiency by working together, it could be the start of a valuable partnership. A mutual respect for evidence (how data guide decision making) is one of the common grounds between finance and clinicians.

Not all quality improvement initiatives lead to decreased cost but by working collaboratively they would be able to identify many opportunities that do get missed at times because of lack of appropriate expertise sitting round the table.

Finance directors cannot design pathways but they can help frontline clinicians to play that lead role by informing them of the financial implications of the changes they intend to make to improve quality of health services. QIPP drive does expect clinician to take account of the financial implications of their clinical quality improvement decisions, which means they have to engage proactively with their finance colleagues at all levels in an NHS organisation.

All clinicians should understand the basics of NHS finance, the role that finance plays in their work and how they commit resources. This is not about turning doctors into accountants; it is about enabling doctors properly to make the best use of NHS resources for patients. On the flipside, we need to encourage finance professionals to learn the business of clinical care delivery—from a reasonable point of view. Of course, they do not need to prepare to do surgery but they need to learn the processes of care, the standards of care and how care is delivered and by who, in order to provide the best and most relevant information to their clinical colleagues.

In the past, financial management was often seen as the preserve of the finance department and quality improvement usually fell within the domain of clinicians – but this approach will not stand up to modern-day demands and expectations. Finance managers and clinicians can do a quick litmus test by asking:  Are they part of a team working directly in dealing with any quality improvement initiative in their trusts?  What mutual benefit have they achieved by doing so?

If so, then I would be keen to hear your views on examples of current engagement, whether you are a clinician or a finance manager – because your intellectual interdependency will improve NHS quality and efficiency at the same time.

In future blogs I will explore what the barriers are to developing effective collaborations and ways to overcome them. Send me your innovative and practical ideas as to how we can take this to the next level.

In Innovation, Mahmood Adil

5 Responses to How do we create effective engagement?

  1. Rod Whiteley says:

    It’s not true that specialists from the clinical and financial worlds hear different music and dance to different tunes. You just have to choose the right kind of specialists. Put epidemiologists and actuaries in a room together and they’ll happily tango cheek-to-cheek, because both understand how to model risk.

    Trying to get a saw-bones and a bean-counter to do the cha-cha-cha, on the other hand, is going to end in tears. Let specialists be specialists. The main barrier to developing effective collaboration is that NHS finance has been too influenced by amateurs who don’t understand cost and risk models, so we don’t see intelligent data-driven long-term planning.

    • Mahmood Adil says:

      You have made a good point that we need to choose the right kind of specialist to develop joined up thinking and outcomes.

      But in order to mainstream quality and efficiency in the NHS, we also need to develop common language and skills of the core clinical and finance professionals to help them to understand each others’ prespective and use their collective strengths to help the NHS on the quality and efficiency front.

      For example, I recently visited a hospital where its clinical teams were working very hard to decrease the number of harm (hospital acquired infection, in-patient falls) without having full understanding of the financial impact of such harm – as such things lead to extra treatment, extended length of stay. But once the quality improvement team incorporated a finance professional in their operational meetings and asked the relevant questions, they had a better picture and encourging insight that their efforts would not only lead to improved quality but also save resources. Such meeting of minds is underpinned by sharing of routinely collected data and applying that knowledge to achieve quality and efficiency outcomes together.

  2. Liam Horkan says:

    The challenge of effective engagement is always going to be difficult when we always assume that clinicians lack commercial acumen and finance/procurement lack clinical knowledge.

    Yes there will always be gaps in knowledge and a lack of in-depth understanding of each other’s areas of expertise but I believe that there are some excellent examples where we have been able to bring together the clinician and the non-clinician to achieve significant savings alongside the improvement in patient care, reductions in clinical risk and to support the faster adoption of new technology and innovations.

    Where your example highlights the introduction of a finance person into the clinical team, there are great examples from across the country where a clinician has been bought into the finance/procurement team to support their development and understanding alongside managing the development of clinical groups and engagement strategy.

    The role of a clinician working in procurement/finance has developed over the last 10 years and was in response to reports in the late 90’s criticising the divide that had developed between the decision to purchase products and the actual contracting and purchase. There was a general concern over the gap between the clinical and financial decision making.
    Today around 60 clinicians are employed directly by Trusts or in my case as a Lead Nurse for a regional NHS Collaborative Procurement Hub.

    Working with clinical groups at local, regional and national levels we have been able to create an environment where this joined up approach has deliver real benefits in the day-to-day working of clinical / financial teams as well as being able to deliver on organisation financial objectives alongside improvements in care. Many examples exist of where this is being successful.

    There is a need to translate some of the commercial language and understanding of public procurement rules and other legal constraints to clinical groups but I think that is the easy bit.

    I am a great believer in how we present data, how we develop our strategy and how we come to the final conclusion will make or break a project and also how much engagement we actually achieve

    As a clinician, I want to use a logical approach, that way I understand the history, I can see why there are issues and I can diagnose and formulate a treatment plan with my team.
    Now apply this to some of the way financial / commercial/ procurement information is presented, it doesn’t use a logical approach so therefore for many clinicians, it is monotonous , it doesn’t demonstrate the impact I can have on improving things so therefore I lack motivation, enthusiasm and a desire to achieve the goal.

    Sit in a clinical meeting, people want the facts, they want to be able to contribute to developing the action plan, they want to know that their input and time achieved a good result.

    All clinicians understand the need to collaborate more, have a greater understanding of the cost base and the need to identify new ways of working, I agree that some of the best ideas come from engaging with the end-users, but equally sometimes we spend too long engaging when we could make decisions quicker, the introduction of new technology is one such example.

    Therefore for greater engagement, I believe we need to engage earlier, be open to seeing both sides and think about how we present information and what we level of input we want from our engagement.
    This can be done, I think we have spent too long now thinking it can’t…

  3. Great blog, and great comments, thanks! In our experience, rather than just approach ‘bits’ of the service it is essential to walk through the entire service in the service user’s shoes – and that requires the participation of everyone involved, including the patient or public.

    We call it SO Change – where you get Social and Organisational change working together. Internally, it may be systems thinking and Lean tools that help identify savings and performance improvements. Externally, social marketing, co-creation and behaviour change helps people use services more effectively and efficiently, reducing DNA rates for example or inappropriate attendances at A&E.

    To use the analogy above, you’ve got to invite everyone to the dance. You’ll be surprised just how many bean counters can cha cha cha with the best of them. And the insight into service improvement is just as likely to come from an administrator or patient who expose an inefficiency as a finance manager or clinician.

    I’d be happy to showcase examples.

    Thanks for the debate!

  4. Mahmood Adil says:

    It is very encouraging and ‘engaging’ to read the recent responses.

    The point is well made that engagement should be a two way story as illustrated by the procurement example where clinicians are playing a pivotal role to bring the best by collaborating with non-clinical/management colleagues.

    Presenting data in a logical way – I love it! I remember vividly reading ‘Hutchinson’s clinical methods’ (famous book by Sir Robert Hutchinson) in my medical school and thinking how good it was to use a systematic approach/data to explore a clinical issue. Then I was asked to present cases by using the same scheme during ward round and so on – and we need to remember that it took a number of years/decades before such an approach became part of clinical thinking DNA based on the availability of data. But that is not the case with finance and other efficiency data in the NHS which is still in its infancy. Therefore, an opportunity for the clinician to influence the agenda and put forward such logical approaches to change data into knowledge for the benefit of the whole system, both in terms of quality and efficiency.

    While talking about systematic thinking, I like the service user approach in particular demarcating internal and external enablers. If we (clinical and finance professionals) are clear about those enablers from the outset then using the right lever will bring the best outcome as suggested in the SO approach.

    Showcasing examples: well this is one of the key purposes of this blog – and I’m keen to receive examples presented in a structured way on one A4 showing clear gains in terms of efficiency and quality and is explicitly attributed to effective clinical and finance engagement with evidence.

    I agree that a lot of good work is going on in this regard but we have to identify it, evaluate it and then spread and sustain it in our modern NHS – and therefore your examples and help will be crucial to me!

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