New research which explores the importance of having the right relationships, behaviours and environment to deliver better value of care in the NHS has been released today. Decisions of Value identifies a number of different factors that supports good decision-making, focussing on the judgements made every day between clinicians and managers. One of the challenges identified was the impact of cultural rather than structural factors and the interaction between people rather than rules and standards. The joint report with Academy of Medical Royal Colleges presents insights into how people interact in the NHS and the crucial factors affecting how they operate within a particular context. “Decisions of Value”, meaning those that balance quality, financial and operational considerations, aims to support and empower those working in the NHS to find solutions to the question, how best to balance the priorities of quality improvement and financial sustainability.
This academic research involved establishing local engagement through a series of site visits and interviews and national engagement with a survey and targeted stakeholder meetings as well as an academic literature review which was led by the University of Birmingham’s Health Service Management Centre.
Commenting on the report, Rob Webster, chief executive of the NHS Confederation, said:
“This is an important report that demonstrates again that “culture eats strategy for breakfast.” The importance of the relationship between clinicians and managers when making decisions is critical to the future of the NHS and this report gives full support to how patient experience and safety should not be discussed separately to finances. “We welcome the Secretary of State’s focus on this issue today and the sponsorship by the Department of Health of this work. Often we see political focus on performance targets and structures and an approach based on cultural factors is very timely. This research project aims to improve the quality of care and reflects the importance of cultural factors for organisations that are working to keep their budgets balanced. This links closely with our combined asks in the 2015 Challenge Manifesto about creating a new culture in the NHS, where patients are fully engaged and staff are empowered to make decisions within a tough environment.
“Alongside this, we need to bring more data and information into decision-making, to reach intelligent decisions grounded in evidence. This is key to getting more value from the resources we have. Clinical and financial staff must work better together, so that every decision is focused on value rather than costs or quality in isolation. This report should be required reading for every Board in the NHS.”
Prof Terence Stephenson, the Chair of the Academy of Medical Royal Colleges said:
“At a time when the NHS is under increasing financial pressure, it is crucial that we ensure high quality is maintained. That’s why I’m delighted that the Academy and the NHS Confederation came together to deliver this work, which investigates the ways in which the NHS can balance decisions on cost and quality. The Decision of Value Report shows the importance of having, above all else, the right culture in place which can deliver high quality and a balanced budget. It rightly outlines the importance of clinician involvement in decision making, providing the right environment for staff and robust data upon which to make the right decision.”
“Also, as the Secretary of State has rightly pointed out today, to ensure patient safety managers and clinicians must have productive and constructive relationships in order to make sound joint decisions about finances and quality. I look forward to working with partners cross the NHS to help implement the guidance and advice as outlined in the Decisions of Value Report.”
Six important factors are highlighted in the study, based on detailed exploration with staff across the NHS are:
• Stronger clinical and financial rapport
• Greater patient involvement
• Deeper values-based behaviour
• More information-driven decision-making
• Increasingly supportive environments
• Larger networks of peer support