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8th March 2013

Service Quality in the NHS


As we move into the new healthcare landscape, many organisations are facing unprecedented changes which demand doing things differently within uncertain environments. This requires a positive shift in mind-set; the need to develop resilience and enable confident innovation, while avoiding being drawn into the ‘downward spiral’ of stress and negative behaviour.

The NHS reforms have led to the emergence of new types of organisations; those delivering Community Care to patients within the community, and Support Services to Clinical Commissioning Groups (CCGs). While these appear to be very different ‘market places’, both will face similar pressures regarding competition and the need to establish financial independence and profitability. This demands a fine balance, one that is more familiar to the private sector – maximising service quality and providing exceptional levels of client care, whilst minimising associated costs. Impact Consulting Psychologists are using an OD model from the service sector (Psychologica), to help two such organisations strike that balance.

Locala Community Partnership is a social enterprise with 1,250 staff providing NHS community services to over 400,000 people, while reinvesting any financial surplus back into supporting patient care. Their new status allows them freedom to deliver care in a more coordinated, integrated and community focused way. While they continue to be part of ‘the NHS family’, delivering care under the same ethos and providing existing staff with the same terms and conditions, they are challenged with creating the right structure and cultural mind-set to compete effectively with the likes of Virgin Healthcare and other service providers. This involves balancing the business to ensure the right people with the right skills are in the right place, while working within a clear values framework based on an employee partnership model.

Cheshire and Mersey Commissioning Support Services resulted from the merger of aspects of eight former Primary Care Trusts (PCTs). They are also challenged with the need to develop a shared cultural mind-set, while delivering a comprehensive range of services to newly formed CCGs, across a wide region from multiple sites. While CCGs are currently tied in for a period of time, many are still developing their awareness of the levels of support they will require and will be free to take up alternative offers from competitor providers in the future.

Both organisations are undergoing structural changes requiring adaptation to new ways of working in order to ensure viability and competitiveness (such as matrix management). A more fundamental challenge is the required shift in mindset from an ‘NHS perspective’ to a more business focused approach.

The Psychologica Model provides a framework for this shift in perspective, through focusing on what really matters to service users. Research has shown this to be: tangible quality outcomes; reliability of service delivery; and emotional aspects of the service experience. Interestingly, initial patient concerns arising from Mid Staffordshire Hospital (Francis 1) map directly onto these service dimensions. The aim is to develop appropriate employee attitudes, behaviours and competences to impact positively on these perceptions. Further, the appropriate service climate needs to be achieved in order to sustain focus on customer care and continual service improvement. This is through placing particular emphasis on improved communication and adaptive organisational processes which align behaviours with espoused vision and values. The use of a central model and common language can help to create a ‘golden thread’ which runs through all levels of the organisation and its activities. Increased awareness has provided a focus for dialogue, open conversations and exchange of feedback between leaders, therefore helping the organisation to understand the new ways of working that will help deliver their goals.

In both cases, assessment processes have taken place using diagnostics based on the model to map skills, identify skill gaps and guide the development programme. This has incorporated 360⁰ Analysis and Development Centres leading to 1-2-1 coaching, manager, senior team and Board workshops and integration of learning (regarding service dimensions) into appraisal processes – to sustain outcomes and embed culture change. These projects are on-going, but initial findings show real enthusiasm amongst the majority of staff to contribute to service improvement and ‘live the values’, where they are empowered to do so.

For more information on Impact Consulting Psychologists and the Psychologica Model, contact:

Dr Phil Bardzil
[email protected]
0161 351 2290