Employing and training the right people is critical to ensuring good quality outcomes. Having the right people in place was identified as critical to expansion.
Providers and commissioners agreed that patients participating in clinical trials could have improved clinical outcomes, and staff training and development, through being involved in research, could improve career development.
There are also opportunities to improve quality outcomes through technology. For example, remote review of radiology and ophthalmology images that enable clinicians to work virtually across the whole network.
Geographic expansion could increase the risk to clinical outcomes if staff do not follow agreed practice, policies and processes, but evidence suggests that rolling out a standardised clinical governance framework
across the network will reduce this risk. It follows that expanding a network will enable a wider spread of standardised care.
Standardisation was highlighted as critical to expanding a service by commercial companies as it allows for service improvements, efficiencies (through good governance and safety) and control of the supply chain.
Case study: standardisation
Compass Group UK & Ireland is part of Compass Group PLC, a world-leading food and support services company. In the UK & Ireland it employs more than 60,000 people across thousands of sites from hospitals, schools and oil rigs to corporate headquarters and major sporting venues.
In the UK, the healthcare arm of Compass provides food, support and retail services in five areas of healthcare (illustrated below), within NHS hospitals, retail healthcare (under partnership), care and residential homes and the private healthcare market.
The Compass healthcare team stressed the importance of due diligence when bidding for contracts, in particular ensuring budgets were sufficient to meet service specifications, whether benefits of standardisation could be leveraged, and having a clear understanding before committing.
Where there was deviation from standard processes, these needed to be analysed and understood. Any variations then needed to be agreed at the beginning of a contract. Contract variations should not replace SOPs, rather they should be seen as an enhancement. Geographical expansion was not seen as a limiting factor to standardisation; on the contrary, scaling up was seen as crucial to making the most of the benefits from standardisation.
Key features of standardisation:
- Flat governance structure: accountability sits with a few contract managers who report to regional directors. This is overseen centrally by one managing director.
- Development of standard operating procedures (SOPs) refined and tested over many years: these are centrally developed, ratified and maintained. This enables processes to be replicated across multiple sites. Services are also process dependent, avoiding quality dependence on any one person.
- Ensuring employees are trained to the same standard: whether recruiting new employees or when merging with other companies.
- Standardised governance, processes and roles are critical to providing consistent care across a growing network and providing assurance to senior leadership.
- NHS providers could apply processes similar to those used in the commercial sector to ensure standardisation, such as the use of SOPs.
- On-site leadership is essential in ensuring good quality care across a network. Executive presence is one of several ways of achieving this.
- Clinical research is more likely to happen across a larger network, which can improve patient outcomes and staff career development.
- Technological advances may provide opportunities for improved quality and geographical expansion.