Comment / Getting the back office onto the front line: the art of conversation

It looks as though we are operating according to Carter rules. As with earlier reviews of pathology services, the more recent review of NHS productivity pushes the service towards economies of scale, rationalisation and consolidation, based firmly around the premise that ‘big is beautiful’.

I wonder if there is also an unconscious belief at the centre that ‘massive is manageable’? It may take time to turn around a tanker, but that’s a load simpler than herding cats, to mix a metaphor.

It appears that the idea that big services are rational – and small ones are, implicitly, irrational – is firmly part of the centre’s culture.

The popular definition of culture is ‘the way we do things round here’. And there is no doubt that delivering new models of care and more integrated services will involve changing the way we do things and changing our culture. That is what we need the help with – how do we actually change the culture.

But what if we define culture as ‘the sum of the conversations going on in an organisation’. Changing the culture is then about changing the conversations. Armed with a deep understanding of data in the broadest sense, finance people should be in a powerful position to change these conversations.

Yet many organisations within healthcare overlook the broader analytical capability of their finance colleagues. The consequences are regrettable, with business cases from clinical areas often displaying an excruciating mixture of shroud waving and wishful thinking.

This lesson has been learned in some of the more innovative healthcare organisations: always put someone from finance onto a team planning a new improvement programme. This delivers a double premium. First, the presence of someone without clinical bias often leads to a clearer, crisper action plan. Second, results of any successful test of change are more likely to be supported by data, including costs, making the case for permanent change far more compelling, particularly when there is a need for up-front investment.

This poses an interesting challenge in Carter’s world of the consolidated back office, with the promise of financial services being off-sited into a warehouse along with laundry, pathology and the booking office. It’s considerably more difficult to change the conversation if you aren’t in the same room.

Of course rationalisation should free up resources for more productive activities, but that isn’t quite how it works in the real world. Not without a little help anyway. So get out there, get visible and start helping make the quantum changes that we are going to need if we are to deliver the level of care the public deserves. Start changing the conversations. You are essential to front line success.