As NHSI/E gear up to introduce Imaging Networks, we have taken a look at some of the lessons that can be learned from the implementation of Pathology Networks.
- It is going to happen.
The experience in Pathology demonstrates that NHSE/I will use any means necessary to ensure the networks are developed in line with their strategy. It’s also true that NHSE/I has learned from the work in Pathology as the initially proposed networks took longer to form than NHSE/I had envisaged and many of them changed in their configuration. It is therefore critical that networks identify their preferred partners, in accordance to their pathways and needs, and agree the initial principles of the collaboration under an MOU.
- Networks are not a hostile takeover.
Networks are about NHS organisations collaborating to make best use the resources in a region with the purpose of improving patient outcomes. A key principle to agree is that while some partners may be taking more risks than others as a result of differences in size, all organisations must work in partnership with shared risk and decision making.. A way to mitigate the perception of a takeover is to ensure that the governance and decision-making structures reflect the equality principle even if the financials may show a different distribution of benefits. Through the use of governance mechanisms, Pathology networks have been able to overcome this issue.
- Getting the commercials right from the outset is critical:
Of all the challenges providers will face, getting the commercials right is one of the most important. The NHS has a few models for integrating providers into such networks but no standard contracts that new networks can adopt. The commercial aspects of establishing a network is therefore going to represent a new kind of challenge to most Trusts. In Pathology, many of the networks left the commercial basis of partnering until too late in the process, resulting in operations and finance teams unable to progress with the target operating model or understanding how changes will impact them. Examples of some of the key commercials that must be agreed for the business case to progress include hosting of the network, asset transfer, TUPE transfer of medical staff, etc. Without such commercial principles agreed, stakeholders won’t know if plans address their needs and risks.
- The early bird catches the worm:
One of the lessons from Pathology Networks is that providers that start the network building process early will reap the rewards. While some regions have clearly defined boundaries and an established shared identity that supports networking, there are other regions where there will be a tug-of-war over which providers group together. Committing to network formation early and agreeing your preferred partners provides you with a much better chance of controlling your own destiny. Those that don’t progress quickly may well be faced with poor choices. The lesson from Pathology is that it pays to be a leader, not a follower.
- Only development of networks will unlock the required investment in technology:
NHS providers and, more specifically, Radiology departments have been starved of capital investment in recent years. As a result, the imaging technology is in desperate need of replacement with some scanners being more than 20 years old. Refreshing this equipment will require significant capital investment that few providers are able to fund. The government has already signalled its intention to fund more imaging technology, but this will be linked to progress on building the Imaging Networks. Providers able to evidence early progress are likely to be first in line for capital, particularly when these requirements are set in light of a joint target operating model.
- Data first, options second:
In developing their Pathology OBCs, providers either followed a top-down approach with a focus on first agreeing high-level strategic models, or a bottom up approach that relied on details, comparable data to drive decision making and the most appropriate solution. By first establishing accurate and comparable baselines for activity and costs as well as standardisation of nomenclature, Pathology networks were able to provide operational and clinical teams with the assurances that the benefits of different models were based on real world data, thereby removing a degree of subjectivity.
- The devil is in the detail:
Once the target operating model has been selected there are still a few critical commercial issues that require resolution. These may include dealing with stranded costs, management accounting, transfers of assets and contracts, trust services SLAs, etc. Many pathology FBCs failed to identify all the detailed commercial elements, focusing only on the major items (voting rights, shareholding, etc) which translated into delays in getting the partnership agreement developed and agreed once the FBC was approved.
- Put as much effort into governance and the day after:
The scale of investment required to transform pathology has led to an increase in outsourcing, particularly to Managed Service models. In one network alone, the 15-year outsourcing pathology contract totalled £2.25bn. The scale of the backlog and need for Imaging equipment replacements means the figures for imaging are likely to be even greater. This is a significant national investment and getting the governance right is critical. Any history of the NHS would not be complete without a reference to large contracts that providers, and commissioners, have failed to manage effectively – PFI being a great example. As the next decade unfolds, Pathology Networks will not be judged on their planning and transformation work, but on their ability to manage and govern the resulting contracts. Imaging will be no different.
- Don’t save on transition management:
A lesson learned from Pathology is that the transition to a new target operating model, whatever this may be, requires a high level of support and input from a dedicated team. Even though current managers will have the best knowledge about the service, they will already have dedicated a significant amount of time to the development of the business cases and, given the increase in activity during the transition period, relying on them to implement the change will have a negative impact on service. Successful implementations have had a dedicated implementation / transformation team that has allowed managers to maintain quality and performance on day to day operations while changing to a new service model.
- Change of personnel can threaten continuity during the monitoring and management phase.
When the implementation of the target operating model is achieved there is a tendency for the expert commercial and transformation teams to change, losing the knowledge acquired on the development of KPIs, contracts, SLAs and service specifications. It is essential that the service retains this knowledge and ensures that the service continues to deliver to the partners. At this stage, a keen understanding of the background of the target operating model is required to facilitate continuous improvement.
These lessons are taken from our White Paper on building Imaging Networks. Click here for the full White Paper.
If you’d like to discuss how we can help you develop your Imaging Network and develop the associated business plans and transformation programmes, call Chris Fourie on 07464 409 459. He’ll be happy to explain how we have helped trusts with their Pathology Networks and how we can help with your Imaging Network.