Key challenges facing healthcare and key solutions

The UK healthcare system is one of the largest organisations in the world, employing more than 1.4million people. It is dynamic and continuously growing in complexity and cost. This presents significant challenges to our aim of consistently achieving high quality care for all.

Shortcomings have been identified across the dimensions of quality. They are the result of many organisational, operational and attitudinal factors, including:

• The belief that the most important investment in quality improvements is in the development of new cures.
• The failure to translate research findings into practice quickly so ‘tried and tested’ interventions are often not implemented.
• Clinical autonomy can result in a lack of accountability. This can lead to tolerance of waste and inefficiency.
• Imperfect systems and resource constraints mean that staff constantly struggle against underlying deficiencies in the system.
• The quality of each person’s care involves many different processes and stages steps provided by many different people, yet clinicians rarely see more than a snapshot of this care.
• The external environment – aspects such as financial systems, performance assessment, regulation and organisational structures – often produce unintended consequences for the quality of care.
• Weak design and planning of the workforce, including team-working.

But we also know that there is a wealth of potential solutions. We emphasise the solutions that we believe have the greatest potential to make lasting and widespread change.

1. Focus on continuous improvement 

• Others work to improve health by identifying new cures, through demonstrating the clinical effectiveness of new interventions or addressing the underlying determinants of health. We believe that better health outcomes can also be achieved by improving the quality of health services.
• This area has been neglected, and it’s essential that health systems focus on closing the gap between best and current practice.
• Strong leadership is important – leaders must understand improvement, and be competent in leading their colleagues towards that aim.

2. Emphasise internal motivators

• For some time, the healthcare system has focused primarily on external drivers of change, such as regulation, economic incentives and performance management.
• Yet internal drivers, such as behavioural change (for example professionalism, skills development, organisational development and leadership) can often prove to be a stronger motivator.
• Both types of drivers are necessary, but there now needs to be a stronger emphasis on finding ways to support and channel the motivations of professionals.
• Good leadership is critical to achieving the right blend of drivers, and in particular appealing to the internal motivators of staff and peers.

3. Align quality at every level

To achieve high quality care for every person, every time, we need to work across the whole of healthcare to make sure that all levels of the system relate to each other in supporting quality, including:

• one-to-one interactions between people who use services and clinicians
• clinical micro systems
• delivery systems
• interventions designed to achieve change at national level.

4. Redefine relationships

• The interaction between people who use services and their clinical team is a critical determinant of quality of care.
• To achieve the best outcomes, people need to be equipped to play an active role in their care, and their care needs to be personalised.
• This requires a different approach to the way clinicians and the wider healthcare system engage with individuals and local communities.

5. Build knowledge, techniques, skills and new practices

• Knowledge, in the form of performance data such as clinical measures and patient reported outcomes, can identify gaps between best and current practice.
• Developing new skills is essential, for instance testing and analysing what is known about effective care, making changes across the system and supporting self-management.
• Bringing about new practices requires recognising the essential organisational and human factors. These may include varying resources, the need for teamwork in a sector with unstable and unformed teams, and the need for processes to ensure that the desires of people who use services are taken into account.