Maximising productivity is critical if the NHS is to survive the pressures it faces in the aftermath of COVID-19 and from the long-term growth in demand for health care. Our new long read highlights practical changes that can improve productivity, and suggests policy also needs to pay attention to whether health care organisations are ready and able to shift to new ways of working. Here we summarise the key learning points. 

1. Improvement approaches that can increase productivity include skill mix change, patient activation, improving flow and the use of technology 

Making sustainable improvements to productivity requires reshaping and improving the delivery of care. Improvement approaches that can lead to productivity gains include supporting the knowledge, skills and confidence a person has in managing their own health, and making changes to the skill mix of the staff involved in delivering care, for example by developing skills to allow staff to work at the top of their skill set more often.  

Improving the flow of patients, resources and information along a care pathway is another effective route to productivity gains, while technology can be used to boost productivity by improving and speeding up information, communication and analytical processes. In many cases, technology also acts as an enabler in approaches focusing on skill mix change, patient activation and improving flow.  

2. Redesigning new models of care also provides an opportunity for transformational change  

These improvement approaches can be used incrementally and focus on making changes to existing models of care. However, it is also possible to use them for more transformational change by redesigning pathways and creating new models of care that can achieve outcomes more efficiently.  

Redesigning models of care creates potential to improve productivity at one point in the care pathway, by making changes at other points. This could involve integrating services or improving co-ordination between them, introducing prevention-focused initiatives that aim to reduce avoidable demand, supporting patients to manage their care at home, or consolidating services into specialist hubs. 

3. Agility is the missing ingredient for NHS productivity 

Despite the range of improvement approaches, there’s often a disconnect between identifying an opportunity to improve productivity and successfully achieving those productivity gains in practice. This is linked to motivation and capability to implement change successfully – a combination of factors which can be thought of as the ‘agility’ of an organisation to realise opportunities for improving productivity.  

Motivation is critical because new ways of working must be accepted by staff if they are to be effective. Capability takes into account an organisation’s skills and infrastructure, including its digital maturity, quality improvement expertise, access to timely and accurate data, and management and leadership. All of these factors underpin any work an organisation undertakes to improve productivity – without agility, initiatives will founder, no matter how well-conceived.  

4. A focus on quality improvement driven and owned by front-line teams is more effective in engaging staff than economic agendas 

The improvement approaches that we’ve highlighted – around skill mix change, patient activation, improving flow and the use of technology – are first and foremost about quality improvement that’s driven and owned by front-line teams. These approaches offer an opportunity to engage staff and to harness the intrinsic, vocational motivations of the workforce more effectively than an economically framed agenda based around targets, competition, and regulation. 

5. Policy should focus not just on ideas for improving productivity, but also on strengthening provider agility 

There are many ideas out there for improving NHS productivity. But to really take advantage of them government and NHS leaders must invest in strengthening the agility of the provider sector, creating organisations that are ready to seize opportunities and implement new ways of working rapidly and effectively. Agility can be strengthened through investment in improvement capability and digital infrastructure, providing implementation assistance within national change programmes, supporting effective management and leadership, and ensuring that regulation and payment systems support innovation. 

The NHS will only be able to meet the demand pressures ahead if providers are in a position to take advantage of productivity-enhancing improvements. Policy must not focus only on the supply of things that can enhance productivity, such as new workforce roles, equipment and promising innovations, but also on whether providers are able to grasp these opportunities and implement them effectively. Factors relating to provider motivation and capability, and how they create organisational agility, should be incorporated into policy and the overarching ‘theory of change’ for improving NHS productivity. 

Explore these issues in more detail in our long read Agility: the missing ingredient for NHS productivity. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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