The challenge facing the NHS is to modernise and reform the organisation to meet increasingly high public expectations and give people a health service fit for the 21st Century. However, health authorities can find it difficult to navigate the shifting and fragmented landscape of policies, plans and targets.
West Midlands South Strategic Health Authority (SHA) is responsible for ensuring the provision of healthcare to 1.55 million people in Warwickshire, Coventry, Worcestershire and Herefordshire. It recognised the need to think differently about the issues it faced and take a more holistic and joined up approach to achieving significant change and realising tangible benefits.
West Midlands South SHA's management team had already defined a high level vision for the organisation: "To deliver the NHS Plan in a way which addresses inequalities, values diversity, is within the resources available and contributes to building healthier communities".
The NHS Plan, the most far-reaching change to healthcare in Britain since the NHS was founded, seeks to redress geographical inequalities, improve service standards and increase patient choice. At the heart of West Midlands South SHA's vision - in line with the NHS Plan - was the need to transform patients' experience, putting them at the centre of healthcare by building the capacity of local organisations to deliver the modernisation agenda.
However, the SHA had not defined what this meant in terms of the specific outcomes it wanted to achieve over the long term. Without that clear articulation, it would be difficult to identify what needed to be done to realise the vision. It would also be hard for BT - or any other local service providers - to correctly identify how, where and why to apply networked IT services solutions to support the SHA's local delivery plan.
BT's Consulting & Systems Integration team began working with the SHA's senior management to identify the strategic objectives on which the organisation would have to focus in order to deliver its vision. To do this, BT used its formal Business Transformation approach which is designed to help organisations think clearly about their long term goals and develop a single, shared picture of the future.
Taking the SHA's high-level vision as a starting point, BT used a series of facilitated workshops to define the outcomes that would demonstrate the organisation's achievement of each of its strategic objectives by 2010, the timescale set out in the NHS Plan. These outcomes were captured in a tool called a transformation roadmap, including all the key outcomes from the NHS Plan and other policy documents such as the National Service Frameworks (NSFs) - which relate to the reform of services, procedures and workforce structures within the NHS.
A key feature of BT's approach is the expression of outcomes as benefits sought rather than tasks to be completed. One of the issues identified at the workshops was the number of separate policy initiatives being progressed in the different functional areas of the SHA. For example, there was a separate stream of work relating to the implementation of each NSF. By incorporating all the relevant data into the transformation roadmap, BT enabled West Midlands South SHA to have, for the first time, a clear overall picture of everything that it must achieve by 2010.
A transformation roadmap is not built as a 'one off' exercise; it evolves over time. With West Midlands South SHA a large part of the roadmap was developed over two workshops, but significant additional input came from specialists and review meetings. "BT's Business Transformation approach has enabled West Midlands South, as a new SHA, to think widely and clearly about its long-term vision and direction," says Mike Marchment, Chief Executive of West Midlands South SHA. "Working with BT has been an engaging and provocative experience and one that our organisation has found very helpful."
Although some of West Midlands South SHA's objectives were self-evident - those that relate to the delivery of care - it soon became apparent that other important underpinning objectives concerning the development of the workforce and delivering value for money had never been considered. By defining all its objectives very precisely, the SHA was able to ensure that these were clearly understood and the results measured accurately.
Once completed, the transformation roadmap showed West Midlands South SHA a consistent view of the future, creating order from a chaotic multiplicity of targets, objectives and policies, and giving the organisation a firm basis on which to plan the streams of work required to achieve its vision. Necessary activities and projects, for example, are now much easier to identify because staff have a better understanding of the wider context.
Mike Marchment explains: "BT has helped us to look beyond our usual short to medium-term planning horizons and to think in a more transformational and challenging way about the outcomes that our organisation wants to achieve over the next eight years, while also placing in context the outcomes required of us by the NHS Plan."
In the same way, it is now possible to identify areas of potential conflict and take steps to resolve them. The SHA policy targets, for example, by identifying that it will seek to achieve a particular teenage pregnancy outcome sooner than mandated.
Mike Marchment concludes: "We now have, for the first time, one shared picture of our extended organisation's future. This provides a robust basis on which to plan our future programmes of work, and ensure that the Strategic Health Authority delivers real and lasting benefits to the community. It is also essential to successful future engagement with potential local service providers."
The Business Transformation approach used by BT is based on first developing a roadmap for what an organisation wants to achieve across its areas of operation, expressed in terms of the business outcomes or benefits that it wants to achieve. A resulting programme plan for achieving desired change is then developed that includes all key implementation themes - for example, organisational mobilisation, change management, process change, networked IT services, governance and finance - and links each project clearly to the business outcomes it will deliver.
The BT approach enables organisations to:
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