Jo Smith at Mott Macdonald explains how an approach to Performance Optimisation can reduce wasted resources in healthcare
It seems to be accepted that wasted resources within healthcare organisations and systems is inevitable. With poorly designed operational and functional processes, outdated workforce models, ageing estates and the inconsistent adoption of digital innovation , the challenge lies in how to design facilities, infrastructure programmes and new ways of clinical and operational working which have the potential to not just improve performance – but truly transform it.
For Jo Smith, an approach known as Performance Optimisation is an answer, helping healthcare organisations and systems improve efficiency and effectiveness of delivery by identifying and repurposing wasted resources. “It’s primary purpose is to optimise resources through a process of benchmarking and analytical anaylsis,” she says. By reviewing current functional, clinical, operational and financial performance and identifying the scale of potential optimisation, it is possible to create a healthcare organisation that has the ability to transform the way itoperates, looks and behaves in a sustainable way.
Jo began her career in operational roles with the UK NHS, focusing on clinical quality, clinical governance and patient safety. She moved into consultancy, joining the former NHS National Clinical Governance Support Unit where her remit was to work with international healthcare organisations which included leading a whole healthcare reform programme for Gibraltar, a UK protectorate of 36,000 people, developing a clinical governance approach for the Italian Ministry of Health, and introducing patient focused care principles to a hospital in Lisbon. From there she had her first stint at Mott MacDonald and led a co-productive team in the strategic and clinical design of the new hospital build for Bermuda; the next stop was at EY where Jo spent eleven years developing their global health business. At Mott Macdonald she is responsible alongside Richard Cantlay for developing the company’s healthcare consulting strategy and delivery approach.
What is Performance Optimisation or PO?
PO is based on the premise that every healthcare organisation around the world, no matter how good, wastes up to 45 per cent of its resources. There is evidence both qualitative and quantitative evidence to support this including from the WHO, JAMA Intermountain Health and the Dartmouth Institute. Waste can be found in different places – in the functional aspects around wards, beds, emergency department operating rooms and also within human resources, clinical teams and non-clinical teams.
Financial waste can also be seen in very simple things like the supply chain or the pay reward structures, or costs to power hospitals. But there is also waste in the whole system. Many healthcare organisations don’t understand their core business and may have clinical teams focusing on unnecessary clinical practices.
There are a number of root causes for this waste and these include: individual and organisational behaviour, healthcare demand not necessarily being created by real need, and unwarranted clinical variation which increases the risk of patient harm and wastes resources.
Performance optimisation works on the premise that an organisation needs to identify what that 45 per cent waste is, where it sits, and how to repurpose it. It can be used for new clinical services, cost improvement, new estates or optimising the way in which the current estate works. It can also be used for creating new pathways across the health care system within a reconfiguration.
A key part of the work in performance optimisation is not only identifying the waste and repurposing it, but also looking at how technology, digital solutions, automation and simple things like an integrated health record can help.
What is the main challenge in performance optimisation?
Healthcare is probably one of the most disruptive industries in the business right now when we consider new technological interventions, new treatments, AI, automation and more. The delivery of healthcare is fundamentally underpinned by process but, despite access to rapidly evolving technology, this process hasn’t changed for years. Clinical teams become used to doing what they’ve always done and staff who move from hospital to hospital don’t want to have to learn a new way of doing things, and in all honesty I wouldn’t necessarily want to be a patient in a hospital that was testing new processes. Therefore one of the fundamental challenges is convincing clinical teams to adopt new way of working whilst asking them to go on a journey that may at times feel counter-intuitive while continuing to deliver high quality, safe patient care.
Another challenge concerns the people. They make healthcare the most fascinating and energising sector to work in, but also can make it one of the most difficult. COVID 19 had an obvious human impact and we were able to change incredibly quickly via technology. But once the threat of COVID dwindled, everything retrenched. Today there is so much pressure on the system, particularly in primary care, that there is not enough capacity to enable face to face consultations anymore. Yet there is always going to be a need for human connection – so how do we meet that need by creating new models of care that enable an integrated health system that is driven by patient need?
How does performance optimisation work best?
There is a moral imperative in performance optimisation, certainly in publicly funded healthcare systems. Generally we are living longer but not necessarily better so healthcare is not going to become cheaper. We have to ensure that every single Pound, Euro or Dollar is therefore used in the most effective way possible.
It’s very much a journey as it depends upon what healthcare organisations want to achieve. If they just want to achieve cost reduction, that’s probably fairly simple. But there is also room to introduce new ways of working methods that will start driving optimisation for both staff and patients, so that patients are seen in the most appropriate place, in the most appropriate way, by the most appropriate clinical individual. This obviously has to be the end goal when looking at optimising the delivery of healthcare.
It’s easy to think that the key to improvement lies in a brand new facility, but we need to look at this new facility through the lens of the potential that can be derived through the delivery of new processes, patient pathways and the supporting systems for a new model of care. The first requirement is a piece of strategic healthcare planning to ensure that a new facility will be designed, or NOT designed, to meet the needs of both the current and future population. This strategy when considering the return on capital investment of healthcare infrastructure programmes. The best return on investment is a wise operator, so to derive the greatest amounts of return on investment from a capital project, performance optimisation has to be considered first and foremost.
Everyone gets very excited by the idea of a new hospital but, if people work in the same ineffective, inefficient ways in a new facility, the potential for transformation is diluted or lost. The potential sits in how the new building drives new operations and improves the quality of care. What’s the point of having a shiny new hospital if nothing changes inside it?
Is there a turnkey solution in PO that organisations can adapt?
I don’t believe that healthcare is just healthcare. You can standardise the way in which healthcare can be delivered, but you cannot standardise the cultural and demographic differences. Places like the Middle East, particularly Saudi Arabia, are thinking about programmes for new buildings as a consequence of the clusters and the challenging geographical issues – they are looking to serve very intense urban populations such as Riyadh, as well as poorly served by health care providers that may be very isolated areas with only a small population. And this strategy is also true of facilities in South Africa and other parts of Africa as well, also in Australia and New Zealand.
So how do you create a health care system which is not necessarily predicated on a building? In such diverse and geographically-dispersed populations, the solution is to create an optimal system where some parts are facility-functioning and other pieces are system-functioning. There is always a way in around performance optimisation which may not necessarily be about facilities.
Are there any other factors that should be considered?
It depends on many things, such as elements of competition. This is where conversations about models of care, quality of care and patient experience are incredibly important. Then there are different conversations around performance optimisation depending upon the pain point of the client. Many large facilities are now being used for medical tourism, so it’s important to identify how to attract insurance companies as well as showing that patients will have the optimal experience.
What do you tell your clients on the first meeting?
I have applied this approach all over the world, not just within the NHS, and I’ve delivered it with both public and private healthcare organisations in healthcare systems. It’s a truly global approach and has been tested in a truly global way.