Virtual Festival of Evidence | Dr. Steven Allder
What I have learned from 10 years of trying to improve quality and reduce cost in the NHS
Steven Allder: In my own department we have seven streams of work. When we looked at five of those streams in depth, we created a 50 percent improvement. To begin with 22 percent of the stroke patients could get on to the stroke unit, and by the end 85 percent could. In terms of getting to the rehabilitation unit, at the start it was 10 percent of patients, and at the end it was 25 percent. All of the people who needed to go could go. In the neurological unit we found that the biggest problem was patients literally waiting for the consultant to let them go home. They might wait for two and half days. We changed the system and we got that down to two or three hours. In outpatients when we started people were waiting about two years. By 2010 we only had 15 patients waiting more than five weeks, which was pretty cool.
Interviewer: Was this an easy process to push through, or were there quite a few obstacles?
Steven Allder: It was more difficult than I’d ever imagined. Getting engagement with the people who delivered the care wasn’t that difficult, but getting engagement with the existing people in the management structure was hard. The managers who were close to it – again, that was easier. But as you went higher and higher up the management chain, in truth it got to the point where it was impossible, if I’m honest. At the moment those people can’t find a way to manage the top-down pressure they experience with what the bottom-up analysis is crying out for them to do.
Interviewer: Is that because they crave certainty?
Steven Allder: Yes, absolutely. From the politicians down everybody wants to have it on a spreadsheet, and for the the plans to be in place, and then they can move onto something else. But the truth is, that’s not how it’s going to be going forward.
Interviewer: But you did push change through. So what was your magic formula after you’d banged your head against a brick wall?
Steven Allder: I’ve been involved in 23 projects. Eleven of them really produced big change. In 12, I didn’t manage to do that. The management didn’t allow that to happen at the end of the day. I think the only way to do it is to actually become a senior manager. The only way it’s going to change going forward is for more people who have experienced the different way of doing things at the bottom to become senior enough that they can allow it to happen on a broader scale.