My name is Julia Gray and I am a chartered accountant. I have worked in NHS finance for 17 years. For over four years, up to the end of 2018, I was a lead on a national NHS Costing Transformation Programme where I worked with acute, ambulance, mental health, and community providers to develop and implement a standardised patient-level costing approach. The purpose of the programme was to help providers understand their costs better, to enable effective benchmarking and to support national uses of cost data.
In the following blogpost I have shared my personal reflections and thoughts on being involved in what is an exciting and challenging project.
Although the value of implementing patient-level costing is well recognised, the NHS faces many challenges to ensure a successful implementation. Good costing is based on three pillars:
Personally, a key challenge was having the level of information required for the costing process. Good costing relies on good source information and some of the information required is not currently collected by providers. So, the question was how to successfully meet this challenge? To implement a new system to collect information and the time required for the information collected to the quality needed can take years, so providers were encouraged to work with what they have now and work towards compliance in a progressive and pragmatic way prioritising high volume and high value areas.
Another key challenge was standardising the costing methodologies used by providers. Only by all providers using a consistent approach can effective benchmarking be done. To ensure apples are being compared with apples, costs needed to be labelled and treated consistently. This was challenging as costing approaches were developed locally with the priority of meeting the needs of the organisation. Many providers were doing excellent work in costing, but everyone was doing this differently. So rather than try to reinvent the wheel providers were invited to share their examples of best practice so these could be adopted and brought together to form a consistent and standardised costing approach that could be implemented by all providers.
Having just outlined what were just a couple of the technical challenges and the pragmatic approaches taken to address them, my personal reflections on the programme are related to the challenges of successful transformation.
Every time you hear someone say, “we’ve tried it already and it didn’t work”, that’s an unsuccessful change programme. Although the organisation is responsible for transformation, it is the individual who must change what they do for the transformation to succeed. That is why both the organisation and the individual need to be supported in a time of change.
What I have learnt from working in a transformation programme is that transformation and implementation of new ways of working is a journey, but it is not a journey you can do alone. My advice is to work hard to build good relationships with your finance and informatics colleagues, service managers, clinicians and other stakeholders. Only by working together can change really happen.
Good communication is the key to a successful transformation so keep talking! Keep talking to all the key stakeholders involved. Really listen and keep learning from your stakeholders. There is so much expertise amongst your colleagues. There is no need to reinvent the wheel - chances are what you need to do is already being done successfully somewhere by someone - make it your aim to find them and to talk to them!
Good planning is essential for transformation to become embedded in the organisation’s culture. Benjamin Franklin said, “Failing to plan is planning to fail”, and I have found this to be true. Because we’re all so busy it can be really tempting to set off on a transformation project without doing sufficient planning. Good planning helps you identify potential issues and challenges and gives you the opportunity to prepare to meet these successfully.
Good planning is a continuous process and you will see the benefits in investing time to plan. So, the top tips I plan to take with me to my next transformation role are: