I have recently been involved with a firm of management consultants on a patient service improvement project. Whenever I mention this to acquaintances, they always come up with their favourite consultant jokes.
‘A consultant is someone who comes in to solve a problem and stays around long enough to become part of it’ is surpassed only by ‘A consultant is someone who borrows your watch to tell you the time and then keeps your watch’.
All very droll and I’m sure the specialists in question groan in weary exasperation every time these witticisms are trotted out.
Management consultants are much-criticised figures but, despite this, appear to be a ubiquitous part of any public service project or initiative. According to the Management Consultancy Association, expenditure on consultancies in the public sector in
Britain increased from £605m in 2002 to more than £1.9bn in 2004.
It would therefore not be remiss to suggest that the Departments of Health and Education, among others, view the input of such consultants as key to successful project management. There is no doubt that, post Darzi, clinical leaders will be expected to look at services, assess their ‘fitness for purpose’ and redesign them.
Let us set aside, as nurses, the obligatory hour we had concentrating on managing change in our training. I, for one, felt out
of my depth at times trying to manage complex projects and the multitude of different stakeholders involved in any service redesign. Perhaps we do need management consultants to help us navigate this often foreign terrain. So I would like to offer a few thoughts to others embarking on this trip.
Consultants need to speak in a language that clinicians understand. Trust me, enquiring whether ‘I have the bandwidth to deliver the cost driver tree by Thursday’ is not helpful and will have me still scratching my head on Friday.
Insisting I deliver reports and data in a format that is completely alien to me will not help to ‘facilitate us going forward’, although it may mean I do have to cancel a clinic because I’m rushing around trying to get the damn things off to your head office.
Having said that, the project I was involved with was successful. As a result, I was invited to a conference to celebrate our achievements and relay my experience.
I was followed on stage by a management consultant. He regaled the audience with a tale of how he had transformed a failing orthopaedic unit with a regime of process mapping and service redesign.
Of particular importance was the fact that he had concluded that the bedside chairs employed post-operatively were antiquated and impeding rehabilitation. He therefore persuaded the service manager to invest in new chairs and, almost overnight, length-of-stay figures reduced and patient satisfaction shot through the roof. Buoyed up by this, I went off to lunch, only to be collared by an angry nurse who said that staff had been pleading with the service manager to replace said chairs for five years.
What did I take from the experience? There is no doubt that we constantly need to develop and improve services. I also believe that, as nurses, it is important that we become closely involved with any projects to change services.
We often do not have the skills to see through the aims and expectations of this kind of work fully. So we do need help – and who better than people who do this kind of work day in, day out?
However, it needs to be done in a language that we understand and within a process that we find relevant and which is unencumbered by documentation just for the sake of it. We are the ones who require the assistance – so it should be done on our terms.
One final word to trust executives and general managers. If you do highlight a service that needs improving, before you get on the phone to a firm of management consultants, take a stroll down to the unit in question. You may be surprised at the wealth of ideas and skills already there.
Steve Duckworth is stroke director at Kent Cardiovascular Network
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