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CHANGE CHALLENGE 2015

What the NHS has got to learn from other industries

  • 14 Comments

Each year the calls grow louder for the health service to look to other sectors for fresh ideas and approaches to generate innovation and change.

When a major manufacturing and logistics company was down to just one customer  - and that customer wasn’t particularly happy – it realised it had to change or die.

The company was Unipart, which today employs more than 8,000 people, and believes its experience of turning itself around has lessons for the constantly challenged NHS.

But how much can be learned from other industries? Just because something works elsewhere does not make it appropriate for health.

“Just because something works elsewhere does not make it appropriate for health”

Last April NHS England CEO Simon Stevens outlined his own vision by saying: “The NHS needs to become the best at harnessing the best – whether spreading good ideas from within, learning from other industries, or cherry-picking from other countries.”

Amanda Molloy, head of sector – Healthcare at Unipart Expert Practices, insists that it’s not about cutting and pasting; a distinctive approach is needed. She says: “Our advice to the NHS is to work with the best but to find its own way of doing things.”

That is exactly what Unipart did in its darkest days, and now it is a global evangelist for continuous improvement through staff engagement.

Mrs Molloy reflects: “We had to change to survive. We had one customer – who wasn’t happy – and a workforce that was disengaged.

“So we started to look at the best in the world, companies like Toyota and Honda. No one organisation did it all, so we learned from them and then created a complete system of our own.”

The result was a process of continuous improvement known as The Unipart Way which was rolled out across the business. This is now spreading far beyond via its Expert Practices consultancy business.

Unipart’s emphasis is on developing the right skills within an organisation to bring about transformational change, whilst engaging the workforce.

Mrs Molloy is acutely aware that within the NHS there are many grand organisational development programmes, run by outside experts which, wither away because they are unsuitable and never take root in the minds of employees or the culture of the organisation. She has also seen great examples of excellence within the NHS.

“Improvement must be everyone’s responsibility and this needs to be in the organisational DNA”

She argues that improvement must be everyone’s responsibility and this needs to be in the organisational DNA. For this to happen demands:

  • A fully committed leadership team
  • Safe, repeatable, reliable and capable processes that add value to patients, are under control and continuously improving.
  • Ensuring every member of staff is engaged and capable of delivering improvements
  • Places to go and learn (Unipart has a Corporate University for its employees)
  • An organisational structure that actively seeks out shortfalls, bottlenecks and problems – then deals with them in a sustainable way.

“It’s not an add-on, it’s the essence. It starts with induction; it’s built into contracts and is a part of daily experience and practice. We put a great deal of work into creating a culture where people really believe that the company is not afraid of problems and challenges, it seeks them out in order to improve.”

She recalls a warehouse visit by 15 NHS executives who went away “buzzing” after meeting frontline staff due to their sense of purpose within the company.

One obstacle, Mrs Molloy has found, is the universal sense of uniqueness that makes people think that radical approaches from elsewhere won’t work for them.

She says: “We took the Unipart Way into logistics and they said they could see it working in manufacturing, but it wouldn’t work there because they were different. But it did. The fact is that I have never found a service or an industry where it doesn’t work.”

“This can involve learning directly from other industries or calling on third parties who have been involved in change”

Deborah Feakins, outgoing head of the Institute of Change Management (CMI) UK and Head of Change Practice at Practicus, also believes that when healthcare organisations want to improve they should look to other sectors as well as internally to seek out best practice and successful approaches.

This can involve learning directly from other industries or calling on third parties who have been involved in change in both the NHS and other sectors. 

She says: “You don’t always need to bring in external help, but it can be a real benefit. You may want to use mixed teams. But sometimes external people have direct experience of the type of change you are trying to bring about which is not available within the organisation.”

Mrs Feakins understands that there are some very specific issues for anyone proposing change in the NHS. These include huge levels of public scrutiny, potential risk to patients and media lambasting when things go wrong – not to mention the risk of sudden shifts in government policy.

“There are some very specific issues for anyone proposing change in the NHS”

Nonetheless the potential is vast and change is becoming the norm in all sectors. It has to be baked into everything we do. This, says Mrs Feakins, has been understood by successful business operating everywhere from pharmaceuticals to oil and gas.

In looking to other industries certain things might simply be replicated, but more often it’s about new approaches to getting the best from your own people.

“No piece of technology delivers change, no process delivers change. It is only if people adopt them that they deliver to their full potential,” says Mrs Feakins.

Looking elsewhere is often about unlocking latent potential.

“The NHS is full of innovative, talented and committed people who really want to achieve things. If we can’t find ways for people who are this motivated and caring to bring about change then there is a serious problem,” says Mrs Feakins.

She suggests a three-pronged approach for NHS leaders:

  1. Connect with other industries through the CMI.
  2. Get help from niche providers who have brought about the change you want elsewhere – and get them to teach your people how to make it stick.
  3. Build and extend your own capacity for change.

Taking a step back, she adds, that the issue is ultimately not about the NHS taking lessons from elsewhere, but for a more open approach in every part of our economy.

“Right now there are all sorts of industries and areas talking to each other, often with apparently little in common. But when they start talking they realise how much they have to learn from each other.”

Dr Emma Stanton, psychiatrist and CEO of mental healthcare provider Beacon UK, says: “There should be exposure to the value of learning from other industries from an early stage in training.

“This should be included in induction, education and training – as well as ongoing professional development. It should also be discussed in supervision and policy fora.”

The induction process is one in which she has a keen interest, citing Aberdeen Group research which shows that 90 per cent of employees decide whether to stay with a company in the first six months, and that high-performing employers use that time to win hearts and minds.

Dr Stanton is especially critical of induction for junior doctors which too often consists of “formal didactic presentations that alienate our valuable workforce before they have set foot on the wards”.

She has suggested looking to the likes of John Lewis for examples of excellence.

“There is a vital need to build organisational cultures which make the most of staff as agents of change and improvement”

More broadly Dr Stanton thinks there is a vital need to build organisational cultures which make the most of staff as agents of change and improvement.

She says: “Complex service industries are most suited for the NHS to learn from. What we need most of all are stories that captivate people’s imaginations; stories that inspire people for their work. But ultimately these can come from any industry.

“It’s about practice and work and leadership. We need a range of examples, stories and lessons to learn from.”

Indeed she points to the way Great Ormond Street Hospital in London studied the incredible choreography for Ferrari’s Formula 1 racing team’s pit stops when it was revamping its system for patient handoffs.

Racing cars were also used as an analogy by US surgeon Atul Gawande when he addressed Harvard Medical School on approaches to healthcare.

“Healthcare is moving at incredible speed and is so complex that every possible source of expertise must be called on”

His argument is that healthcare is moving at incredible speed and is so complex that every possible source of expertise must be called on to build systems that work for patients.

He told the audience: “By a system I mean that the diverse people actually work together to direct their specialised capabilities toward common goals for patients. They are co-ordinated by design. They are pit crews.”   

Part of this must be a willingness to take on unexpected ideas from unlikely sources.

While at medical school he could easily imagine a future where hi-tech robots were used in surgery, but never dreamed that something as mundane as a checklist would be a game-changer.

“They turn out, however, to be among the basic tools of the quality and productivity revolution in aviation, engineering, construction – in virtually every field combining high risk and complexity.”

The message is clear – whether it’s coming from Unipart, John Lewis or from US surgeons, the NHS cannot afford to ignore outside influences; indeed, it should be seeking them out.

  • 14 Comments

Readers' comments (14)

  • michael stone

    I think 'the NHS' seems to like consultations, but is not good at conversations.

    The Neuberger Review of the Liverpool Care Pathway called for a National Conversation about Dying, because of 'obvious perspective differences' (my phrase) between the NHS/clinicians, and patients/relatives which it had come across while reviewing the LCP.

    The LACDP group, which came up with 'One Chance to Get It Right' as a 'replacement' for the LCP, wrote on page 15 of OCtGIR:

    16. Alliance members also agree with the foreword of the independent review panel’s report and believe that it is essential that there should be a “proper national conversation about dying”. They take this to mean that everyone, members of the public, health and social care staff
    and the media should have opportunities to participate meaningfully in discussions about dying to raise awareness and understanding of this important part of life that everyone will experience, and to help ensure that people’s care and experience is as good as it can be. Alliance members commit to working together and with all these groups to generate and promote this conversation.

    I can't find this National Conversation about Dying, in the sense of a conversation forum where doctors, patients, public, nurses and all, are talking about the issues around end-of-life and dying on the SAME forum.

    So I suspect that 'learning from outside organisations' will not be easy for 'the NHS'.

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  • STILL going off-topic Mr Stone?

    The NHS needs to learn from the car industry and throw out all of the middle managers who just promote their own agendas

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  • michael stone

    redpaddys12 | 21-Feb-2015 3:17 pm

    Nice to see your username again, red.

    Yes, it is a bit off-topic - but it is not far off topic, and I think it is closely related.

    This, however, is off-topic (for this article).

    I am still being told that because I'm not a clinician, I have no idea what I'm talking about [by various anonymous posters on this website]. Well, I'm not a lawyer, or a GP, or a witness in clinical negligence cases.

    Go and have a look at the first 3 rapid responses on the BMJ website at:

    http://www.bmj.com/content/350/bmj.h841/rapid-responses



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  • why can't the NHS learn from the King's Fund, sound management theories from the likes of Harvard and the very best available from elsewhere and other high functioning health services, and in particular in Europe that all work and those who have had the experience and privilege of working in them?

    I disagree with drawing on the car industry or supermarkets. management theory started with Henry Ford's inhumane and coercive scientific conveyor belt system of management and the NHS followed on with 'general management' which developed from it bringing about stereotyped and impersonal patient care which resulted in attempting to process them through a system as goods in a manufacturing processing plant as a result of a report from Roy Griffiths, a grocer and CEO of Sainsbury's!

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  • michael stone

    There are 2 different things to be taken from outside.

    One is the 'new pair of eyes' looking at what is being done, factor.

    The second is, to use my phrase' 'the importation of a better method of working from outside which would improve things'.

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  • michael stone | 23-Feb-2015 12:27 pm

    your commentary gets worse by the minute.
    have you nothing constructive to say?

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  • Anonymous | 22-Feb-2015 2:28 pm

    Snag is "management theory" is pretty much an evidence-free area, long on assertion and short on fact (see the likes of Matthew Stewart's The Management Myth), lacking anything that I recognise as decent evidence (disclaimer - science degree before coming into nursing).

    As clinicians we are, rightly, moving further into evidence-based practice: it would be very helpful for management to follow the same route.

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  • michael stone

    BasketPress | 24-Feb-2015 11:19 am

    Ah - '(disclaimer - science degree before coming into nursing)' - that could be why I usually agree with your posts (my degrees are in chemistry).

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  • BasketPress | 24-Feb-2015 11:19 am

    are you rubbishing all the reports emanating from the King's Fund and the theory from Harvard? I would suggest those engaged in research there have far more knowledge than a mere science BSc!

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  • michael stone | 24-Feb-2015 11:51 am


    good lesson for Mr Hard as Stone in his narrow dichotomously small world who sees no further than his own black-white thinking; that in a fast changing environment such as experienced by those in the normal world the rules are carved in sand and not in STONE!

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