Read again: Embracing stewardship in the NHS

As practice managers, embracing stewardship can empower vital decisions on resource allocation, service quality, and patient outcomes. Here we explore how stewardship can insight value based and patient centric healthcare.

 CREDIT: This is an edited version of an article that originally appeared on Healthcare Leader

In the throes of the 21st century, the NHS finds itself at a crossroads. Facing a litany of documented challenges, from workforce shortages to resource constraints, the question beckons: how do we pave the way for success in delivering the coveted Triple Aim? It’s clear that a revolution is in order. But it’s not a radical reinvention we seek, rather a transformative shift in mindset – a willingness to adapt to the changes already afoot.

Economists’ wisdom: A new course for the NHS

Up until recently, the NHS functioned within a market-oriented paradigm, resulting in a labyrinthine network of individual entities providing myriad services across localities. But as Oliver Williamson astutely observed, healthcare is too intricate to fit neatly within a market structure. Markets thrive when clear outcomes abound, and choices abound among providers.

However, the intricacy of managing health conditions reveals a different narrative. Many individuals grapple with multiple healthcare needs but often have access to just one local GP practice and perhaps one or two local hospitals. The result? A fragmented approach to healthcare provision, where providers often reap rewards based on the quantity of services delivered rather than the quality of outcomes for patients. The promise of system-wide collaboration beckons, but only if we are willing to shed the ingrained market-centric mindset. This is where stewardship enters the picture.

As a practice manager, you can actively contribute to stewardship groups, participating in decisions related to resource distribution, service quality, and patient outcomes. Your input is invaluable, as you understand the day-to-day dynamics of primary care and can advocate for services that genuinely benefit your patient population.

Stewardship: Navigating the healthcare commons

At its core, stewardship entails acting as responsible custodians of shared resources, acknowledging the need for collaborative skills essential to success. Picture shepherds allowing their sheep to graze on common land. As more shepherds introduce their flocks, the land becomes overgrazed, and everyone suffers – a phenomenon known as the “tragedy of the commons.” This analogy applies to any sector with finite resources. Yet, when these shepherds also bear responsibility for the common land, they naturally unite, embracing a culture of stewardship.

Elinor Ostrom’s research revealed that when users of resources collectively shoulder responsibility, they naturally cooperate to sustainably utilise these resources for everyone’s benefit. Crucially, those who directly use or request resources are ideally placed to be the stewards. In healthcare, this means involving clinicians and patient groups in determining the optimal resource allocation. Arden & GEM has been actively supporting Integrated Care Systems (ICSs) in the Midlands and the South East in establishing stewardship groups.

Value-based population healthcare

Stewardship goes hand-in-hand with a value-based approach to healthcare. For practice managers, this implies a fundamental shift in care delivery. Instead of merely focusing on increasing patient numbers, you have an opportunity to champion practices that enhance patient well-being.

By adopting value-based care principles, you can influence the choice of treatments and interventions that deliver the best outcomes. This means considering alternatives to traditional treatments, such as exploring the efficacy of physiotherapy over surgery in specific cases. Your role in advocating for these shifts can lead to more streamlined care processes, reduced hospital admissions, and greater emphasis on community-based healthcare.

Cultural transformation

Fundamentally, this entails a cultural shift for those of us working within healthcare. It requires a collective recognition that we must enhance public comprehension of what constitutes a promising NHS future. Traditionally, “good” has been synonymous with bigger, superior hospitals and increased patient volumes, akin to the market model. Yet, the NHS stands as an economic outlier in Europe – we disproportionately allocate funds to hospital care, while our European peers predominantly invest in community settings and preventive care.

Practice managers can lead by example, demonstrating that success can be measured through improved health outcomes, decreased waiting lists, and prudent financial management. This shift will not happen overnight, but it is already underway, with pockets of change evident throughout the NHS.