Making improvements with healthcare productivity challenges

Sarah NolascoFrom our Senior Consultant, Sarah Nolasco

Despite growth in funding and clinical staffing, levels of productivity in NHS services have not increased as expected. Indeed, with the announcement of £3.4bn in capital funding to support digital and technology projects, productivity is the current hot topic in the NHS.

As Thea Stein, Chief Executive of the Nuffield Trust, recently pointed out, most NHS staff do not come to work to be productive. They have entered a profession to be caring, empathetic and to help others. And to do this, they need the correct support, tools and approaches in place. This in turn supports productivity, but, more importantly, improves patient and staff experience.

Senior Consultant Sarah Nolasco and the wider team take a people focussed approach to productivity improvement. This combines detailed analysis of where the improvement will come from and the time it should take to be realised, with extensive engagement, support, training and post implementation planning. It is a crucial element in generating and/or releasing the improvements intended. In this blog, Sarah highlights four common areas to focus on but more importantly what’s important to get it right.

Taking a Digital Approach

Digital tools and AI are often being hailed as the answer to productivity challenges. While these technologies can streamline processes and free up time – they require planning, support and time to be effective.

  1. Staff need time and space to learn how to use new technology. Ultimately, this may mean that productivity needs to drop for a short time to allow them to use a new system to its full potential.
  2. A test period with the selected tools is essential for those colleagues who may need to use the technology on a day-to-day basis.
  3. A thorough review of the technology in relation to the clinical pathway is incredibly important. Its introduction may change where and how patients flow through a clinic, potentially impacting on the admin required by clinical staff in a way that they have not previously been used to doing.
  4. Organisations need to look at the change resulting from any solution on an individual level, assessing needs and impact on a person-by-person basis. This is the productivity plan that is crucial to release the savings or capacity resulting from improved productivity and ensuring the strongest chance of success.


An organisation’s staff are at the centre of everything it delivers. Any changes in the use of technology or any new system need to take account of how staff are being used, their demographic and the development of new roles. Many organisations do not have the visibility or time to review their workforce and yet, without this information, it is very difficult to understand if people are being used appropriately, what role redesign is required.

Again, as a minimum any change should understand:

This can then be used to baseline current performance and track improvements.

Patient Solutions

When looking at productivity, we sometimes look to the role of the patient. Again, here is where co-production and engagement are key but often not fully considered. Too often, it is easy to think that non-attendance or poor preparation for appointments is because some patients are careless or take services for granted. However, at a time when people are waiting so long to be seen, it’s important to consider what else might be going on. Patients may be scared of the interaction with healthcare professionals or their results, they may not have English as a first language, low levels of health literacy or simply did not receive their appointment letter.

I’ve been involved with organisations where true engagement with patients and their carers has identified reasons why their population struggle to attend, resulting in solutions that can  address these problems.

The more we really listen to patients, the better our productivity will be. For example, identifying patients that can attend appointments at short notice and having clear processes to reuse slots for them.

Organisational Culture

Lastly, we need to talk about the role an organisation’s culture plays in ultimately increasing productivity – none of the practical solutions above will have a true impact without looking at culture. Staff need the permission to try new ways of working, which will inevitably sometimes fail. They should always be adequately prepared and trained for any large-scale change.

Most importantly perhaps, staff also need to be recognised and rewarded for their hard work – and, on the flip side, those who are not contributing need to be challenged.

Without this, the true change that is required will continue to be a vision on the horizon we will still be talking about in the same way for many years to come.

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