The NHS in Wales is staffed with people who care but is often making the headlines for all the wrong reasons. Politics and the media play a significant role in shaping the perception of Welsh healthcare – while sometimes positive, as in the case of free prescriptions – the public image is often coloured by negative stories of failing healthcare boards and long ambulance waiting times.
Despite being widely acknowledged as the birthplace of our septuagenarian NHS, Wales’ own devolved healthcare system is often seen in a less favourable light than its counterparts in England, Scotland and Northern Ireland. However, these images can be far from the truth and Wales is a hot bed of experimentation and leads many innovations in healthcare practices.
So what does Wales have to teach the world about how to deliver better healthcare? The answer is: quite a lot, actually.
I have been working with the Bevan Commission (a leading health and care think tank in Wales, hosted and supported by Swansea University) for several years to measure and evaluate the impact of healthcare innovation through their ‘Bevan Exemplars’ scheme.
The scheme seems deceptively simple: each year, a cohort of 30 – 40 NHS professionals in Wales are provided with mentoring, training and support to try out and test their own expert ideas, in their own clinical or care settings. Anyone in NHS Wales can apply, and the scheme has seen porters, nurses, physiotherapists and surgeons join its ranks. Ideas range from using future-facing technology to improve patient experiences (i.e. VR distraction therapy for cancer patients) to environmentally-friendly ways to reuse hospital waste (i.e. recycling single-use plastic into valuable polypropylene blocks).
Size matters: a particularly ‘Welsh’ model
The format of the programme – which includes structured training and networking sessions and 1:1 coaching - is co-designed by its participants, guided by the Prudent Healthcare principles. Prudent Healthcare, in summary, seeks to make people and patients equal partners in their health and care, to care for those with greatest need first whilst using all skills and resources to bes effect, to do only what is necessary, do no harm and to reduce variation by using evidence-based practices. The Prudent Healthcare philosophy has become the cornerstone of Welsh Government policy, featuring heavily in its Long-Term Plan for Health and Care, A Healthier Wales. This makes the Bevan Exemplars scheme an unusual and particularly Welsh model and methodology.
The adage of ‘small and mighty’ also holds true for Wales. Healthcare systems the world over face common challenges in terms of aging populations with increasingly complex care needs and growing inequalities between the wealthy and the poor. Wales is no different, but my research shows it has many specific advantages in terms of its size and consequent agility. In Wales, it is possible to get an entire profession or care pathway in a room to work on a few vital innovation and transformation projects that can unlock effectiveness of people’s skills and resources.
The new radicals
Many in the NHS maintain that “all change fails” within the health service. Although this may seem like a gloomy prediction, previous research from The King’s Fund has indeed found that 70% of all NHS change projects / programmes in NHS England fail.
Through the Bevan Exemplars scheme, NHS professionals in Wales are tasked with thinking differently and finding new innovative ways of doing things: to challenge existing practices and systems whilst learning how to deliver better health and care more effectively. Trying out and testing innovation entails significant risk which could expose these NHS professionals (and their radical ideas) to organisational resistance to change and possible failure.
However, in Wales we have not only found a majority success rate for Bevan Exemplar projects, but the actual figure achieved was an 80% success rate. In my research into the second cohort of the Bevan Exemplars scheme, I found that each project generated, on average, £196,000 in economic benefits (which could include savings on staff time or resources) and that 32% of these experimental projects were suitable for immediate scale-up or adoption. The NHS professionals on the scheme achieve three key learning outcomes: how to do things right (standardising good practice), how to do things better (learning how to innovate) and how to do things differently (challenging the purpose of NHS processes).
So why does this Welsh programme for healthcare innovation succeed where others (with equally honourable intentions) do not? The size of Wales and the potential for networking within it may provide one possible explanation. My interviews with the NHS professionals who make up the Bevan Exemplars also point to a number of reasons, including: hands-on training, new skills and the support of a credible, external organisation (the Bevan Commission) in making the case for change.
Making change stick
This may all sound very rosy for healthcare innovation in Wales, but the challenge will be in ‘making change stick’ – and spread. Many successful healthcare innovation projects falter when trying to scale-up from the original (small) team to adoption at a national scale for all sorts of reasons.
My evaluation report makes several recommendations for improving scale-up and expansion, including:
Integrating NHS employers with professional bodies (such as Royal Societies).
Establishing ‘spin-out’ businesses for suitable projects to share revenue with the NHS professionals responsible.
Improved support for alumni of the Bevan Exemplar scheme.
Better connectedness between organisations and agencies in NHS Wales, industry partners and more.
If Wales can master the scale-up of its innovative ideas, it really could become a driving force for change in healthcare in the UK and beyond. The signs are already there in terms of transforming services and joining up healthcare to create a system that is, once again, the envy of the world.
Nick Rich is Professor in Operations Management at Swansea University School of Management. He is a socio-technical systems researcher, meaning he has an interest in how people and technology work together, and his interests cover healthcare systems reliability and high performance manufacturing and service operations.
The views contained within this blog are those of the author and do not necessarily represent the views of the Bevan Commission.