Decision Support

How can public service organisations make better decisions, take action and support improvement? We suggest that answering just 4 questions might be the secret.
Decision Support
Jul 26th 2018

Imagine the situation: you are in an urgent care programme board in an NHS Acute Trust. There are 16 people in the room – clinical leaders, operational leaders and administrative staff. The clock ticks past the 60 minute point indicating that time is up and you are now late for your next meeting on a typically busy day.

People are still talking. Discussing issues that have caused patients to spend longer than needed in A&E or wards. This is the most important issue facing the Trust and emotions are high. The problems are difficult to solve and there are differing opinions on how to solve them.

You consider what has been covered so far:

  • There are too many people coming to the hospital – it’s up by 9% on last year, which was 7% up on the year before;
  • There are too few staff in the hospital to deal with this demand and recruiting more staff is challenging;
  • There is a lack of clear communication between the Trust and the local community provider, which inhibits the discharging of medically fit patients;
  • And, the money that was promised for a bigger ambulatory care centre hasn’t come through.

They all feel like important issues and, if the Trust solved them, the quality of care would surely improve for thousands of patients.

However, you have a nagging doubt that there could be a better approach to managing problems. You realise you’re not actually confident these are indeed the issues directly causing the problems. They are the issues that have surfaced from the conversation in the room, but they weren’t determined by data.

Furthermore, you muse: “Has anybody actually decided to do anything about these issues?” Not really. In fact, you and your colleagues have spent an hour without agreeing a single action between you. And, what’s more, you’ll return to next week’s meeting for more of the same.

For this hospital, the chance of improving their situation looks bleak. They have a number of large issues, no way of making good decisions, and no way of supporting each other to take action.

A simple decision framework could help transform this situation. If the leader asked these four simple questions, the outcome of the meeting, and the Trust’s performance, could be completely different.

Decision Framework

This way, the team is focussed on actively solving the biggest issue, rather than dwelling on a range of challenges, preoccupations and blaming others for the situation. They’ve taken control of the situation and have a clear set of actions to inform the next step in the process. They have a structured way to collaborate through running experiments and holding short working group meetings.

For example, one Trust that had been trying for months to get a streaming service started, decided to try this approach. On the first afternoon they got together, they decided on a trial to send suitable patients to the urgent care centre. They tweaked the solution the next morning based on their observations, and launched their full process the next day.

In these situations, it’s vital that the leader supports the team to implement the agreed actions by giving visible support and removing obstructions. Without support, individuals won’t want to take a risk on trying something new or may be thwarted by something they can’t influence alone. The leader and their team need to be brave.

It may sound overly simple, but with these four questions, based on 2020 Delivery’s D5 improvement framework, and your support to help your team find the answers, you’ll have a more focused and constructive approach to problem-solving and feel more in control of your Trust’s performance.

Chris Bradley is a director at 2020 Delivery. 2020 Delivery helps public service organisations solve their biggest problems. We do so by identifying the behavioural and cultural issues holding leaders and teams back. We have a proven track-record in urgent care improvement.