Interim Managers - the key to driving efficiency in the NHS
Jason Atkinson, Director, Russam GMS
In the private sector it is standard practice to hire an Interim Manager to address a specific business challenge, deliver a strategic project or help an organisation restructure or turnaround.
This was not always the case in the NHS, but times are changing fast. In recent years, the use of Interims in the NHS has risen significantly as Managers in NHS Trusts are understanding increasingly the value these experienced and seasoned Interims executives can deliver. They are now being brought in to help Trusts transform the way they operate, improve patient choice and services and to improve efficiencies at every level.
The 2005 British Social Attitudes survey revealed that 65% of patients said they wanted choice of treatment, 63% wanted a choice of hospital and 53% welcomed a choice of appointment time. The NHS has come a long way since then in its drive to provide greater choice and most tailored, customer-focused services.
One of ways it has achieved this is through the help of Interim Managers who have been parachuted into many NHS Trusts to undertake strategic change management or turnaround projects that have eradicated inefficiencies, improved processes and delivered millions of pounds worth of cost savings.
One of the main misconceptions that still exists however, is that Interims are too expensive. It is true, they are well paid. The latest industry snapshot figures from leading interim management provider, Russam GMS, published in January 2009, revealed that average daily pay for a manager in the NHS ranged between £684 and £603 a day last year and that experienced Interims working on large turnaround projects can command higher salaries.
But, firstly it is important to remember that they are hired to tackle strategic short-term projects which cannot be handled internally.
Interims are overqualified individuals with skills that do not exist within most organisations and they deliver results from day one. In the first five days they've got to define objectives, build relationships, become part of the 'furniture', justify their day rate, identify the quick wins.
Unlike recruiting permanent staff, there is no lengthy induction or grace period when the new employee settles in and no expensive overheads that would be associated with a permanent hire do not exist; all these factors should be weighed up.
Interims are also a more cost effective option than management consultants who can charge up to three times more and provide only strategy and not implementation. Interims on the other hand are do-ers as well as strategic thinkers, which is why they are increasingly popular in the public sector and being used in place of management consultants these days.
In the NHS, Interims are being used mainly to deliver efficiencies in many areas including the patient pathway which means speeding up the flow of patients through hospitals and GP Practices.
For example on project worked one of Russam GMS’ Interims was to implement a new IT system in an NHS Trust that automates patient appointments for GP Practices. The new system automatically calls patients before appointments and asks them if they are still attending their appointment the next day or would like to reschedule. The system has reduced the ‘no show’ rate at GP surgeries in the area and saved a great deal of money for the Trust.
Interims are also being used in hospitals to improve efficiencies and introduce smarter working practices which will eliminate inefficiency.
The kinds of projects include looking at if the movement of patients through the ward could be improved, the optimal resources needed to deliver the best patient services on the wards or whether wards and operating theatres are being efficiently used.
One such Interim is Ian Gray, a turnaround specialist with extensive hands on international experience of start-ups, regeneration, recovery, and turnaround projects. This former CEO of Tottenham Hotspur has a 19 year proven track record of working on turnaround assignments in the public and private sector including several successful turnarounds projects for NHS Trusts.
In 2006 to 2007 he worked on two major projects for Mayday University Hospitals NHS Trust in Croydon, South London and Epsom and St Helier University Hospitals NHS Trust to deliver process and cost improvements.
In both cases, Ian’s challenge was to eliminate inefficiencies and introduce smarter working processes and systems that would deliver significant cost efficiencies.
In 2006, Ian began work at Mayday to undertake a project which eliminated a predicted £9m deficit through effective financial and commercial evaluation of the organisation in just four and a half months. To do this, he first conducted a complete financial and commercial evaluation and then worked closely with the senior managers and clinical and non clinical staff to make changes that would improve working practices and save money, whilst ensuring that patients received the best standard of care.
One of the main areas of inefficiency was in the operating theatres.
There were 12 operating theatres in the Trust, but they were working at 66% efficiency. Ian was able to improve the efficiencies to 95% which meant that four theatres could be closed and the remaining 8 operated on a rotation system, which also allowed time for cleaning.
Another area of improvement was in the children’s surgery ward. When Ian arrived, the children's surgery took place every other week with many of the children remaining on the paediatric ward for a few days following surgery. The ward occupancy was at just 50% so after careful analysis, Ian recommended the surgery take place every week which meant reduced operating lists and improved occupancy of beds. Ian was able to close half the paediatric ward saving costs and resources.
A key part of the success of the turnaround project was to ensure that all NHS staff including managers, clinical staff and non clinical ‘bought into’ the new processes. Ian ensured that mentoring was available to them to help them deal with the changes.
One of his colleagues in the Finance department said. "Since Ian has been at Mayday there has been an overall willingness to change, staff are motivated and have a drive to take the Trust forward. Ian looks at the core basics within the organisation and engages the staff ensures the right processes and structures are in place to ensure long term sustained turnaround."
At Epsom St Heliers, Ian reduced the deficit by £6m in just five months and one of the key ways he achieved this was by take some of the inefficiencies out of the patient pathway – which meant that patients were staying in hospital longer than they needed.
Ian recommended a series of changes to processes improvements which eradicated these inefficiencies which meant that patients could go home earlier and 160 beds were closed generating significant cost savings.
Jon Sargeant, Director of Finance at Epsom St Helier Trust says, "Ian has helped the Trust to focus on its turnaround programme. During his time at Epsom St Helier Ian has worked at all levels of the organisation providing support and where necessary the discipline to release real cash releasing savings, whilst ensuring the organisation can still function. During Ian's five months at the Trust, nearly 20% of the bed capacity has been closed, with no change in activity levels and no increase in readmissions. His contribution has been much valued at a very difficult time and I would gladly work with Ian again." March 20, 2007
One of the keys to a successful turnaround assignment according to Ian is not to waste time, to do it quickly and deliver value for money. Ian says, "I don’t want to hang around. It less painful to identify problems and make changes quickly – my job is to see a problem, fix it and move on." And his is where the values of Interim Managers lie.
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