insights

The NHS doesn’t have a strategy deficit. It has an execution problem Spencer Humphrys, Founder, Nexus Consulting If culture hasn't eaten your strategy for breakfast already, the general NHS approach to execution is about to kill it. Let's start with the obvious. Walk into almost any NHS organisation right now, and you’ll find a 10 Year Plan response, a Medium Term Planning Framework submission, a clinical strategy, and a handful of improvement programmes. Probably all running simultaneously....

In my last blog on Maximising SDEC (same day emergency care; you can read it here), I talked about how getting the right patients into SDEC, even if that means SDEC isn't 'full', can have a far more positive impact on flow than just sending everyone that 'could' go. Hopefully, my message was clear: SDEC works best when it treats the right patients. And when SDEC works well, flow improves, cost reduces, and quality gets better I got a few comments and direct messages on the importance of the...

Same Day Emergency Care (SDEC) has been around for years under various names. I remember setting up the service with one of the best doctors I've ever met back in Basildon Hospital in 2015. Hagen isn't with us anymore, but I know I'm not the only person who is still influenced by his passion, his over-caffeinated excitement, and, most importantly, his absolute focus on patients and on making sure SDEC (or Ambulatory Care, as it was back then) was as efficient and effective as possible. When...

By Spencer Humphrys. Founder of Nexus Consulting Most people don't have an effort problem. They have a focus problem. Too many initiatives. Too many “priorities”. Too many things on the to-do list. Too many metrics that don't actually mean anything. I don't think I've ever visited any organisation and said, "You really need to do more work. Oh, and your action plans should be twice as long". What is consistent is that I always tell people to do less, just do what actually matters. In...

If you’re trying to improve performance, productivity, or patient flow, you’ll hear the same phrase over and over: “We need to fix the process.” But most organisations don’t actually have a process. They have a collection of habits, workarounds, and heroic efforts that somehow get the job done — until it doesn’t. The proper name is Business Process Modelling (BPM), which makes it sound more formal and difficult than it actually is. BPM just helps to turn “how we think it works” into “how it...

Good problem-solving skills are the key to leading and delivering safer, faster, and better care. In healthcare, there is always a lot of discussion and focus on 'best practice' processes. Spreading best practices has undoubtedly improved care; just look at the improvements in stroke outcomes and the reduction in central line infections. However, in other areas, it has made things worse. The pressure to deliver change at pace often leads people to seek easy wins, which usually involves trying...

In-hospital flow is returning to the priority list as health systems prepare for this Winter in earnest. We've worked in more than 80 hospitals and health systems in England, probably more if we thought about it longer. There are similarities in all the places we've been to, good and bad, in mental health, community hospitals, acutes, care at home, and so on. One universal goal is always to increase patient throughput. Clinical and operational teams want shorter lengths of stay, earlier...

In acute healthcare, every minute matters. It matters for clinical staff who need more time to deliver the care they want. It matters for patients, with every minute waited an extra minute in pain or an extra minute uncertain about the future. And it matters for health systems, with every minute waited unnecessarily increasing cost, reducing performance and adding no value. In A&E, time is more critical than in most other places in a health system. Wasted time increases queues, and longer...

Delivering health services is tough. Having worked in the NHS for over 14 years, I still struggle to explain how complex it is and how difficult simple things are (like finding a computer that works or, almost impossible, a printer that's connected to a computer). There are many approaches to supporting and driving improvement. I think one of the most valuable is simple process mapping, as long as it's clinically led with full input from staff. If you've never heard of it, it's just creating...

Navigating the messy reality of change in Health and Social Care….. Studies show only 1 in 3 organisational change efforts are a clear success, dropping to around 20% in healthcare. So, why so difficult? Implementing change in health and care is like wrestling an octopus. We're dealing with entrenched processes, complex organisational systems, some questionable IT answers multiple stakeholders - there’s a lot to manage. Just looking at the stakeholders - clinicians, clerical staff, patients,...

At Nexus Consulting, we've had a front-row seat to the challenges and triumphs of healthcare transformation across the NHS and Social Care. Working as clinicians and managers in acute provider organisations and as management consultants, we've seen firsthand why driving meaningful change is so complex and critical. The Stats Don't Lie The harsh reality is that despite being a world-class healthcare system, the NHS struggles to meet demands. A 2019 study in the BMJ estimates that yearly NHS...

Lean can be a 'don't mention it' topic. If I had a pound for every time someone said to me, 'Lean doesn't work in health and social care,' I'd have enough money to park in an NHS car park for a year. Well, maybe six months, the pounds don't stretch as far as they used to. There are several misconceptions about Lean in the healthcare sector. Many people I've spoken with over the years see Lean as a complex concept beyond their comprehension, as a set of rigid techniques and foreign terms, or...