What managers really, really want…

[A personal view from a top manager on the research which would make a difference]

At this week’s SDO/HSRN conference, there was a stimulating lunchtime session with Simon Pleydell, Chief Executive of South Tees NHS Foundation Trust.    He outlined to researchers the challenges for managers of meeting 5-10% reductions in real terms against increasing demands.  This meant a saving for his trust of £22million in the next year.  Simon Pleydell emphasised that this was the driving preoccupation of all leaders of health organisations today.  At the same time, there was great volatility at the top - an average length of time for a Chief Executive in post of 18 months.   How could research help managers to make difficult decisions at a time of contraction and flux?

He outlined his own wishlist of four key areas where evidence could help (I have indicated some relevant studies against each from the SDO portfolio):

1)     What workforce and skills are needed to deliver high quality and safe care? 

Key issues concerned nursing grade mix, substitution and roles.  For South Tees trust, 68% of costs were on workforce (and 80% of these were in frontline roles) and so the right people for the right care was crucial.  For instance, what is the right mix of band 4s on the wards?

[A recent SDO network digest on evidence relating to support workforce
http://www.nhsconfed.org/Publications/digests/Pages/SDO-Digest-1.aspx and some SDO-funded studies on workforce http://www.sdo.nihr.ac.uk/projlisting.php?srtid=4]

2)      Integration and moving services out of the community

There is policy push for moving services out of hospital, but evidence to date suggests that costs are higher although with positive ratings for quality and acceptability to patients.   More studies may be helpful on those aspects of care which could be transferred without compromising on costs and productivity or other ways of modernising services.

Key SDO-funded Roland study http://www.sdo.nihr.ac.uk/projdetails.php?ref=08-1518-082

3)      Care of elderly with multi-functional problems and dementia

At his hospital, over half of inpatients had some form of confusion.  This had a huge impact on services, how delivered, medication safety, workforce training and day to day practice on the wards.  What research could help with this?

Number of SDO studies on older people http://www.sdo.nihr.ac.uk/projlisting.php?srtid=17 and current call for new dementia research projects

4)      Introduction of new technologies

Every week, clinicians were introducing exciting new technologies.  At his trust, this included da Vinci robots for minimally invasive surgery.  How were these new technologies embedded in the service?  What were the mechanisms for judging their cost-effectiveness [note, NICE interventional procedures http://guidance.nice.org.uk/IP would assess some] and how was this evidence dispersed to managers?  What was the wider impact of new technologies on the hospital - for instance of image-guided surgery on workforce, surgical practice, throughput and theatre use?

Live SDO technology adoption projects http://www.sdo.nihr.ac.uk/projlisting.php?srtid=18

In all this, he stressed he couldn’t wait four years for the answers.

After discussion and encouragement of greater exchange between researchers and managers, I asked him for the pieces of health services research which had made a difference to him.   He mentioned a few areas which reflected his personal interests.  These included moving care to the community; safety and human factors (including work from the IHI on improvement science and observational studies on how errors happen); and work on leadership and workforce, such as Michael West and Beverley Alimo-Metcalfe. 

The challenge though was to get managers to read outside their personal areas of interest and lead them to evidence which might help them face today’s demands and the unknown challenges of tomorrow.