The Junior Doctors Dispute

The critical balance of delivering essential transformational change whilst maintaining patient safety

The ongoing row

In November 2015, the British Medical Association balloted over 37,700 members on industrial action in response to the government’s proposed new contract for its workforce. With over 76% taking part in the poll, some 98% voted in favour of a full strike.

Since then, the protracted row over contract reform for Junior Doctors has rarely left the headlines and, whilst both the Government and the medics remain in discussion with the support of the conciliation service, Acas, the parties have yet to be able to reach a deal. With one strike already taking place in early January, we face the prospect of further action this week (10th February). 

The row raises important questions for policymakers: in an environment of unrivalled pressure and scrutiny where patient safety is paramount, how can significant structural and operating model change be delivered without compromising the best possible outcomes for patients? What are the key learnings to be taken for those seeking to deliver effective healthcare change programmes? 

Five positive change enablers for healthcare

The healthcare sector is little different from any other sector (be it financial services, telecoms or transport) when it comes to what is required to deliver successful change. Where it contrasts with other sectors is in the consequences of failed change; lives can be directly impacted. To successfully deliver transformation, healthcare organisations should look to focus on five enablers to deliver positive change and achieve improved patient outcomes: 

  1. A clear articulation of the future state: organisations must have clear objectives that help to paint a picture of where transformational change will take them.
  2. A strong and compelling business case: the benefits, both financial and otherwise, should be well defined, with a clear understanding of the information required to be able to monitor the realisation of the proposed benefits. This must also argue why the status quo is not acceptable.
  3. Two-way communication: leaders must be able to not only communicate why change is required, but also listen to views of their staff. A workforce that understands why change is happening, and feel they can shape how it is delivered, is more likely to be supportive of its success. 
  4. Align people, processes and technology: together, these can deliver benefits in full. It is well understood that the combination of these elements is required for successful delivery – however, it takes a strong focus on delivery and execution, underpinned by education and training. 
  5. Strong governance underpins all transformation: this ensures programmes can be delivered to the necessary quality, budget, and timeframe, whilst ensuring early identification of potential challenges and enabling the appropriate deployment of resources.  

Lives depend on successful change

In healthcare, perhaps more than in any other sector, it is essential that change is delivered safely and effectively. Policymakers would be wise to take the transformation of London’s Stroke Service as an example of successful healthcare change. Here, a defined national strategy, with a clinically-led coalition, underpinned by a clear benefits case built the rationale for change, and successfully delivered improved patient outcomes.

Back to the Junior Doctors contract row: perhaps a clearer articulation of the desired future state, centred on improved patient quality of care and outcomes would assist with the pain of this transformation? Perhaps greater involvement from the BMA themselves in the design of the future contract would mean more buy-in to the changes? Perhaps a clearer case for change and business case would help gather greater support?

Against such a challenging and emotive context, it’s difficult to know if these enablers would be enough to solve this row. Currently, trust has broken down between both sides, and there appears no immediate resolution in sight. 

What this row demonstrates is the challenge of getting healthcare transformation right

What this row demonstrates is the challenge of getting healthcare transformation right. With the need to communicate with multiple stakeholders with diverse views, a clear vision is not always straightforward to articulate in a way that meets the needs of all. In addition, with benefits that are not clearly quantifiable from the outset, embarking on transformational change where the case for change is (right or wrong) open to challenge is no easy task. Whilst not guaranteeing success, by putting in place the five key enablers as a strong technical foundation, the more complex challenge of winning hearts and minds can become the focus. 

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Alex Goodman Manager