Einstein once said the definition of insanity is doing the same thing over and over and expecting a different result.

Few would disagree, yet this is a trap people fall into time and time again. When things fail, they try again, but rarely try differently.

Yet to have a remarkable impact within your market segment, you need to think beyond the features of your drug, device or appliance.

How to avoid the race to the bottom

Focus on cost-effectiveness and value for money within a pathway rather than simply the acquisition cost of the drug, device or appliance. That way, you avoid a race to the bottom to find the cheapest drug, device or appliance. Instead, focus on the pathway outcomes to deliver real cost-effectiveness and value for money.

By doing this, you position your pathway as offering a better overall solution, which is exactly what’s required. By understanding the cost of every step (and yes, I do mean every step in the pathway), you get the full picture of the actual cost of delivery.

It’s likely the more times a patient is seen within a pathway, the higher the costs. Conversely, the fewer times they’re seen, the lower the costs are likely to be. And when you cost every step, the drug, device or appliance makes up a tiny percentage of the overall cost within a pathway. The higher costs are usually associated with the people providing the service.  

How will your redesign offer value?

Can you offer?

  • Less waste
  • Quicker results
  • Fewer repeat diagnostics
  • Shared results
  • Care closer to home
  • Avoiding hospital referrals/admissions
  • Better patient outcomes

Could you expose:

  • Avoidable and unnecessary duplication
  • Waste
  • Unhelpful variation
  • Unnecessary steps

Process map how your pathway works

Process-mapping will enable you to create a visual picture of how the pathway currently works. It will also help if you involve a range of people from across the pathway. Everyone can discuss the actual steps taken through the journey/pathway, which is where patient input becomes invaluable as they walk every step. Those different perspectives allow you to consider what works well or less well from a service and patient perspective.

From there, it becomes about rethinking the current delivery models, as this is the only way to deliver a redesign. As Einstein highlights, if you keep doing what you have always done, you will keep getting what you have always got!

Remember, capacity in NHS primary and secondary care is finite

Lastly, keep in mind that capacity in primary and secondary care is finite. You can calculate what that capacity looks like by basing a clinical session at 3 hours and 30 minutes and calculating how many patients can be seen in 10, 15, 20 or 30-minute appointments.  Or the appropriate number of minutes based upon the pathway you are reviewing. Does your new pathway positively impact the workload and the workforce; does it create any new capacity here?

By way of example, we have used subcontracting work between providers as a route to increasing capacity. This has proved to be a dynamic route between hospitals and General Practice, mainly when hospital waits are long and General Practice can safely deliver the work.

While it sounds counter-intuitive that bringing in more work creates capacity, we can evidence pathways where the hospital wait was 4, 5 or 6 months and sometimes more. In those circumstances, symptomatic patients will be in and out of General Practice on numerous occasions while they await their hospital appointment, test, or results. By moving the work to General Practice, paying them properly for the service they provide and reducing the wait to a matter of days, you will create significant capacity within the Practices and the hospital while having a positive impact on workload and workforce.

With the development of Primary Care Networks, GP federations and super practices, this is a route we are working on with more and more and will be for a long time to come. Indeed, we are now seeing fully integrated services with hospital teams working alongside the GPs, where the hospitals are delivering the first outpatient appointment and the GPs the follow-up work.

Stop and think about how you can apply this approach to your work and deliver that more sophisticated solution.

If you have any questions, please do not hesitate to connect with me on LinkedIn and I will respond as soon as possible. I’ve been working as an NHS management consultant for 15 years, but I’ve also worked in sales for a Pharmaceutical before that, so I can offer you insights from both sides.

Scott McKenzie helps pharmaceutical, medical technology and device firms increase revenue by getting their products and services in front of the right NHS decision makers. If you want to get your products fully embedded into treatment pathways, we can help you. We’ve doubled revenue for our clients and can share these processes with you too. Download your free guide: here

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