Think at London Business School
Wednesday 24 March 2021
Esther Duflo and Abhijit Banerjee discuss potential ways forward, in conversation with LBS’s Elias Papaioannou
By Matt Munday
The disruption of the pandemic has made the NHS more receptive to lasting reform
NHS best practice developed in the pandemic must now be transmitted and implemented across the service
Looking ahead, modelling and data science, the basis of government response to the threat of COVID-19, has an important role to play in improving healthcare delivery.
Clinicians must understand how better management practice contributes to patient outcomes to further progress these reforms
The pandemic has forced the UK’s health service to adapt its resources, procedures and practices to an unprecedented degree.
Founded after World War II, the National Health Service has been a huge source of popular pride in the UK over the course of the pandemic, with supportive messages for doctors and nurses decorating front windows throughout the lockdown. But, like any large taxpayer funded bureaucracy, how it is paid for and organised is a constant source of debate.
For Sir Andrew Likierman, a Professor of Management Practice in Accounting at London Business School, and a former deputy chair of an NHS governing body, the NHS as it emerges from the COVID-19 crisis, is on the cusp of an opportunity to change for the better.
To seize this opportunity, Sir Andrew was joined by Nicos Savva, Professor of Management Science and Operations at London Business School, and Raffaella Sadun, Professor of Business Administration in the Strategy Unit at Harvard Business School, to take part in the Wheeler Institute’s UK webinar series.
Sir Andrew sees opportunities in the short-term, in measures developed in anticipation of a second wave of COVID-19, and in the longer-term, more fundamental organisational improvements.
“A deeper understanding of this data could play an important role in reintegrating non-COVID patients”
Using a framework, he has developed within the context of judgement, Sir Andrew’s focus in the NHS is on the question of experience. What do we know of the background that informs our decision making? And with additional reference to insights from current NHS managers, he has developed actionable takeaways for the NHS.
At a national level, he sees opportunities for closer collaboration between the health bodies that make up the service. Sir Andrew has seen traditionally separate organisations, that haven’t had contact with each other, that have developed ties and collaborate. These links must be maintained and developed, after the virus is long gone.
Another long-term opportunity is in the area of artificial intelligence (AI). Sir Andrew sees the pandemic as a “breakthrough moment” in terms of what is an acceptable and normal application of AI. Its broader acceptance within the NHS could allow hospitals to offer better value and more sophisticated offerings to patients.
In the shorter term, there are two areas which have seen positive developments at a national level, one is in the sharing and provision of beds and equipment. Here Sir Andrew sees it as crucial to capture and build upon the way resources were shared in the pandemic and extend that into the post-pandemic world.
Another area of opportunity is in staff conditions, where once again an organisational stretch has forced the development of novel ways of maintaining working environments for better productivity and clinical effectiveness.
At a devolved level, among the health services of the nations that make up the UK, Sir Andrew wants to see reinforcement of existing procedures for best practice to be communicated around the NHS. Good practice in individual units, in individual hospitals and individual regions, should be transmitted.
With nobody in the UK having experienced a pandemic before, there is now a danger a little experience will mean health managers could jump to the wrong conclusions about how a second wave will behave. Sir Andrew’s research into judgement has shown the dangers of inappropriate analogies. He hopes this occasion won’t be one of them, because the indications are that the second wave of COVID-19 will not behave like the first.
“There is a wider piece of cultural change around how management itself is perceived by clinicians”
In terms of what the NHS has still got to learn, Sir Andrew now wants to see the reintegration of non-COVID patients into the hospital service. Here he argues, the NHS has yet to make best use of data analysis and risk management tools.
Data Science expert, Nicos Savva, Professor of Management Science and Operations at London Business School, has been collaborating with Imperial College School of Medicine on its processes. He wants data analysis to be part of best practice across the NHS.
To get a handle on the pandemic recovery situation, his work simplifies a hospital into a network of patient flows. For example, the emergency care pathway starts at the emergency department, with say 400 patients arriving every day or one patient every four minutes. Most of these patients go home, but some of them are admitted either to an observation unit or an admission unit, and depending on their needs, they may even be admitted to wards for a longer recovery time.
It is a simplification of what a hospital is and what it means to be providing care, but a useful simplification because it allows us to use data science to optimise patient experience, efficiency and resilience of the hospital system. An example of this could be bed capacity allocation, or staff optimisation. It helps to answer questions like, how many beds do we need at different points in the hospital on this pathway? And how many staff, with which different specialisms at what time of day?
Professor Savva is hopeful a deeper understanding of this data could play an important role in reintegrating non-COVID patients, who have seen their treatment postponed in droves. A network workflow is just one of the first steps to quantify the impact of COVID-19 and to plan how to catch up as quickly as possible.
Raffaella Sadun, Professor of Business Administration in the Strategy Unit at Harvard Business School, agrees the pandemic has revealed ‘extraordinary abilities’ within the NHS, an organisation that has at times been seen to be bureaucratic and slow to change.
While she sees further areas for improvement in human resources and procurement, to add to Sir Andrew’s list, she also sees a wider piece of cultural change around how management itself is perceived by clinicians.
She hopes that the pandemic will help shift perception of management practice among clinicians, so that it is no longer seen as a career path that takes doctors and nurses away from frontline care, but an important tool that directly contributes to patient outcomes.