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Dr Simon Brooks, Morgan Academy, Swansea University

14 August 2020, 8:10 UTC Share

Resilience, agility and value-based health care

There could hardly be a more apposite time to be talking about resilience.

The Covid-19 pandemic has brought to the fore the need for individual resilience, societal resilience and organisational resilience. At the same time, the word ‘together’ is appearing everywhere, on signage and stickers, telling us we are “all in this together” and suchlike. This implicit linking of resilience with togetherness leads me to reflect that nowhere is the need for these two attributes more evident than in the provision of healthcare.

I am part of a team of academics and practitioners who are examining the importance of ‘togetherness’ in the form of collaboration between the life science industry and the public sector in the delivery of healthcare. We have tried to understand the conditions that need to be in place for successful collaboration, as well as beginning to investigate how this process might be best managed.

The idea of public and private sector partnerships is obviously nothing new, but the key focus of our work is placing the recipient of care at the heart of the ‘value’ equation. Anyone who has studied management will be familiar with the centrality of value in strategy. In the 1980s, Michael Porter of Harvard Business School drew attention to the importance of adding value to the consumers of your goods and services, as well as extracting value in the form of profit for your company. He later developed the idea of ‘creating shared value’ between the private sector and society, as well as focusing specifically on healthcare provision to introduce the idea of ‘Value-Based Healthcare’.

So, if collaboration is to work to increase the resilience of healthcare delivery, and maximise value for patients, we need to address two over-arching questions. Firstly, what foundations need to be in place, and secondly, under what shared principles should the collaboration be managed?

An in-depth examination of Value-Based Healthcare research shows that five inter-linked guiding conditions should be present.

Firstly, the collaboration should be truly multi-disciplinary, where the knowledge and value that all stakeholders can offer is brought to bear.

Secondly, a robust technological infrastructure to gather, store, and share information is key.

Thirdly, measure the right things that contribute to value; patient reported outcomes alongside the cost of care.

Fourth, we need to understand the full cycle of care to get a holistic (rather than fragmented) picture.

Finally, innovative financial models that incentivise the centrality of patient value for all stakeholders are needed.

To approach the answer to our second question we considered what is at the root of resilience and concluded that adaptability is key. However, adapting cannot simply mean ‘blowing with the wind’ as it were, so what is needed is a form of what INSEAD academic Yves Doz calls ‘strategic agility’. This is broadly defined as maintaining an overall mission, or strategic direction, while at the same time remaining sufficiently ‘fleet of foot’ to respond to unexpected changes.

For collaboration to be sustainable and resilient, it needs to be organised around three principles that underpin strategic agility.

Firstly, all collaborators should remain strategically sensitive and alert to changing circumstances and develop communication channels to make sense of these changes.

Secondly, collective commitment to action is needed, avoiding political and selfish ‘win-lose’ calculations among collaborators that risk delaying decisions.

Finally, resource fluidity is essential, not only financial but staff deployment, sharing knowledge and reconfiguring infrastructure is implied here.

Our forthcoming paper (Rees et al, 2020) in ‘Transforming Government, People, Policy and Process’ sets out these ideas in more detail, but our main message to policymakers and those charged with implementation is that value to the patient is central. To achieve this focus, however, requires the establishment of and management of effective collaboration, based on a number of underpinning conditions.

Fundamentally though, as Covid-19 has shown us, the implementation and maintenance of this collaboration will depend on adaptability to ensure long-term resilience.

Dr Simon B. Brooks is Associate Professor at Morgan Academy in the Swansea School of Management.

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