So what are the key factors to ensure the success of this partnership? Dr. Burgess and his colleagues identified two interconnected components of the partnership: a protected relational space and an informal behavioral contract known as a “compact.” Many factors were taken into account in the elaboration of the Pact, which all constitute the guidelines for further cooperation. Then, if a group does not meet the conditions of the pact, an open discussion takes place at the monthly meeting of the TGB to understand the violation and consider what all members of the cooperation could do differently to improve progress towards their common vision. This pact (agreement), developed by Drs in Training and Healthcare Leaders, has been approved by the BMA for use by health authorities to outline the expectations of both parties and promote common understanding and the development of a fair and mutually supportive training and employment environment. An important behavioral aspect of the pact was the agreement of open and transparent communication with the associated responsibilities, including listening and giving and receiving constructive criticism with good intentions (or the assumption of good intentions on the part of the employee making the criticism). Another behavioral factor that was taken into account in the Compact was the focus on continuous quality improvement from the patient`s perspective. Related responsibilities for improving the NHS included maintaining the positive atmosphere of collaboration and empathy for the issues service providers face when promoting localised versions of the Virginia Mason production system, even when both parties are under external pressure to demonstrate immediate change. Pact A is an informal and non-binding agreement between the groups involved in the partnership that resembles an explicit (mutually agreed) psychological contract. This could be seen as a first step towards building relational authority, as representatives must work together to agree on the terms of the pact. It took NHS partnership members almost 12 months to negotiate the expected behaviours and responsibilities outlined in the pact. Since 2018, Dr. Nicola Burgess and colleagues at Warwick Business School gave a comprehensive assessment of the partnership between NHS hospitals and the Virginia Mason Institute.
The team is expected to produce a full report in 2021, but their observations so far have yielded positive results. An unexpected but promising result illustrates a shift in the relationship between senior NHS England/NHS Improvement members and the CEOs of each of the five NHS hospitals. This change can be attributed to the partnership with the Virginia Mason Institute and a commitment to the implementation of the Virginia Mason production system. As part of its professional responsibilities, NHS Lothian expects all doctors in training to do so: NHS Lothian expects the doctor in training and NHS Lothian to do it together: In 2015, five English NHS hospitals were selected to partner with the Virginia Mason Institute and implement localised versions of the Virginia Mason Production System. The goal of the partnership is for each of the hospitals to develop localized versions of the production system and foster a sustainable culture of continuous improvement in their organizations. A protected relational space refers to a safe and supportive atmosphere. where employees should feel free to discuss both their successes and failures without judgment. What do you think is the biggest obstacle to implementing relational authority in the NHS? Burgess, N., Currie, G., Crump, B., Richmond, J., and Johnson, M.
(2019). Improving together: Cooperation must start with regulators. BMJ 367:l6392. doi.org/10.1136/bmj.l6392 A protected relationship space A protected relationship space refers to an atmosphere of safety and support rather than a specific place where employees should feel free to discuss their successes and failures without judgment. It should also be a space where processes that would challenge current institutional practice can be discussed. Dr Nicola Burgess and colleagues at Warwick Business School (University of Warwick) analysed the progress of a partnership between the English NHS and the Virginia Mason Institute (Seattle, USA). The aim of this partnership was to transfer lessons learned from an adaptation of the Toyota production system (also known as Lean) by Virginia Mason Medical Center – a Seattle hospital – to five English hospitals in order to promote a sustainable culture of continuous improvement. This regular meeting created a spirit of partnership between senior members of NHS England/NHS Improvement, the Virginia Mason Institute and the five CEOs. The meeting requires each CEO to present their progress in implementing their localized production systems, the results of the improvement work, and reflections on the challenges that have arisen. While the governance and accountability meeting is clearly structured, discussions between the CEO peer group and the senior members of NHS England/NHS Improvement are open and fluid.
The monthly meeting bears the mark of a learning network in which new knowledge is created together and all members learn together. A promising start During the evaluation, Dr. Burgess and her colleagues noticed a significant shift in inter-organizational relationships as a result of this partnership. One particular aspect of the implementation of the Virginia Mason production system proved particularly beneficial: the monthly meeting of a Processing Guidance Board (TGB). This collaboration was underpinned by a “spirit of partnership” that continued to benefit from a significant investment in resources; in particular, a significant investment of time on the part of senior NHS leaders, which has helped to develop relational authority. The challenge for the NHS and any health system is how we take the time to regularly bring healthcare leaders together to create a protected relational space for inter-organisational learning. The agreement highlights a number of commitments from both parties that will allow them to work together and advance the delivery of high-quality treatments and services to patients in specialized services. Although we are part of the clinical departments of NHS Lothian, we strive to provide you with an excellent working and learning environment.
Specifically, high-quality postgraduate medical education requires coordinated time and effort on the part of trainers, health managers and physicians in training. NHS Lothian is the employer of all doctors in training who are placed on our board alongside career staff in the role of clinical trainer. NHS Education for Scotland is the organisation responsible for monitoring progress through training. Dr Burgess and colleagues suggest that this relational regulatory approach could and should be extended to the wider NHS system. Improving the NHS Dr Burgess and colleagues suggest that this relational regulatory approach could and should be extended to the entire NHS system. The positive attitudes of the parties involved in the partnership and the transition to open and honest discussion and learning between groups suggest that this could be a valuable approach to moving the NHS forward in terms of quality improvement if regulators and service providers can adapt processes to put patients first and develop trustworthy and respectful inter-organisational relationships. The monthly face-to-face meeting of the Transformation Steering Committee provides an example of a protected relational space. The monthly meeting lasted about six hours and did not include phones, laptops, or other management distractions. Contrary to what one might expect, several representatives described these meetings as “the best day of the month”.
The CEOs of the five NHS hospitals rarely missed a meeting. Dr. Burgess and his colleagues attribute this attitude to the friendly and informal atmosphere that characterizes these meetings and allows for an open discussion about all the problems faced by employees. Over time, the relationship between the regulator and the service provider has shifted from a relationship characterized by positional power, where one party exercises power over the other, to a more informal relationship, meaning that both parties saw each other as equal partners working towards a common goal. This relational authority fostered honest discussions and established trusting relationships among the high-level members of the partnership. Lean is implemented as a production system and requires the participation of all in the pursuit of continuous improvement by eliminating activities and processes that do not add value from the customer`s point of view. These non-value-added activities are collectively referred to as “waste”. Applied to healthcare, the goal of a production system is to continuously eliminate waste so that the quality and timeliness of healthcare is continuously improved, which benefits both the patient and the payer, as fewer resources are devoted to activities that do not add value to the patient. Healthcare regulators are currently at the top of the NHS hierarchy, issuing orders to service providers (NHS trusts, hospitals) among them in hierarchical order. However, this top-down regulation may cause providers to focus on implementing new processes or achieving goals rather than whether the new prescription is useful to customers (usually patients). Since the merger of NHS England and NHS Improvement in 2019, there has been a debate about how this major new regulator can best foster a culture of continuous improvement across the healthcare system.
The Virginia Mason Production System The Virginia Mason Production System (VMPS) is a translation of toyota`s production system, widely known as Lean. Toyota`s production system evolved from the late 1940s to compete with American automakers like Ford, which had invested heavily in automation to achieve economies of scale through mass production. .