Podcast | Leeds Teaching Hospital – Using CI to solve a budget crisis

Better Never Stops |

Leeds NHS Trust

Chris: Thank you for joining us for Better Never Stops, our podcast for healthcare leaders and everyone committed to transforming healthcare. We interview leaders from our clients and partners around the world, as well as leaders right here in Seattle who work to maintain a culture of continuous improvement at Virginia Mason Franciscan Health.

In each episode, we hope to explore a philosophy of go see, ask why, and show respect. My name is Chris Backous and I’m an executive partner for transformation services at Virginia Mason Institute. I’ll be your host for this episode of Better Never Stops. Today, we’re talking about the truly incredible story of how one hospital trust figured out how to save 16 million pounds, that’s 20 million U.S. dollars, in the space of two weeks. That’s right, 20 million dollars in two weeks! They managed to turn a worst case scenario into a best case opportunity. So how did they do it? Well, spoiler alert, Leeds Teaching Hospital Trust uses a model rooted in the Virginia Mason Production System, and they call it the Leeds Improvement Method.

I’ve been lucky enough to be the executive partner for Leeds over the past two years, and I am so excited to really dig in and talk about our work together. We have three wonderful guests with us today who are going to tell us all about it. I want to start by introducing Wendy Korthuis-Smith, who is our executive Thanks so much for joining us today, Wendy. 

Wendy: Thanks, Chris. So for those who I haven’t met yet, listening to the podcast, I’m the executive director of Virginia Mason Institute, and our vision is to partner with leaders and organizations across the globe to transform healthcare.

So our partnership with Leeds began in 2015 during a five year engagement with the National Health Services of England and five trusts that were selected from across the country from a pool of 62 applicant trusts. And the objective of this partnership was really to develop these localized versions of our transformation approach to improve quality and safety and foster a culture of continuous improvement capability within each trust, as well as deliver lessons learned and how NHS can effectively build this capability around quality continuous improvement across the wider healthcare system. So it’s important to note that this work included third party research by Nicola Burgess and her team at the Warwick Business School, and this culminated in a report in the fall of 2022 titled Leading Change Across the Healthcare System. It really highlighted the lessons learned during this five year journey. 

So as one of the five trusts, it was during this journey that Leeds became our partner in the development of their own improvement system, leveraging the lessons learned of Virginia Mason Production System. And we continue to partner with Leeds in continuing their journey towards higher quality, better safety, team member satisfaction, engagement, and all while reducing waste and kind of those non valued activities, thereby lowering costs. So we’re really impressed with their journey thus far, um, as well as this recent work, which we’re going to talk more about today.

And personally, I’m really excited to hear this conversation. It so aligns with the vision of Share and Spread and that opportunity to offer insights and learning across the wider NHS.

Chris: Thanks so much, Wendy. It’s great having you on with us. I’d like to introduce our next guest, Phil Wood, the Chief Executive at Leeds Teaching Hospital NHS Trust. Phil, thanks so much for joining us today.

Phil: Thank you Chris, it’s great to be on the podcast.

Chris: So glad you’re here. So we know we’re going to be digging into the story of the exceptional financial turnaround just earlier this year. But first, can you set the stage for us? I understand that this all began when you reviewed your financial status somewhere around April 2024. Can you tell us a little bit more about what happened?

Phil: Sure. So maybe a little bit of background first off. We’re a large hospital trust in the NHS. We employ around 22,000 staff across five hospital locations in the north of England. We have, for a decade now, had something that we call the Leeds Way, which is a values-driven culture of collaboration and empowerment. And so, as Wendy described, when we engaged to become part of the Virginia Mason program, we were really attracted to the method by the fact that it chimed so strongly with our culture of frontline empowerment. We’ve developed, the learning from Virginia Mason to have our single management system called the Leeds Improvement Method that we use to mobilize our staff in pursuit of daily excellence.

We have worked this year on a number of commitments across the organization. And of course, as well as really ensuring we’re focusing on high quality care, we commit to delivering our financial plan. And like all organizations, we have a lot of staff who are employed full time here. And then because of shortfalls or rotor challenges or sickness or whatever, we will use a kind of variable pay control, to plug gaps in rotors to ensure staffing is safe for patients.

And although we ended the last financial year in a breakeven position, we found that after month one of this financial year that variable pay spend and indeed our overall budgetary position was significantly off target, to the tune of 8 million pounds, which over a 12 month period would quickly rack up into a significant shortfall. And over the last six or seven years, we’ve had a really good financial performance and we were very quickly aware that we were at risk of a rapid deterioration unless we acted.

Chris: That’s so great, that initial awareness, that the time to act is now. And so Phil and Wendy, I think your vantage point on this high level, understanding the value and importance of Production System improvement systems being deployed in the organization. From that point of view, I think I’d love to get the two of you talking about this. So, Wendy, do you want to start us off?

Wendy: Sure, I would actually love to hear a little bit more from Phil in terms of this example, because it’s really bold, I think, in how you took such a large scope of work and thought about the improvement system. And in some cases people have the improvement system, but when something like a crisis hits, they kind of default and go back to kind of the command and control methodologies and approaches.

And so how did you stay bold and think about using this for this particular problem that cut across such big areas of Leeds?

Phil: Sure. So I think there are a couple of things you said earlier on Wendy to remind our listeners that we started our journey in 2015. So that’s nearly a decade ago. And of course, a journey of engagement and continuous improvement in an organization of our size is clearly going to take – and of course, we’ve had the pandemic for three years in the middle of that nine year period – but you touched on the issue that I discussed with my exec team, which is that we had a big problem, which needed fast action. Did we approach that in a traditional command and control way, or did we actually test ourselves to say how well embedded is the Leeds Improvement Method in our organization? 

How confident are our staff in using it and can go ahead, uh, to use it to solve the problem? And felt that the time was right to actually test out our confidence and resilience in the use of the improvement methodology by challenging ourselves to stand up a process improvement event across the whole organization to really engage the organization in the urgency for change. But also to test out how successful we have been over those nine years in getting our staff to be confident in the methodology.

Wendy: I love that. I mean, just how you’re describing, Phil, the testing out. I think offers that welcome, like, we don’t know exactly how this is going to shape up, but we’re going to test it and see and learn from it. And that’s pretty impressive. When you describe that, you think about the urgency for change, did you have any resistors? Was everybody on board, ready to go? Totally believed it was appropriate to jump in and do this work?

Phil: I think that people recognized the urgency for change. I think that one of the ways we got into the conversation with our wider clinical leadership community was to talk about one of our values, which is accountability. So our teams had gone into this financial year with a commitment to financial stability and they had a financial plan. And the way I approached it was to have that wide introductory meeting to say, let’s hold the mirror up to ourselves and ask ourselves where that accountability value has been for all of us. So I think the urgency and need for change was well recognized. I think it would be fair to say that there were a lot of nervous leaders using the Leeds Improvement Method as the approach as opposed to the traditional prescriptive way of tackling, particularly, a financial challenge.

Chris: So that’s a great initial start in understanding kind of the big problem. And I think what you’re demonstrating for us, Phil, is that real core value understanding your improvement system at the level of “we need to trust the process.” Going in with that curiosity, and so we kind of have an understanding now of the setting that brought us to this opportunity and saw the value of there’s got to be something within the Leeds Improvement System to guide us there. And I think that’s the beauty of recognizing organizational challenges and turning to the improvement method where we empower the people who do the work to improve the work. So I think it’s now time to shift our focus and talk a little bit about what do we actually do with the method. So now that we know that there’s something about the method, how do we use it?

So I’d like to bring in our third guest, Jimmy Parvin. Jimmy’s the improvement lead for the Leeds Improvement System at the Trust. Jimmy, thanks for joining us today as well.

Jimmy: Thanks, Chris. Really good to be part of the conversation.

Chris: Yeah, it’s been great working with you as we’ve had that work to deepen the adoption and adaptation of the improvement system across the organization. So, Jimmy, if you could take us through the process, talk about how you figured out pulling this all together, that would be great. So can you give us a description of what you did?

Jimmy: Yeah, thanks, Chris. So this was pretty ambitious as Phil outlined earlier. So we had a, essentially an all hands meeting, about 10 days ahead of the event, where Phil and the executive team framed the challenge. And we took that away and normally myself and the team, and this was a very wide effort. I should emphasize not just the normal improvement team.

We do six to eight weeks to plan an event of a much smaller scale, let alone something of this scale. So that gives you a sense of the pace at which we were trying to deliver it. We set up a structure, where we had tiered daily huddles. So there was check in points for each of our 19 clinical service units every morning, and they were supported by an improvement team and we had five improvement teams.

There was colleagues from HR, from finance, from corporate services, as well as improvement specialists in those teams to really try and help ask the right questions and offer that support to the clinical service units who were doing the work of thinking about this problem and how they were going to test some ideas to make a difference. So, with that work set up, our debrief at the end of each working day was hosted by Phil and the executive team. And that was filtered through the ideas that had come, and where each team was against their metrics for that.

So, overall, that involved over 800 staff being directly involved and there’ll be more who are indirectly involved across our 19 clinical service units, and that’s people at all levels of the organization, all layers, different professional groups, clinical, non clinical. 

Chris: Phil told us a little bit about the high pressure moment you were in. I bet you were feeling a little pressure too, because this is new territory for the improvement method. But you knew the Leeds Improvement Method was there and ready to use. Were you hopeful that this could work? And what kind of expectations did you have going into the process?

Jimmy: I think as Phil said, there was probably that moment where you’re like, “are we really going to try and do this?” And then the realization that it really was the only way we could try and do it. If we wanted to really hold true to our method, that as you’ve heard, we’ve grown and evolved over the years to work for us over the last 10 years or so. So there was certainly something around the pace at which we were trying to do this. As we’ve discussed, Phil and the exec team set us an ambitious target of being ready in 10 days or fewer, as I recall, to deliver this organization wide.

But as you also mentioned, we had a really strong platform to do that, and we needed just to be adapting what we knew to a scale that we weren’t familiar with, as opposed to having to design something from scratch. So I think once that realization came to perhaps myself and the team, that initial apprehension was more into, okay, well, this is a really good opportunity to explore how we can use our method at this scale. And we’ve never been so bold before.

Chris: Well, and I think that when you know the method and you continue to learn from the method, you trust enough to say “there has to be something here. I’m sure we can.” We just need to figure it out together. And I think that’s the beauty of the methodology. It’s not so rote that things either fit or not fit.

But it’s if we understand it enough the way we have used it, how might we use it differently going forward to address a situation we may find ourselves in for the first time?

So you talked about 10 days. That’s a very short time to ramp up improvement, and this seemed to be a large organization effort. So what was some of the work that you actually got in motion to assure success for the activity itself?

Jimmy: Yeah. Thanks, Chris. So first thing to say is this is a real team effort. So this is not me as an individual doing this. There’s a lot of people putting a lot of time and effort in behind the scenes to do this. So we created improvement teams. So we’ve got 19 clinical service units that deliver care across our organization.

We knew that we needed to put a framework in place so that this event had a fighting chance of delivering on our expectation. So we had improvement teams and they supported about three of our service units each and comprised of experience from improvement, from human resources, from finance. From corporate leaders and clinical leaders as well.

So those teams brought this rich expertise that was then available to the service unit teams and their management structure throughout the week. So that was the first thing we had. We had some data, as you’d appreciate, really important to have some data there. So some really hard work done, from colleagues to make sure that we had some baseline data.

We didn’t have everything we would have needed at the time, and I think that’s an important point because we went with what we had, because, as you can appreciate, you can probably gather data for months and months on something this big. But then you’ve lost your opportunity. So we had to take a judgment call of, have we got enough, and offer what we had and appreciate that it was perhaps imperfect, but it helped us to move forward.

So there was the data piece that was shared widely. And then the structure, I guess, around the event. So we call it a whole organization focused improvement event. So Phil and exec colleagues dedicated their time at the close of business on each day of the week. And we had structured huddles on a tiered basis through our service unit team so that they had a chance to speak to their people and explore the opportunities.

 And then that fed forward the improvement teams. And then that was collected, if you like, at the end of each day as a sort of situation where are we at? So that we had that real tracking through the week. Um, it was a bit rusty day one. It was certainly imperfect, but that’s what this is about, isn’t it? As we’ve said, this is about, we’ll have a go.

And certainly by the Thursday of that week, we had it refined down and people were a lot more confident with what they were sharing.

Chris: It’s that kind of courage to start and begin to pull the string and just see where it takes you, having that confidence of the management system and knowing what’s available to you, um, you know, so having that previous experience of having structure, having approach, having a process you can trust that gives you that flexibility to adapt it as you need it and learn as you go. Phil, we’re not talking about a small organization, though, are we? I mean, Leeds is a fairly large organization. Could you give us a little bit of background of it? Just how big an organization are we talking about here?

Phil: Yeah, thanks, Chris. I mean, overall, we employ 22,000 staff. Uh, we have quite a flat organizational structure where we have what we call clinical service units, which are centered around a number of comparable clinical specialties. And they have a triumvirate of leadership with a clinical director, a head of nursing and a general manager. We’re a clinically led organization. So those clinical directors hold the accountability for a lot of the devolved responsibilities from the organization. So, um, when Jimmy describes the numbers involved, we’re talking around 800 staff across our, uh, Uh, CSU, uh, teams being involved, clinical and non clinical teams, corporate and clinical teams working very much, uh, hand in hand. Um, and I think that the, benefit of that flat structure is that that type of meeting where myself and my exec team were visible reaches a lot of the organization. So we’re not talking to a small number of senior leaders who then cascade information down through, actually reaching a number of staff. Through those daily huddles, and I think that visibility was actually a really important element of the success.

Chris: Absolutely. Jimmy, you know, given the size of the organization, the urgency to do this work, did you have any challenges bringing these teams together? Were there some learnings there about bringing the teams together? 

Jimmy: Yeah, certainly. I think although we’ve got 19 clinical service units, they’re not all of equal size and complexity. So there was certainly some learning around the opportunity that some had versus others. Um, the other thing that we didn’t acknowledge is there’s variation in the variable pay position.

So some service units had done some great work and almost taken some opportunity or whether they were others were a little bit further to go. So I think some of the challenges were around that level playing field we were trying to create. It’s a shared expectation as Phil and the team said, everyone’s going to get involved with this and we want everyone to contribute.

And balancing that with the acknowledgement that what people can contribute is not necessarily going to be equal. So being careful, this is not a leaderboard of performance in our daily huddles and in our reporting, but more what’s the opportunity you’ve found, how can you share that? So I think those initial challenges are worth commenting on and how we tried really hard to make sure that we frame this in the way that we, I’ve described, this is about providing better care for patients by using our resources more effectively and everyone’s got a part to play in that.

Chris: Phil, you know, this really kind of touches back to a concept that we addressed when we did the work together on strategic alignment that led to the seven annual commitments. And it’s that whole idea of system-ness, the real value of the system and what it can do for each other, instead of thinking about the different silos. So seeing this as a system problem, bringing the system together, but there was also the, Wendy, you talked about it about the command and control. So a situation like this is very tempting for a leadership team to step in and say: “Here’s what we’re gonna do.” But you didn’t do that. You know, you put the superhero cape away and you brought the people who do the work together. So at this point, I think I’d love to just get into what you did, what you learned. And then Wendy, of course, if you have follow up questions, please join in. I think my, my first question to lead off the discussion is, this is a story about financial. And yet this wasn’t about financial operations.

This was about people providing care and making sure that the right people and the right numbers of carers were there to provide that care. So how was this, um, connected to the patient, yet maintaining that importance of this is a real financial concern for us. So Phil, maybe we start and then Jimmy, you want to come in after

Phil: Yeah, so thanks Chris. I guess I’d offer a couple of comments around that. I think the first, the narrative from the start, which is the issue of financial stability as a prerequisite for being able to deliver safe and sustainable, um, patient care. And we know that those organizations that lose that financial stability, then actually find it difficult to deliver that safe care. I think the second was a very explicit, uh, uh, concept that we would look at patient safety and any risks to patient safety from, from the off. So we wouldn’t do the, uh, improvement week and then retrospectively assess, uh, where things were in terms of any adverse patient events. And so actually part of the battle rhythm of the day was to gain assurance around any concerns that had arisen as a, as a, as a consequence of some of the financial and staffing controls in particular.

Chris: Jimmy?

Jimmy: Yeah, I think I’d echoed that. I think it’s a really strong message, that balanced scorecard approach. So yes, our aim was to be more efficient with our resource, but that was not, at  the cost of, of quality or safety, as Phil said, they should go hand in hand. And I think that was, that was a very important message and one that we were consistent, um, in how we supported it.

The other thing, just touching back on the command and control temptation was just the conversations we had in the setup with the improvement teams, with the other clinical leaders. And, and you’ll know that our method is very much that curiosity. Um, we want to be understanding why people do that and offer a coaching approach.

And that’s sometimes a bit of an adjustment for people who are used to chasing results. So that was an important message as well. The improvement teams were there as a supportive function, not as a punitive one, uh, and acknowledging that there was so much to be learned. By sharing good practice across the organization as well.

So that collaboration, which, um, I think as an organization we do very well was another dominant theme as we approached it to try and set the scene in the right way for colleagues.

Chris: Did you find that people who, who normally don’t work together found real value in setting new relationships or making new connections, kind of increasing that connectivity across the organization?

Jimmy: I’ll jump on that one because it’s a simple yes for me. I certainly saw that come through very strongly. And I think one of the things we haven’t touched on is that we were addressing an acute need, but there was a duality to this work, which was, can we make some significant impact here? But also, can we make sure that the daily management, our financial daily management is robust going forward?

So this is really thinking about our standard work for how we manage our variable pay. And I think that was something that came through in terms of the appreciation of what colleagues who you might have not worked with before could actually bring that knowledge and understanding and how that could really be of benefit. So it would be a strong yes from me, Chris.

Chris: How about you, Phil?

Phil: Yeah, I think, um, I think that for us, the flat structure clustered around clinical specialties brings a huge amount of benefit for our people. I would reflect that one of the risks for that structure is always that the differences are greater than the similarities. And I think some of the collaboration opportunities that came out broke down some of those barriers of, Uh, well, we, we can’t do that because we’ve got this group of specialties that work in a certain way.

And as Jimmy describes, actually getting down to standard work around how you manage your study leave absence or your sick leave. These are areas that. are neutral in terms of whatever area you’re working in as often the power of the continuous improvement approach is breaking down the assumptions people have about where their problem sits and actually realizing that their problem sits in an area they weren’t previously aware of and actually tackling that, I think was a big driver for the success.

Chris: Wendy, do you have any questions?

Wendy: Well, yeah, I’m still very intrigued with, I know we talked about, um, some of the command and control, particularly in crises. And sometimes we call it “enlightened command and control” because it’s an evolved form of that, but it ends up being the telling thing. When you describe the huddles, The daily huddles of this work, like, particularly you, Phil, as an executive, like, how did you go into that space and how would you describe that, if another leader was interested in doing that? Because we know that’s a moment of kind of testing your own behavior and your desire. So share a little bit about that with us if you would.

Phil: Yeah, sure. So I chaired those huddles and they were prioritized for me to be there. There, of course, were elements of command and control because I expected the rest of my executive team to be there as well and to prioritize those. I would also reference that, um, we stood this up in a few days, with a participation that wasn’t voluntary. So of course, there are elements of command and control in all of that. But I think we, the huddles had a format where in fact we had our teams reporting out to the rest of the organization. So assurance was very much in confidence in the process to deliver the results against the metrics we had set ourselves rather than the traditional assurance meeting where if the dial isn’t turning to where you need to, you start to interrogate the, The approach, but because we’d agreed on an organizational wide approach, we had to have a collective trust in the process to deliver us the outputs by the end of the week.

And as Jimmy referenced earlier, we went into this with a PDSA approach. So actually, if at the end of the week, we hadn’t had delivery. Then we would have had to sit down and say, okay, well, we’ve tried. This wasn’t successful. How do we need to adjust what we’re doing? Do we need a different approach? And so we went into those meetings very much in that spirit rather than a kind of structured assurance approach.

Chris: You know, as you describe that, Phil, I’m thinking about some of the work around situational safety and how people can do their best work when they feel safe in that, that balance of having clear expectations and good structure. But an environment that allows people to feel safe enough to try without expectation of you need to, you need the big win. We hope you get the big win, sounds like what the message was that perfect combination of clear expectations and a structured way to go about this, also that safety to try did you find that that allowed for more? Experimentation ,willingness to be a bit more open.

Phil: I think so because I think we set the expectation and the aspiration, but the message that we had confidence and trust in our leadership teams to find the experimental approaches to delivery, was something we held firm to during the week. So I think that space for teams to experiment and knowing that we’d put our confidence and trust in them. I’m sure helped drive some of the bigger successes for, uh, the week. And of course, some of the things would have been tried and rejected before they came to that daily huddle. So I’m sure, um, you know, Jimmy will be aware of a lot of the things that kind of ended up on the cutting room floor, as it were. So things that wouldn’t come to that huddle. Um, but again, that’s a testament to the space we gave the teams.

Chris: Jimmy. Do you want to come in on that?

Jimmy: Yeah, I think, I think that’s really helpful for that. I’d agree. There’s certainly some things that were tested locally and didn’t make it as far as the exec meeting at the end of the day, but that safety that you referenced Chris is so important, isn’t it? And some of the things I heard were people who were willing to call out what they realized they didn’t know.

And what in another place might be a quite a difficult thing to say as a leader and someone who maybe felt they should have known that they actually didn’t, but only in doing that and acknowledging it, can we then ask for help with it or pay attention to it and do something about it? So I think that, uh, the safety space, the psychological safety, the setup around this work.

Only in that context, can you have people going, I’m going to ask a question and be vulnerable here because I don’t think we know what we should about this.

Chris: Absolutely. So at the end of all of this work, which I think is absolutely amazing What do you think was the easiest part? And what do you think was the hardest part? And Jimmy, how about we start with you, and then we’ll come over to Phil.

Jimmy: The hardest part, perhaps, just that willingness to take the step. You know, I give huge credit to Phil and the exec team. I think the pressure, is unseen on senior teams sometimes, but as Phil’s touched on lightly, if we don’t take responsibility for ourselves, then someone will come and help us out and offer us that help.

That’s how it works in the NHS in England. So I suspect that was really pretty tough. And then that cascades down for being willing to come out of this mental valley we talk about, don’t we? So you mentioned it earlier, Chris, like how do we go from, “we can’t because we’ve never done that before. We’ve never gone that big. We’ve never said everyone has to come with us on this thing this week?” to, “how could we do that? And how can we do it in 10 days time?” 

So I think both the hardest part there and coming into the easiest bit, I think the easiest bit is once you realize that there’s so many people with so much great stuff to offer when you give them the platform, the easiest thing is to keep that sort of momentum with it in the week and coalesce that great idea.

And as you’ve seen that the results play, I’m going to sandwich it because then again, as we all know, in the room, the momentum and keeping that going is really tough. So that ties into that. How does this become the way we do business around here rather than something we’ve put a huge amount of focus on for a week and then let drift?

And I think credit to the teams. Uh, well away from mine, particularly in our finance, finance teams, et cetera, who’ve kept this momentum going, kept the focus on it and continue to refine the improvement.

Chris: Phil, how about you?

Phil: Yeah, I think the easiest thing in a way was to take the step to experiment, to do the event, uh, The hardest thing I think was to hold the confidence that we would see some results. and partly because I knew in my position that if we haven’t made a success of it, then we would have had to quickly move to a more structured and more draconian approach to correcting the financial position. And I knew how damaging that would have been for the culture of the organization, and the narrative that the Leeds Improvement Method was how we did things in Leeds. Because actually, if we’d failed at it, we’d have had to take steps which would have been very detrimental to both of those things.

So, you know, as, as a chief exec of an organization, that’s a big, that’s a big risk to take.

Chris: Absolutely. Wendy, just to put you on the spot for a moment, as you know, our leader, who has the charge of helping healthcare globally, using a method like the Virginia Mason production and the Leeds Improvement System. Why is this story so important for other organizations in the NHS and other places to hear?

Wendy: Yeah, what a great question. And it’s interesting, as you mentioned that, Chris, because I was going to actually ask Phil and Jimmy about transferability of this work within the NHS, but I will give you my perspective at first and then I’d love to hear comments from them as well. I mean, I think this one is so important for several reasons.

One is the scalability, which the size, you know, you talk about 800 people across these, these areas and just the phenomenal work that you went in. And That spirit of test and assess is so great. And then thinking about sustainability. And then Jimmy, you talked a little bit about that in terms of, you know, this is the way we do, and how do we make sure we have that momentum and continue with that, because as we’ve all seen, things can come and go with that.

So I see this as a, you know, scalability, a sustainability, and then the transferability. You know, there isn’t a healthcare organization out there across the globe that isn’t struggling right now with financial challenges and particularly around workforce issues. But I’m not in the NHS while I’m in London, 60 percent of my time, but I want to hear from, uh, Phil and Jimmy in terms of transferability for NHS, which we, we’ve all seen the Darzi reports. We’ve heard the prime minister say we change or we die. Um, what, what are your reactions to that?

Phil: Well, a couple of things. I mean, I think that, the NHS has launched what we call NHS Impact. Improving patient care together. It’s been, uh, recognized that a continuous improvement approach is the way to think about some of the long term challenges. I think a couple of things within that are that yes, we’ve talked in this podcast about our rapid improvement week, but actually one of the reflections we had was that we can’t do this for every large scale challenge that the organization faces. Everybody pivoted to doing this piece of work for a week, and that wouldn’t be a sustainable or viable way of doing everything. But I’d also come back to the fact that we spent a lot of the last half, three quarters of an hour talking about a culture of empowerment of trust, of honesty and transparency and a culture in which people can feel confident to speak out around what they don’t know, feel confident to try something and fail, feel confident to celebrate together with their successes. And I certainly within the wider NHS, we still have a long way to go to create that culture across the whole system in a system which always has such a lot of political oversight and interest. Which inherently lends itself to a structured hierarchical approach.

Chris: Jimmy, how about you?

Jimmy: Yeah, much of what Phil says resonates there. I think I’m struck by the connection, if we take it back to where you learned first, Toyota and the challenge where people tried to take lean concepts and drop them into something and then wondered why they didn’t quite work and get the results they wanted.

And that was because it’s socio-technical and the people matter so much. So exactly as Phil’s referencing there, I think the concepts, the building blocks, we can write those down and offer it as a case study as we will do. But sometimes it’s the intangible stuff that actually makes the difference to whether you’ll succeed or, or maybe I should say the extent to which you’ll succeed with this kind of ambition.

So I do think it’s transferable, but I think as ever, the preparatory work is maybe something that might take some organizations a little more than 10 days.

Chris: Well, and I think you bring up a really good point. It’s some of the key takeaways from this conversation. Um, I think it came through very clearly, the importance and power of trusting a process and the people. You know, they’re brilliant people who come to work every day given the time to think and, and a common method, the power of that is just really, um, the potential is just who knows just how far you can go without as an organization. And I think the importance of your story and getting the story out there to the point you just made, Jimmy, it’s not about copying what you did. But what’s the takeaway for other organizations, and how do you take the learning and make it your own? You know, which is kind of that core concept of the Virginia Mason Production System and Leeds Improvement System is, you know, you learn from others, but you need to make it your own.

You know, we often say, steal shamelessly and then make it your own. You have to remember the important part is you need to make it your own. Your people, your organization, Your challenges, but a shared method. So as we conclude, I’m wondering if there’s just a final thought from Jimmy, Phil, and then Wendy, and then I’ll wrap up our conversation. This has been a great time. Folks. Jimmy, any final thoughts?

Jimmy: I think we just touched on it for me, Chris. You’ve summarized it beautifully. Have the process, have  the method, but you’ve got to take the people with you and, and they’re at the heart of it. So, um, that, that’s fundamental for me with what, whatever process you try and apply.

Chris: Phil how about you?

Phil: Yeah, I’d agree with that. I mean, I think that the reflections I’d have were that we could have taken longer in the co production space. We had a very accelerated phase and landing. Um, and there was a little bit of method in, in doing that to create the sense of urgency. but I think it empowered teams to realize that this approach really can work and really does bring dividend. And we’ve seen that in the fact that the benefits have been sustained month on month. Um, in this part of our financial, uh, control and governance. So I think if you can give people confidence that you’re not just chasing the money, but you’re, uh, using your approach in a kind of balanced way and give people time to engage, then I think you can generate great success.

Chris: This, the takeaway every time I’ve talked with you both about this. story. You’ve linked it back to the importance on patience. This is about making sure the organization can be here for your community. So that’s, that’s just really exceptional. Wendy, thoughts?

Wendy: Yeah. I mean, this is such a fabulous story and I think in such a critical time right now for the NHS as well as other healthcare organizations across the globe. [00:48:00] I guess going back to the, the elements that we talked a bit about with transferability and scalability. And sustainability. I mean, I’m just really excited for you.

We’ve been on this journey for 20 years and we still are learning along the way. And we learned from our client partners and you are right there at the top with being on the journey for us since 2015. And I know Chris and I had the opportunity to be on site not too long ago and see some of the things you talked about with the vision and the values and the culture and the people and the day to day kind of drumbeat of this work.

And so just. Such an exciting time and really excited to have you share this more broadly about the great work that you and your team have, have accomplished. So well done. done.

Phil: Thank you.

Chris: Well, I think that’s about all the time we have. So I just really want to extend my appreciation to Wendy, Phil and Jimmy for joining us on the podcast today.

Wendy: Thank you, Chris.

Phil: Thank you.

Jimmy: Thanks for having us.

Chris: Thank you for listening to Better Never Stops. What a great conversation with Wendy Korthuis-Smith, Phil wood and Jimmy Parvin about the 20 million dollar turnaround at Leeds Teaching Hospital NHS trust. You can stay up to date with our latest episodes by subscribing on Apple Podcasts, Spotify, or wherever you get your podcasts.

You can also find us on social media or send us an email at info at Virginia Mason Institute dot org. Thanks again for listening and remember: transforming health care is not just about a pursuit of a perfect patient experience, but a mindset that we can always do better because better never stops.