Author: Professor Nick Rich, Swansea University
Published:
The programme demonstrates the power of applying a prudent approach to healthcare (as promoted by the Bevan Commission) in Wales and these principles serve as a global benchmark for others to emulate. The principles of Prudent Healthcare provide a framework with which to exploit greater clinical performance as demonstrated by the range of successful projects. The programme has an unconventional design and uses an innovative ‘peer based’ programme of learning and ‘critical friendship’.
Wales now has new strategic capabilities as a result of the investment in the Exemplars. These include, at least three new capabilities in Appreciate Inquiry, Systems Thinking and Postcards ‘Because We Care’. A capability is an investment for which there is a future ?pay back? and these capability centres allow other national NHS staff to gain access to expert knowledge generated as a result of this programme. The Health Technology Exemplar projects, which involved collaboration between NHS staff and industrialists, resulted in a 5:1 total investment.
This investment includes NHS Wales’ Exemplar employer organisation and the industrial partner involved. Put simply for every £1 of Central Government tax payer investment ? a match was achieved of a further £5 invested by the employer and industrial partner (as measured by ‘in kind’ support and equipment/materials supplied). The average project yielded an economic return of £69,000 (in total costs) and the potential savings from the single top performing project has paid for the programme in its totality (in reality twice over). The total economic net benefit of the programme is estimated to be £3mn to the current employers. If ‘scaled up’ to the Welsh economy (national level adoption of projects) the programme has the potential to release £21mn of total costs. These costs are mainly staff time savings and therefore these release time to invest or be redeployed towards more value adding activities (staff development, seeing more patients, or releasing time for more complex care processes).
The Exemplars programme coproduced the support and personal development requirements with participants and delivered them on a just in time basis. This meant that the programme was not set out in advance but developed over time during the course of the programme and in response to participant’s needs. The programme was led by Siôn Charles (Deputy Director at the Bevan Commission). The wider benefits of the programme (and intangible benefits) include a major addition to clinical and process leadership across the 10 Welsh Health Boards and Trusts.
The Exemplar programme has fostered and developed new working relationships with industrial partners and this has resulted in joint exploitation of benefits and a low risk approach to innovation. It has also highlighted significant opportunities for joint Intellectual Property exploitation.
This cohort (2 streams) are now serving as advocates for the Bevan Academy and providing support as mentors to the current and active programme of Exemplars (generation 2). Several of the Exemplar projects have been nominated and won national awards for excellence and one has reached a global audience and celebrity engagement with the Exemplar community. The Bevan Academy itself has also benefitted in terms of international recognition and also for the Exemplar programme design itself (MediWales, 2016). The Bevan brand has proven to be an asset when developing organisational and clinical engagement with these change programmes. The Exemplar network remains strong and serves as a good example of a peer group learning network with significant amounts of freedom to determine which skills they collectively sought training in (for example behaviour change, the Cynefin methods, costing improvements and business case justification for change and A3 as a structured improvement cycle).
Overall the programme should be regarded as a success and at multiple levels.
