One of the key barriers that need to be overcome is the fact that saving money is not the prime

motivating factor for clinicians. In her view, any improvement work which focuses on the ability to deliver cost savings is unlikely to succeed. Up to 70 m could also be saved through the Enhanced Recovery Programme by reducing the length of stay in four key specialities (across eight procedures) including neurology, colorectal, gynaecology and orthopaedics We need to look at how hospitals can be incentivised, instead, for fewer infections, less beds and speedier care, she commented.

It is necessary to identify where inefficiencies are located and where services do not make sense, while baseline data is critical to enable the success of improvements to be measured and evaluated. importance of engaging the entire team in the redesign of processes, while staff must be able to pilot and test different ways of providing a service in an environment where they feel free to make mistakes. Involving people in process mapping, as well as the piloting and testing of changes, is a very powerful tool for engagement,

The biggest drivers of change are clinicians and no change should be set up without a clinical and managerial partnership. However, unless you can walk in the shoes of the patient and understand their perspective, it will be very difficult to validate any changes,

the benefits of the Enhanced Recovery Programme. whole multidisciplinary team in ensuring patients are in optimal condition before, during and after surgery. Recovery is much quicker with hospital stays reduced Pre-operative assessment, planning and preparation before admission. Reducing the physical stress of the operation. A structured approach to perioperative and post-operative management, including pain relief. Early mobilisation.

One of the biggest enemies of improvement, in her view, is resistance to change typical views include: It wasnt invented here, We dont work like that, We cant do more work without more staff/equipment, Its easy for them. They have more staff. For improvement work, it is all about looking at the longer term,

there needed to be a better understanding of the patient pathway, as well as organisational issues such as leadership, clinical and managerial engagement and local culture. There also needs to be greater clarity of vision. All too often people jump straight to the solution, without fully understanding what the service looks like and how it could it look in the future,