Private expertise can cure the NHS – here’s what we’ve done already

Paolo Pieri

INNOVATION in any industry comes from new entrants finding disruptive solutions to old problems. As a rule, incumbents tend to deliver incremental change, and this is no less true of Britain’s healthcare system. It will take newcomers to create fresh models to fundamentally improve the patient experience and clinical results, and to reduce costs for patients, taxpayers and private medical insurers.

I work for Circle, an employee co-owned hospital group with a mission to transform Britain’s broken healthcare industry. The sector is suffering from massive efficiency challenges, stagnant productivity and serious quality failures. Game-changing innovation is the only cure. Just over a year ago, we were given the chance to test our model in the NHS. Last February, Circle became the first private firm to run an entire NHS hospital when we won the contract for Hinchingbrooke in Cambridgeshire.

The key behind our approach seems obvious – that “customer is king”. Sadly, the customer service revolution has yet to hit healthcare, with the type of tragic results we saw at Mid-Staffordshire hospital. Too often, NHS and even private patients have to suffer a “get what you’re given” approach to care. Where other industries have responded with agility to rising consumer expectations, the monopolistic nature of UK healthcare has caused patient power to lag behind.

Our solution is a business model that shares ownership between investors, clinicians and frontline staff, and an operating model that gives doctors a majority on hospital boards through a flat management structure. Where most hospitals are run as a hierarchy, with layers of management, we give the people who know patients best the biggest say in how hospitals are run.

Our operating system also splits hospitals into separate business units, designed to unleash doctors’ entrepreneurial talents. Doctor-led teams are handed the power to act as small businesses in their own right, with control over budgets, staff and rotas. Each doctor is given a seat on the main hospital board, meaning that tiers of management can be removed between the board and the ward. Each unit takes ownership of its own data, including patient feedback, clinical results and the profitability of its service, and each doctor leader faces peer pressure from board colleagues to improve his or her team’s performance. In this way, we create a professional services environment that gives the people closest to the customer real responsibility.

We first launched this model with a new-build facility in Bath, designed by Lord Foster’s architectural firm to look more like a five star hotel than a hospital. CircleBath has gone from strength to strength. It has won the regional “customer service” award for two consecutive years, and 99 per cent of patients tell us they would recommend the service to friends and family.

And our time at Hinchingbrooke has produced similarly dramatic results. This year the hospital was ranked as the top full-service hospital and the top accident and emergency service out of 46 in the East and Midlands region league. Clinical mistakes have dropped by 60 per cent and it is one of the ten most improved hospitals in the country for patient safety. Taxpayers were due to lose £10m at the hospital this year. Instead, we found £6.3m by improving efficiency and spent £3.7m of our own money investing in structural changes that will make the hospital sustainable over the long term.

We use TripAdvisor-style feedback forms and publish all replies, good or bad, online

Key to these achievements has been a cultural revolution. One of our founding principles was putting “hospitality” back into hospitals. This means treating patients as customers and responding rapidly to their needs and wishes. That’s why we’ve introduced TripAdvisor-style patient feedback. At Hinchingbrooke, the number of feedback forms we get has increased 24-fold, and every good, bad and ugly comment is published verbatim on our website. In response, we’ve scrapped parking fines and overhauled menus, so that all food is fresh and locally-sourced rather than frozen and mass-produced. As a result, we’ve consistently ranked in the top ten out of 46 hospitals in the Midlands and East league for patient experience.

In most industries, it’s normal to treat customers as empowered consumers. But in healthcare, patients have been locked out of decision-making and left to suffer sloppy service. We’re determined to see a customer service revolution that changes patient experience for good.

Paolo Pieri is chief financial officer of Circle.