Feature / Getting together

A new guide from the Department of Health looks to help NHS providers build on best practice in clinical-financial engagement. Steve Brown reports

It was 2007 when the Audit Commission’s  A prescription for partnership report put the spotlight on the need for clinical-financial engagement. It called for greater mutual understanding between the clinical and financial professions, with clinicians taking responsibility for the finances they commit, supported by finance staff providing meaningful information and understanding more about how care is delivered.

Six years on, significant progress has been made, at least in recognising the need for effective clinical-financial engagement. Work by the Department of Health, led by national adviser Dr Mahmood Adil, and the HFMA has continued to make the case for clinical engagement and to highlight best practice.

But the need for ever greater engagement continues. In part, this is required to address problems highlighted by the Francis report, which identified a culture of silo working, poor cost control and poor patient care at Mid Staffordshire NHS Foundation Trust. But the current financial challenge – achieving better outcomes with the same or fewer resources – also demands much more engagement.

What organisations have been asking for is a clear picture of what effective engagement looks like and help understanding their own levels of engagement and how they can borrow from existing good practice. Now a new report – Effective clinical and financial engagement: a best practice guide for the NHS – has been published by the Department of Health to fill this gap.

Drawing on surveys of finance leaders and clinicians by the HFMA and the Department, and developed with practitioner support, the guide sets out the characteristics of effective engagement in three categories:

• Organisational behaviours
• People
• Data.

So, for example, within the organisational characteristics, it stresses the importance of a whole-system approach, with engagement taking place across all grades of staff, not just between consultants and cost accountants.

Self-assessment checklist

Perhaps of most practical use to organisations is a checklist-based self-assessment tool. This builds on the four levels of clinical-financial engagement first described in the HFMA/ Department surveys and later included in the Department’s annual reference costs survey to track improvement in engagement. The checklist provides a basis for making this annual assessment more objectively, but the guide emphasises that assessment should be a continuous process to drive development rather than meet an annual submission. The tool sets out the characteristics expected at each of the four engagement levels, again arranged in three groups:

• Culture and behaviours
• Process and tools
• Benefits and outcomes.

To achieve a level, the guide says a trust must demonstrate ‘most though not necessarily all elements of the checklist’ related to the characteristics across the three groups.

‘The tool is deliberately simple. We wanted something to support organisations’ self-assessment as part of the reference costs submission,’ says Dr Adil. ‘More important, we wanted to provide a route map for provider trusts to help their clinical and finance staff to embark on this engagement journey and to improve quality and efficiency by concentrating their efforts on the relevant elements described in the checklist.’

The guide includes suggestions and enabling factors to boost engagement locally. Promoting the value of patient-level cost data, it highlights the use of data to support the redesign of clinical practices and pathways, reducing length of stay and helping pathways to be standardised for patients’ benefit. The identification of clinical and cost champions at specialty level is held up as a good way of promoting communication between clinicians and finance staff, encouraging the flow of information, dialogue and constructive challenge.

Robust, timely data is essential, but the guide says that it also needs to be clinically owned if engagement is to be improved. Joint analysis of data can enhance the credibility of the data and the guide suggests that feedback – from the friends and family test and patient reported outcome measures for example – should also be reviewed together.

In one trust, clinical engagement objectives have been set for finance staff and there are plans to mirror this for clinicians. The guide finishes with some examples of clinical-financial engagement in practice, demonstrating various elements of the checklist. This includes joint work at West Middlesex University Hospital NHS Trust to review patient flow, which led to a new bed management system and the closure of two wards with no adverse impact on patient care.

‘We know that providers understand the importance of clinical-financial engagement,’ says Dr Adil. ‘What we need now is to help organisations turn this into practical engagement at all levels that will help them improve quality and reduce costs safely.

‘This engagement is not an additional burden on top of existing challenges, but is part of the solution to those challenges and the sooner we spread best practice the better. Effective engagement means knowing each other’s business on a large scale across the NHS and this best practice guide is designed to help,’ he says.

Download the guide at www.gov.uk and search for clinical and financial engagement