From performance targets to service design and healthcare infrastructure

Challenging performance targets have been set for the UK National Health Service. In order to respond to these targets, the NHS has adopted approaches such as Lean Healthcare to reduce waste and improve its effectiveness. This paper explores the topic of Performance Management and the consequent redesign of services in the NHS. Using the lens of the TFV model, changes in the NHS are examined in an effort to understand the impact on the demand for infrastructure. The traditional approach in the health service is based on a transformation model concept where functional areas are central and the emphasis is on clinical specialties. Lean Healthcare concepts are now being applied to reduce lead times in the NHS. This represents a transition from a transformation model to one where the flow of patients is the main perspective. In an effort to reduce the lead time for patients to access services, major service redesign efforts have led to changes in the demand for infrastructure and the need for refurbishment and new buildings where functional areas are co-located. The NHS is also moving towards being 'patient led' and increasing value to the taxpayer and to the patient. It has been demonstrated that infrastructure has a high impact on patient satisfaction and their choice of health service provider. Thus, as the NHS moves towards a competitive healthcare marketplace, high quality infrastructure is of increasing importance.