Nursing input is vital to set services on a new course

Nurses must be involved in transforming care if it is to be patient centred

Nurses must be involved in transforming care if it is to be patient centred

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Nurses and other healthcare professionals are well versed in leading innovative service improvement.

We know from the case studies demonstrating the success of the NHS England (2016) strategy that we, as a profession, can lead and improve the experiences and lives of patients.

We also know that pressures on the healthcare system will continue despite service improvement, so we must ask ourselves: ‘Is service improvement transformational and do nurses need to do more than improve to provide a sustainable service?’

In a healthcare context, transformation is a process of profound and radical change. It orientates an organisation in a new direction and takes it to a different level of effectiveness.

Unlike service or quality improvement, which imply incremental progress on the same plane, transformation implies a change of basic character to something with little or no resemblance to a previous configuration or structure.

Watch: Kelly Bishop on involving nurses in transformation



Shared discovery

When involved in transformation, leaders venture into the unknown.

The end picture is unidentified so, increasingly, clinicians need to be skilled in leading teams through an open and transparent process of shared discovery to reach a conclusion.

At a regional or integrated-care-system level, transformation may be the only solution to fragile and unsustainable acute services.

Only radically different models of collaborative delivery across several providers can offer a sustainable future, clinically and financially.

Communicating benefits

The NHS England assurance process requires that front-line clinicians affected by proposed changes are involved in them (NHS England 2018).

Clinicians are powerful advocates and play an important role in communicating the benefits of change to a wider community; they should therefore determine and drive the case for change based on the best available evidence. 

Those involved with developing-transformation programmes have worked hard to achieve change by appointing transformation clinical leads and ensuring clinicians are members of design groups.

However, the term ‘clinician’ is often translated as ‘surgeon’ or ‘physician’, which has led to a progression of clinically led models of care that benefit patients attending for once-in-a-lifetime procedures, but do not necessarily offer holistic care to the rest of the population.

The wider clinical workforce of nurses and other healthcare professionals are seen in these leadership roles less often or are less active in design forums.

Nurse involvement

The need to transform how we deliver acute services across integrated care systems is growing and the scope of services included is becoming increasingly broad.

Transformation programmes now touch services that affect many more patients, and nurses should be involved to ensure their perspectives are heard.

Through better prevention, or the provision of care interventions closer to home, we can reduce the need of patients ever accessing acute specialist care.

While doctors can agree the standards and equipment required for one-off specialist interventions, we need to speak for patients who also require transformed prevention and care.

Asking questions

Nurses need to be present to ask questions such as: ‘Will the centralisation of specialist nurses affect our ability to maintain valuable nursing skills locally?’ and ‘How can we introduce innovative approaches in our local hospitals and community services that will deliver what is important to patients and support the delivery of one-time major surgical interventions?’

Nurses have a role in in service redesign and must ensure their voices are heard and that the vital care aspects of patient pathways are improved for the wider population.

Only with valuable nursing input will service transformation by truly patient centred.

Find out more

  • For more about the NHS Transformation Unit’s work to help senior nurses and other clinical staff to feel more confident in finding a path through complex service design, go here 
  • For more about NHS England’s ten commitments to improve of health and experiences of our population, go here


About the author

Kelly BishopKelly Bishop is head of nursing at the NHS Transformation Unit

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