The emergence of the ‘interim consultant’ in the Health sector
In essence, the context of interim management is ‘the temporary provision of management resources and skills to support an organisation with a period of change or crisis where the need for a permanent individual is not required and there is a lack of resources internally to be able to deliver” whilst management consulting can be described as ‘the practice of helping organisations to improve performance through diagnosis, analysis and articulation in order to develop improvement plans and to assist with organisational change and development’.
Each offers a unique set of benefits but we are seeing more assignments requiring a hybrid of both. This has resulted in the emergence of what I call the “interim consultant” or - put simply - a management consultancy firm in one individual who is able to deliver a piece of work that has already been articulated through an external review.
This kind of approach is especially relevant for the Healthcare sector and one assignment that we successfully placed for that really showcases it at its very best is at Sheffield Teaching Hospitals NHS Foundation Trust. To give a bit of background, the Chief Executive had a view on what was required in terms of support for the Surgery Directorate; whilst Michael Harper - the General Manager - had a perception of what this might look like. However, the challenge for us was to deliver a person who would satisfy both.
As a business, we work with many, many talented interims on a daily basis and as always this assignment required someone who had the right skills that straddled both the resource requirements but also the analytical needs. After a lengthy process, Ellen Ryabov was appointed to the Directorate of Surgery in April 2013. Since then she has become the Interim Chief Operating Officer within the same organisation.
Ellen has worked in the Healthcare sector for 25 years, including at several large teaching hospitals across the UK; and for the last three years, Ellen has worked as an Interim. Her knowledge of the Acute sector is unrivalled having always worked within this sector of the NHS. She has held many senior positions - from operational to financial – including, Chief Operating Officer, Director of Integrated Care and Head of Project Management.
It quickly became clear that Ellen encapsulated everything that was needed; again... a management consultancy firm in one individual. Since starting with Sheffield, she has delivered on many levels including a recovery plan for General Surgery around SLR (Service Line Reporting), an information dashboard for the Directorate and improved 18 week delivery. Ellen has also supported the team by reducing management pressures and she has supported improvement in managing targets. It has been a challenge but below Ellen shares her own experiences and tells us a bit more about what she has been delivering and how she has found the process.
Ellen, why the assignment appealed?
Firstly, the assignment was in the Acute sector which is where my expertise is so it was a good fit. Secondly, it was in General Surgery - I have spent a large part of my NHS career working in surgical services and I was therefore sure that I would enjoy the challenges that this assignment would bring. Having met the team, I was also confident that it, and the wider Trust, would be an environment that I would enjoy working in. Finally, it had both an operational and a finance mix to it which fitted my skill set down to a tee.
What were the key challenges?
The Directorate had very significant SLR deficit and it needed to develop a three year plan to bring this closer to financial balance; this required an overall cost reduction of some £3.5m. There were some further revenue savings that were needed, both in-year and full year for non-pay, amounting to circa £250k which was delivered. I also supported the in-year cost improvement plan which when delivered provided for an in-year revenue budget improvement of around £300K against the original plan.
There were two other specific pieces of work that I led and delivered on; one of which was to develop and set up a financial performance reporting tool; the other was a specific piece of work to support improvement in 18 weeks for surgery. Since implementing that plan, the Directorate has improved month on month since August 2013. The 18 week plan developed for surgery was also used as a standard template for roll out to other areas in the Trust.
What were the key outcomes?
In terms of patient benefit, there were several... waiting times came down and therefore patients were seen and treated earlier. The efficiency savings delivered as a result of changes to non-pay stock items did not have any detriment to care, but reduced revenue spend so the same number of patients could be seen and treated with reduced cost whilst also maintaining the same quality of care.
The performance reporting tool was of significant benefit to clinical staff in terms of improving their understanding at a more granular level of detail. It also helped them to understand what their individual practice was like when compared to other members of the team across a range of metrics.
In terms of finance there were significant benefits for the organisation, namely;
- A 3 year plan for delivery of an improved SLR position which is set to deliver efficiency improvement of circa £3.5m
- An in-year plan to deliver non-pay cost savings of £250k FYE
- An in-year improvement of the YE financial position of circa £300K
- A robust financial performance reporting tool was developed and implemented
- A performance improvement plan for 18 weeks was developed and implemented
What was your main learning?
I learned about a new organisation and how it worked and also that you can identify efficiencies without the need to reduce quality or service. This can only be a win/win situation for any hospital and the patients that it serves. I realised that whilst things had gone well for both the organisation and the patients who were treated in Sheffield, there was certainly an upside for me as following the end of my contract with the Directorate of Surgery, I was fortunate to be asked to take on another assignment as the Interim COO and clearly this was an assignment which I was delighted to accept.
Why do you think choosing an interim the right solution?
I think that hiring an interim in this situation was the correct solution as I provided additional senior capacity to support the existing the team and was able to spend time developing and implementing solutions to key challenges which would have proved difficult to do for those holding down a key role within the base team.
In conclusion, it is clear to me that an experienced individual who understands organisational challenges at a granular level not only has the ability to articulate the challenge, but also deliver on it. Ellen has proved that; she challenged the system and she put a lot of new processes in place. But – more importantly – she left the division with the right tools that have driven it forward which has enabled the team grow and develop.
Whilst this model could be viewed as more expensive than a traditional interim method used in the past, there was a consensus that this was justified because the delivery and benefits were clear as was the legacy left by Ellen. However, in simple economic terms, the value (pounds, shillings and pence) outweighed the cost in terms of return on investment.
If you would like to learn more about Sarah or her work, please do look at her profile.