The National Blood Service became a national service in 1993. Prior to 1993, there were 14 blood centres in England all collecting testing and distributing blood and blood products. In October 2005, the service was re-named The National Health Service - Blood and Transplant (NHSBT) and became established as a Special Health Authority when merging with UK Transplant. There were numerous synergies and clear opportunities to cut duplication and to reduce costs to the NHS. NHSBT consists. (NHSBT Intranet, 2010)
The National Blood Service - Collection, Processing, Testing and Issue of blood and blood products
Organ Donation and Transplantation - Collection processing testing and distribution of organs for transplantation and Tissue services.
Bio Products Laboratory - Pharmaceutical wing of the organisation to fractionate plasma into its component therapeutic parts to supply the NHS and any other health organization.
The NHSBT is accountable to the Department of Health for the standard of products and services provided and are also subject to the Healthcare Commission's 'Annual Health Check' against the Department of Health's 'Standards for Better Health' - the national process by which the NHS performance is measured and assessed. NHSBT Performance (2010)
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As stated by (dti n.d.) improvement is a never ending cycle. Within this cycle performance measurement plays many important roles, such as:
â€¢ Identification and tracking of progress against organisational goals
â€¢ Identification of opportunities for improvement
â€¢ Comparing performance against both internal and external standards.
The evaluation criterion appended lists many performance improvement tools. The three selected are based on the marking exercise; the three methods are Benchmarking, Balanced Scorecard and Audit. Each tool is effective in its own right and each will be discussed within the report.
Reviewing an organisations performance is important when formulating the strategy and direction. It is imperative to understand where the organisations strengths and weaknesses lie before embarking on any performance improvement. First we have to decide on the organisations present position. Using SWOT to analyse the strategic requirements and improvements, the strengths can be examined to see if any of these provide insight into other areas that are not part of the SWOT statement. These may provide direction for other SWOT analyses. The weaknesses tell you the current state regarding the SWOT statement. Once the improvement tools have been initiated and carried out SWOT analysis should be completed again, too see if any of the original weakness still persist. Opportunities are goals and they should be prioritized. Once SWOT has been completed action plans will be required. These can be formulated as Gantt Charts or ''to do" lists. This will allow for implementation to be managed as a project with assignable responsibilities and due dates. The gaps that are highlighted will enable the organisation to provide resource and time to closing the gaps and improving the overall performance of the organisation.
As discussed by Ahmed and Rafiq (1998 p. 237), the comparisons made and identified with benchmarking are about identifying and understanding the gaps. The performance measures discussed will aid in the identification and rectification of the gaps.
Finally the implementation strategy will be formulated and the critical success factors (CSF's), that would have a significant impact on the implementation will be identified by the SMT.
Within the public sector, benchmarking activities are influenced by many activities, such as government Bowerman, Francis, Ball and Fry. (2002 p 430). Due to the global financial crisis and cuts within the public sector, any initiative will invariably undergo close scrutiny. Due to resource issues within the organisation, the fear is that benchmarking will not be prioritised and not be completed correctly. The Benchmarking process will require commitment and time from the managers and staff (Hinton, Francis and Holloway (2000 p 52).
As discussed by (tutor2u n.d.) the benchmarking process involves looking outward. This requires looking outside at a particular organisation, industry or country to examine how performance levels are achieved by others. This will enable the NHSBT to understand where they need to improve to achieve excellence. When the lessons learnt from a benchmarking exercise are applied, they facilitate improved performance in all critical areas of the organisations environment (tutor2u n.d.). According to tutor2u (n.d.) and Grayson (2002) cited by Auluck (2002, p. 112) the application of benchmarking involves certain key steps:
Always on Time
Marked to Standard
Understanding of the existing processes
Analysis of other organisations processes
Comparison of your own organisations performance with that of others
Implementation of the steps necessary to close the performance gap
Senior management support and commitment
Integration with the organisations strategy
Must include all staff and be addressed as a team activity
Must have correct and succinct planning, organisation and management
The points discussed are invaluable to the implementation of benchmarking. The first thing the organisation needs is an understanding of the current processes. Without the understanding of where we are now, the benchmarking process will be of little use. Benchmarking should not be and cannot be considered a one-off exercise. This is top managements priority. The benchmarking process will need top priority to be effective; it must become an integral part of the organisation with the ultimate goal of keeping up with the agile and ever-improving best practice (tutor2u n.d.). The benchmarking process will bring many benefits to the organisation. Such as: Stage-Gate (n.d.)
Identification of specific problem areas
Prioritisation of improvement opportunities
Shifts internal thinking from "inputs" to "outputs" (i.e. measures)
Serves as an excellent baseline
Makes it easier to increase performance expectations
Creates a sense of competitiveness
The choice of approach is likely to be critical to the success of the benchmarking initiative. It is suggested by Auluck (2002, p. 113) that benchmarking exercises that examine processes are more likely to lead to performance improvements, since they examine the gaps in performance. Camp defines four types of benchmarking: Kennedy, Allen, Allen (2002 p. 432). Functional; generic; internal and competitive.
Private sector benchmarking has best practice as its primary focus Bowerman. M., Francis, Ball and Fry (2002 p. 433). The aim of benchmarking within the private sector is to become the best. Within the public sector organisations strive to become "good enough" to demonstrate that they are not the worst, the aim is for average rather than the best. This is most noticeable within the NHSBT where there is no competition within the UK, which invariably means that the organisation is content with just being good enough. Benchmarking should be seen as an internal management tool, which will help the NHSBT to change processes and strategy.
The continuing popularity of performance league tables, especially in the public sector, and the tendency for "benchmarking'' and "benchmark'' (Hinton, Francis and Holloway (2000 p. 54) is of concern for the NHSBT. The difference between the two will need to be stipulated and the need to reduce the use of league tables must be implemented. The league tables will only serve to dampen the employee's spirit and morale if they see no visible climb up the league table. The benchmarking wheel discussed by Bhutta and Huq (1999, p 258) is a useful visual tool to use for the SMT and staff alike.
The benchmarking Wheel - Bhutta and Huq (1999 p. 258)
The idea of benchmarking within the NHSBT would be to improve performance across the supply chain from the blood donation phase to recipient patient. Although there are many benefits that benchmarking will bring to the organisation, there are some prerequisites that must be adhered to for successful benchmarking. Without commitment of the top management; linkage to the vision and strategy; training and a desire to become the best, the initiative will fail. (Goetsch and Davis 2010, p. 522)
Commitment of the senior management team (SMT) is critical to the successful implementation of the Balanced Scorecard (BSC) (Parmenter, n.d. p1). Commitment alone is not enough; there must be top level involvement. The first steps of the Implementation process would be educating the SMT on what the balanced scorecard is and what benefits it will bring to the organisation. Without the complete backing of the SMT the BSC will become another piece-meal fad that will only fade away into the abyss along with other improvement methods that have been tried before. For the BSC to be successful there needs to be top priority and full commitment and involvement not only from the top but from every employee within the organisation. The steps required to implement the balanced scorecard are discussed by Bryant (n.d. p 1)
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Assess the mission and vision statements.
Review organisational strategy. Focus the scorecard on creating a by focus on customer wants and needs.
Define the scorecards objectives. These should be actionable and measurable.
Interpret and communicate the scorecard from top management through to baseline staff. Highlight the level of commitment, support and resources to be dedicated to the scorecard in the future. The communication loop must also take into account feedback.
For any initiative to truly work the critical success factors have to be considered and determined. These will be the catalyst that triggers the direction of the performance measures. The CSFs are the aspects that determine the organisational and where the organisation needs to perform well. From the CSF's the Key Performance Indicators (KPIs) can be determined. These performance measures allow the strategy to b implemented at the operational level. Kaplan and Norton recommend that a maximum of 20 KPI's are used Parmenter, n.d. p 5). It is crucial that the SMT focus on providing the project team with the CSFs. If this is done well the balanced scorecard will be effective, but the scorecard must be tailored to the needs and be adapted to the organisation. (Student Notes 2010, session 9:2 p. 11)
Comparing the organisations performance with one who does better than you can have two results- 'turning green with jealousy' or 'using it for self-improvement' Balanced Scorecard Designer (n.d.). If the BSC is implemented correctly there are numerous benefits that the organisation will accrue, such as: Effective monitoring of performance; alignment of the strategy and operations; increased awareness and understanding throughout the workforce on the strategic aims and how these are going to be achieved and making the organisation more flexible and agile.
Kaplan and Norton identified five principles of successful organisations (Parmenter, n.d. p 2). These five principles are a description of the key elements an organisation needs to focus on to deliver its strategy and deliver results. They are as follows: (Parmenter, n.d. p 2
Mobilise change through leadership
Translate the strategy into operational terms
Align the organisation to the strategy
Make strategy everyone's job
Make strategy a continual process
The above principles are essential to the success of the balanced scorecard implementation. The SMT must be committed to the BSC, to drive it down through the organisation. Properly implemented, the BSC will create a dynamic environment. But before it can do this, the SMT must be sold on the concept (Parmenter, n.d. p 2).
If the SMT does not see the BSC as an improvement tool, the whole process will be difficult, for example, when deciding on which KPIs to use and which trade-offs are to be made. (Parmenter, n.d. p 2).The balanced scorecard is powerful tools that will enable the organisation to implement its vision and strategy. (Kaplan and Norton 1996 cited by Chia, Goh and Hum 2009 p. 605)
Quality Audits are an essential tool for the continuous improvement of an organisation. Early in an organisations lifecycle audits tend to focus on adherence to standards and regulation whereas as the organisation matures then the focus can shift to continual improvement whilst still maintaining compliance.
Audit acts as an assessment of where the organisation is in relation to regulatory compliance but more importantly can be extended to assess an organisations ability to respond to customer needs and therefore to enable a competitive advantage. Audits must be conducted in an open environment and be able to encompass the views and knowledge of all within the organisation and should be a catalyst for radical change whilst focussing on system efficiency.
Audits as they mature can have a generic core which is common to all organisations and departments but be able to take an overview of the organisation to work towards continual quality improvement.
Audits and Self Assessments
"A major difference between Quality Audit and Self Assessments is reflected in one of the main principles of auditing, being the auditor independence (ISO 10011, 1991). Namely, an auditor must be free of any conflict of interest and be unbiased when making judgments." (Karapetrovic & Willborn 2001 p. 369)
Audit should be viewed as a method of continual improvement. With an organisation such as NHSBT it is expected by the MHRA that a non-conformance noted in a particular blood centre in June should not be found in the next blood centre to be audited in September of the same year. In effect the audit process is pushing to display continual improvement and awareness of the environment that the organisation finds itself in. However this is only one method of improvement and is usually related to a failure of the organisation to adhere to standards and procedures and does not always lead to continual improvement.
There appears to be a requirement for a dual approach to audit. Firstly external audits are necessary to ensure that the organisation is following both legal requirements and its own quality policy. Secondly and with a joint focus internal audits or internal self assessment needs to focus on the same role of policing against standards while also identifying areas for continual improvement. The focus on continual improvement must include the local employees to ensure that they are included in the process, that their views are listened to and that they buy in to the overall improvement process. The audits have greatest benefit if conducted in real time and the auditors must have acquired a holistic understanding of quality management and business excellence models. In order to reduce costs and to minimise duplication then the audit needs to be standardised so that a generic audit format can be utilised across the whole organisation.
Quality audits are the opportunities to work towards excellence. They are useful in providing advice from across the organisation and also to incorporate new ideas and help from outside the organisation. They are essential to develop innovation and a problem solving culture including all levels of the organisation. This is provided that they also encourage openness and a spirit of cooperation. They can be used to probe and challenge established procedures to develop a best practice implementation culture.
Karapetrovic and Willborn (2000 p. 683) suggested the following requirements of quality audits: - Quality audits should be open and dynamic. They should serve as a method of facilitation to integrate the entire organisation to achieve common strategic goals. The audits should be adaptive and agile and the criteria of quality audits should be improved with time. Individual audits are harmonised and aligned to the achievement of the organisations strategic goals, through continuous improvement of processes. Karapetrovic and Willborn (2000 p. 682)
Continual improvement is necessary to improve the effectiveness of the quality management system and therefore the improvement of the organisation and its staff. Continual improvement begins with good leadership. The leadership needs to be proactive and one that encourages employees to get involved in the determination of best practice. Leadership cannot be too prescriptive; the leadership within the organisation needs to be an enabler for staff to work to improve quality.
Clear and precise communication is essential to any successful implementation (Sarker and Allen, 2003, p. 816). The communication process should include sharing positive and negative results, not only with the specific teams, but with all staff within the organisation. This will allow the staff to express any concerns that they may have. The communication process will need to be a continual process and it is imperative that the feedback loop remains intact.
If the strategic plan is followed and communicated appropriately, then the implementation of the discussed performance tools should run smoothly. The worrying concern is that if the strategy changes and the changes not communicated to the staff, this will cause problems with the employees, and ultimately have a significant effect on the implementation plan.
Benchmarking could be an important part of the future of the NHSBT. As long as it is aligned with the long term strategy and completed correctly, it could prove to be a powerful tool to continuously improve the processes and systems within and eventually lead to "best or better" practice. The future of any initiative will lie with how this is incorporated within the organisation.
The Balanced Scorecard is a powerful tool that will help the organisation implement the strategic aims. The current gap within the organisation is the lack of clarity regarding the content of the strategy and the distribution to all staff. The use of the balanced scorecard will allow the strategic aims to be implemented at operational levels. The transparency of the scorecard will allow staff to visualise the aims of the organisation.
Audits are essential to the continual improvement of the organisation. The biggest obstacle is how staff perceives auditing. Some see audit as policing and negative instead of opportunities. This could stem from the attitude of the auditor to the auditee, and the terminology used for errors such as Non-conformance instead of areas for improvement. If audit is to succeed within the organisation, all staff will need to be trained on the benefits of audit and the future benefits that continuous improvement will bring to the organisation and the staff working within.
Within the current climate, any implementation process within the NHSBT will be a difficult and fruitless task, until the organisation move away from a quality assurance and compliance culture to a culture of continuous improvement, any initiatives that are implemented will invariably fail.