Outcome Focused Design in Shared Services
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The NHS has been exploring the use of shared services for many years, with benefits including economies of scale, the reduction of duplication, and standardisation across organisations. However, the uptake of shared service models in the NHS has been slow due to operational and financial challenges posed in implementing at-scale back-office solutions. To address these challenges, an outcome focused approach is needed in the design and implementation of shared services in the NHS which prioritises user needs. In this article, we will explore the concept of outcome focused design and its potential to help the NHS overcome the challenges of implementing shared services at scale.
What is Outcome Focused Design?
Outcome focused design is an approach that focuses on achieving specific, measurable outcomes rather than just delivering outputs or tasks. It places the emphasis on the end results and value for the user. This service is then continuously improved based on user feedback and data on the user experience. The principles of outcome focused design include:
- Defining clear objectives: Identifying long-term desired outcomes, prioritising what success looks like for both internal stakeholders, such as administrative staff and healthcare professional, as well as external stakeholders, such as patients, suppliers and the government. For example, reducing the administration costs across NHS Trust hospitals by 15% within the next 5 years.
- User-centric approach: All design decisions revolve around meeting the needs of the end users and solving their problems, by focusing on what the end user values most it will ensure the service is more efficient and will often reduce complexity as the service is designed with simplicity and intuition in mind. For example, the use of surveys, focus groups and end-user interviews.
- Measurable metrics aligned to outcomes: Quantifiable metrics evaluate the level of success in meeting objectives. For example, improving service user satisfaction net-promoter scoring as well as increasing payroll accuracy by 2.5%.
- Flexibility and adaptability: Desired outcomes may change over time in response to evolving end user needs. Building in flexibility and adaptability into a shared service operating model design allows organisations to effectively manage challenges as they arise. For example, building in a modular approach to service design. This would allow for the different needs of NHS Trusts to add / remove modules as needed to suit changes in demand.
Our Centre Office approach to shared service design prioritises user needs throughout the design and decision-making process, as laid out above. Consistent feedback loops and a focus on delivering value for end users, allows for an adaptable approach to shared service design and ultimately an improved outcome for frontline workers.
Benefits of Outcome Focused Design in NHS Shared Services
The below details a scenario in which an NHS Integrated Care Service (ICS) used outcome focussed design processes in centralising their legal services across four NHS Trusts:
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Stage |
Description |
Objectives |
The NHS ICS defined measurable objectives to guide their efforts in designing a shared service for legal across the ICS: 1.Reduce legal costs by 20% within the first year by centralising legal services and leveraging collective buying power through selected firms. 2.Develop a shared repository for knowledge and collaboration among the x4 NHS Trusts in the ICS. This is to share lessons learnt and reduce the need for outsourcing advice from third-party legal firms. 3.Increase the utilisation of in-house NHS legal resources by 30% within two years, reducing reliance on third-party legal firms and reducing spend. |
Process |
The organisation used an outcome-focused design approach: •Conducted extensive research and engagment with key stakeholders, including legal staff from each Trust. •Carried out user interviews, workshops, and collaborative sessions, identifying pain points such as fragmentation, high costs, and limited knowledge sharing. This insight guided the design process, ensuring that the shared service model addressed these issues effectively. By keeping a strong focus on user needs and desired outcomes, the organisation developed a streamlined and user-friendly system that centralised legal services across the ICS into one organisation. Regular user testing and feedback loops were implemented throughout the design and implementation processes to ensure that the model remained useful and efficient for the end users. |
Outcome |
By defining measurable objectives, the ICS was able to track their progress and demonstrate tangible results. They successfully reduced legal costs within the first year, achieved improved knowledge sharing and collaboration among the Trusts and increased the utilisation of in-house legal resources using apprenticeships and solicitor hires. These outcomes not only delivered cost efficiencies but also improved legal support for patient care. The shared service model allowed for better risk management, resource resilience, increased compliance, and enhanced legal outcomes, benefiting both the NHS Trusts and the patients they serve. |
How to move to an outcome focused approach
While the concept of outcome focused design presents a clear opportunity for user centred shared services within the NHS, there are challenges to overcome:
Supporting cultural mindset changes - Implementing shared services often requires significant changes to well-established processes, roles, and responsibilities, which can be met with resistance from staff and stakeholders. To overcome this resistance, clear communication and stakeholder engagement are essential. While innovation and outcome-focused design are not necessarily interlinked, fostering a culture of innovation can help to encourage staff to think expansively and approach challenges in new and creative ways. This can lead to more effective and efficient solutions that better meet the needs of end users and stakeholders.
Integrating flexibility - Designing shared service models with flexibility and adaptability in mind is essential to accommodate the merging of different organisational structures. In addition, prioritising user needs and designing shared services with a user-centric approach can be particularly challenging in the NHS. Unlike private sector retail and service interactions, where user experience (UX) has become the norm, the NHS has traditionally struggled to prioritise UX and user-centric design. This is due to a variety of factors, including the complexity of the NHS structure, competing priorities, and a lack of funding.
Leveraging technology - Legacy systems, interoperability issues, and limited IT infrastructure can hinder automating back-end processes within shared services. Investing in modern technology solutions up-front, such as cloud-based platforms, may provide long-term value and efficiency improvements.
Outcome focused leadership - In high-pressure and low-resource environments, such as the NHS, short-term objectives are prioritised. Leadership should be exposed to regular insight sharing from frontline staff and patients, making the long-term need for shared service implementation clear. This is to ensure the focus remains on long-term outcomes throughout the design and implementation phases of NHS shared services.
Conclusion
The potential benefits of outcome focused shared services at scale for the NHS are significant. By prioritising long-term outcomes, fostering a culture of continuous improvement, and leveraging technology solutions, the NHS can bring about efficiency, cost savings and productivity gains which ultimately lead to improved patient outcomes. At Deloitte, we understand the challenges and complexities faced by the NHS. With our expertise in operating model design and implementation, we are well-positioned to support the journey towards implementing shared services at scale. To sign up to be notified of Healthcare Shared Services publications from Deloitte, please sign up here: Healthcare Shared Services - Community sign-up | Deloitte UK.
