Defining an NHS Shared Service Operating Model

The NHS is one of the largest healthcare organisations in the world, serving millions of people across the United Kingdom. As outlined in our Introduction to Shared Services at Scale article, shared services can improve the productivity of the NHS, deliver economies of scale, and drive standardisation. However, the successful implementation of a shared services model within a system as complex as the NHS is dependent on its operating model design. In a time where the NHS faces unprecedented operational and financial challenges, shared services can use resources efficiently, deliver services effectively and maximise patient outcomes. In this article, we explore four key components you should consider as you begin to think about your NHS Shared Service Operating Model.
 

1. Customer Value Proposition
 

Who are we delivering for and how:

Mapping the key customer value proposition for an organisation ensures the design of the operating model meets the needs and expectations of customers – mostly NHS colleagues who will interact with the shared services but also patients, families and carers who may also benefit from it.

The success of any shared service model is ultimately contingent on the value it delivers to its end users. For the NHS, the core value proposition is to provide high-quality healthcare accessible to everyone. This extends across unique internal and external stakeholder groupings, each with differing requirements (as shown below). Understanding various perspectives allows a shared service model to meet these internal and external requirements and stakeholder expectations and contribute to high-quality, accessible care through reducing administrative burdens and / or improving service user experience.

Designing effective channels of service delivery and communication is essential to meeting stakeholder expectations – understanding who you are serving, how and why. Healthcare professionals may prefer direct communication channels for urgent matters like payroll, holiday bookings or ordering tests, while patients may prefer the convenience of digital platforms for scheduling appointments or browsing health records. To ensure inclusivity and equal access to shared services, NHS organisations also need to factor in different needs such as language, cultural and disability requirements. Placing these service users at the centre of designing new services is a must to ensure the model delivers value and matches expectations as opposed to improving process or efficiency for individual shared service functions themselves – the apocryphal change of a process that helps finance do monthly accounts faster but requires 10 new steps for budget holders should not be the aim. Doing this properly will also allow a shared service to set the ambition and scale of delivery – be that at Trust, Group, ICS or Regional level of operation – by understanding customer journeys and across which organisations these will take place.

2. Governance
 

How it will be managed:

Governance serves as the guiding compass that will steer an organisation towards a successfully implemented shared services model. It ensures that the delivery of services is conducted in a manner that is both efficient and accountable and helps to manage risk while seizing further opportunities as the shared service develops. There are three layers of governance:

Across governance layers, there are several focus areas:

• Risk Management: Processes for identifying risks to service delivery and implementing mitigations.
• Performance Monitoring: Assessing the effectiveness of the shared service through Key Performance Indicators (KPIs), ensuring the model remains responsive and continues to deliver value to stakeholders.
• Continuous Improvement: Feedback mechanisms put in place to capture lessons learned and to foster an environment to adapt and improve processes over time.
• Stakeholder Engagement: Regular touchpoints with patients, staff and partner organisations ensures the shared service meet the needs of those it serves.

Designing the governance system to match new shared service offerings, processes and changes is imperative and should be a major focus of any operating model.
 

3. Processes and Data
 

How we will operate:

Processes allow an organisation to deliver value to customers in a repeatable and scalable manner. In operating model design, there is an opportunity for existing processes to be redefined to eliminate inefficiencies and improve workflow. For example, process mapping both HR and finance corporate services processes in tandem to identify opportunities for automation and technology integration. We are also seeing an increased maturity in central government and private sector shared service operating models that are looking to move whole, end-to-end, value streams¹  instead of individual functional processes into shared services e.g. ‘Source to Pay’ (the sourcing of a product or service in the market all the way through to paying for it) or the entire ‘Recruitment to Onboard’ (creating a job role through to helping the new joiner enter the organisation) journey.

ICSs are partnerships designed to bring together local organisations to meet health and care needs. In this context, there are significant opportunities to consolidate administrative corporate services processes across multiple NHS organisations at the ICS level and the scale of this ambition should be set within the operating model. Working at this scale, provides opportunities including pooling of resources to reduce costs, increased procurement buying power and the achievement of greater economies of scale for the collective which can be shared by the individual members of a shared service. Standardising processes across an ICS can improve staff productivity and deliver a consistent user experience (especially if shared services are patient and public facing). Furthermore, leveraging both shared knowledge and technology platforms can stimulate innovation for further process improvements. 

Underpinning process design, accurate data allows for informed decision-making. Data capture mechanisms should be integrated into operating model design to help collect data on service delivery metrics, quality indicators and key risk factors. Data visualisation dashboards can be used to convert complex information to bring about actionable data-driven insights within each shared service process or value stream. The fragmentation of data systems across different NHS Trusts and organisations can sometimes be seen as a challenge in integrating into a shared service. For example, across a single ICS there may be differing electronic health record (EHR) systems, administrative databases, HR and finance systems. To release the true, scaled, potential of shared services in the NHS the creation of the shared service operating model will prioritise understanding these differences by analysing underlying data architecture and models; planning ways of integrating data through data sharing, data capture changes in processes and tools to “join” and simplify data; and ultimately chart a path to a more simplified data and technology platform across the shared service over a number of years by outlining system lifecycle analysis, suggestions on joint procurements / re-platforming and showing the journey to more harmonised data across an organisation or a health system. Data complexity and fragmented systems shouldn’t be a brake on progress towards scaled shared service and the right operating model design can help to bring clarity about how to achieve this better.
 

4. Physical Resources
 

Who, what and where:

Physical resources are a key component of effective end-to-end operations for the NHS – be that people, buildings or tech. A shared service model offers the opportunity to consolidate and improve physical resources, enabling the delivery of deeper specialisms and more efficient automation and digitisation. This consolidation also allows for a more attractive and rewarding career path for colleagues, resulting in better recruitment and retention of the best talent as the shared service provides a critical mass with corresponding career pathways, training and technical leadership.

The operating model will help you to define who will host the function, from a structural and legal perspective, as well as who will work in it. To deliver value to stakeholder groups, the shared service workforce should be designed with the necessary skillsets and experience. Undertaking the right level of design can help identify and address skill gaps, implement experience transfer approaches (e.g. apprenticeships) and refresh performance incentives. It also provides an opportunity to embed a new workforce culture that is user centric and data driven.

Technology is a critical enabler for corporate services. Investment in interoperable technology solutions can facilitate cross-functional collaboration and efficiency. The scalability and security of technology systems must be assessed as part of operating model design if multiple shared service partners are moving to single system solutions, ensuring that organisation and patient-level data is protected. If integration of multiple systems is required then the model needs to design this into implementation and be aware of it when assessing process and workforce improvements.

Finally, if corporate service functions consolidate into a shared service model, this provides an opportunity to optimise the use of NHS estates. Assuming one NHS Trust were to host the shared service operations, surplus estate property can be re-assessed for purpose. Void and underutilised properties can be identified that can be sold, leased for commercial use, or repurposed for clinical use to better allocate estate resource and funding.
 

Conclusion:
 

As NHS organisations navigate the current challenges, shared service models offer a pathway towards productive, agile, and high-quality corporate, administrative and back-office functions that ultimately should drive time to care and help clinical colleagues to increase productivity. Throughout operating model design, the clear components of the value proposition, governance, processes / data and physical resources need to work together to design an effective and, importantly, holistic shared service model. To start your journey to scaled shared services, dedicate time and energy to the operating model design as a first phase of action.

At Deloitte, we understand the challenges and complexities faced by the NHS and we have huge experience in the design and implementation of scales shared services within and outside of the public sector. 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. 

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Reference:

1. Value Streams are described as the end-to-end, cross functional, processes that take an input to a process all the way through to the end customer / user and encompass all the individual processes within that stream.