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From volume to value 

Healthcare providers must play their part to reform a struggling global health system  By Andrew Coombs, Group Commercial Director at HCA Healthcare UK
By 2020, global spending on healthcare is expected to reach a staggering $8.7tn 1. Health systems across the world are contemplating the challenges that come with managing the health of a population that is living longer but increasingly with chronic and multiple health conditions.

Never before has there been a greater motivation to reform the way healthcare is delivered.

The UK’s state-run National Health Service (NHS) embarked on a programme of improvements five years ago called Getting It Right First Time 2, which is putting the theory from John Wennburg’s seminal 2010 research into unwarranted variations in care into clinical practice 3.
Andrew Coombs
As private providers of healthcare operating in a global market, I believe that the NHS’ Getting It Right First Time programme reinforces three ways in which we too must change in order to operate more efficiently, contain costs more effectively and most importantly, continually deliver even better outcomes for our patients. The 2018 Deloitte Global Health Care Outlook report refers to this as the “shift from volume to value”4:

Clinicians must be front and centre of change

Having been piloted by the British Orthopaedic Association, Getting It Right First Time now covers more than 30 clinical specialisms, each led by those who have both broad and deep understanding of the specialism they are trying to improve. Having foremost consultants leading the programme from the outset has been pivotal to how well it has been embraced by the teams implementing it 5.

In 2018, HCA UK restructured its hospital network to align our major clinical specialisms by department – matching the very best healthcare systems in the world. The Departments comprise of over 1,000 consultant members, and are led by some of the most esteemed leaders within their fields; the Chief Medical Advisor to the Cardiovascular and Respiratory Department, for example, is celebrated by his peers as a ‘father of electrophysiology’. Each Department focuses on ‘getting it right first time’ by: setting quality standards through data and peer-reviewed research, the streamlining and optimisation of patient pathways, and innovation within their specialism.

Within these Departments, we are incredibly lucky that consultants from world-renowned teaching hospitals, including University College London Hospitals, St Bartholomew’s Hospital and Great Ormond Street Hospital, choose to work with us. They have built up their expertise through decades of research into new treatments and techniques. Every day across our hospitals, these consultants come together within each of their respective specialisms and sub-specialisms as part of multidisciplinary teams to debate, challenge and agree treatment options for patients with the most complex illnesses and life-limiting conditions. We combine the broad and deep skillset of these clinicians to put our patients on the best possible pathway - so that a second, third or fourth opinion is debated first time round.

Quality reform must be underpinned by data

As providers of healthcare, whatever our quality ambitions entail, they must be underpinned by high quality data. A fundamental component of Getting It Right First Time is in the way it uses intelligence drawn from national data sets to find new opportunities for learning and improvement.

The clinical analytics team at HCA UK lead the way in the UK private healthcare sector, delivering real-time insights and analysis to our frontline clinicians.


Diagram: A nurse’s view of one, six-week episode of data from a patient who has experienced a major haemorrhage following surgery

In 2017, Professor Sir Bruce Keogh announced our partnership with the prestigious CASS Business School to develop the next leaders in healthcare. Our clinical scientists and research fellows are working together to carry out ground-breaking research, using machine learning to predict the needs of our patients before they have even entered hospital. In the future, nursing levels on the wards will be coordinated in this way, too.

We are developing new ways to parse natural language, so that we can understand more about how our patients would like us to improve.

We do all of this not simply because it makes commercial and operational sense. We do it because we are a learning organisation; we have a moral obligation to seek out the challenges that are going unchallenged in healthcare.

Healthcare must be delivered within a robust regulatory structure

It is not just in the acute hospital setting that Getting It Right First Time is helping us to think about healthcare reform.

As healthcare providers, we must embrace arms-length oversight to drive up quality standards and ensure that we are held accountable for the care that we deliver. Having a robust and transparent regulatory system is one of the reasons that the UK is consistently ranked top in a list of developed nations’ healthcare systems, which also include France, Germany and the United States 6.

In England, the independent regulator of health and social care is the Care Quality Commission (CQC). It ranks every healthcare provider in the country on a four-point scale from Inadequate to Outstanding. HCA UK has the highest proportion of Outstanding hospitals of any provider group 7. We are the only private provider in the country to be accredited for our cancer care by the European Society of Medical Oncology (ESMO). We are the only private maternity provider to be accepted by the Royal College of Obstetricians and Gynaecologists. We are JACIE accredited for our stem cell and bone marrow transplant services. In every hospital, across every service, we are seeking out ways to raise the benchmark of outstanding care. 

But driving up quality standards is not simply something that should be done within our hospital walls. We are striving for sector-wide collaboration in the delivery of excellent care.  Last year, we announced the introduction of the HCA UK Advisory Board, comprised of pre-eminent leaders within the healthcare sector. Our Chair is the former Chairman of NHS Improvement, Ed Smith CBE. The Advisory Board provides strategic insight to our senior leadership team; helping us to deliver long-term change in the way healthcare is delivered in the private market. 

Conclusion: Creating a virtuous circle

Now more than ever, global health systems must take advantage of the appetite and opportunity for change. 

I believe that what Getting It Right First Time really demonstrates is that to effect the greatest change in healthcare, we need to recognise that continuous improvement is created through a virtuous circle of increasing quality standards through intelligent use of data, underpinned by an organisational culture that embraces change and shares a collective vision amongst those delivering the care to our patients. 

As providers and insurers of healthcare, it is incumbent upon us to work together to consider how we respond to the changing needs of our customers. 
Disruptive, computer-based technologies are revolutionising healthcare and enabling consumers to take greater control over their health and wellbeing. 

We must use artificial intelligence to change the way we deliver care for the better. We must take advantage of innovations in robotics to pioneer minimally invasive, minimal access surgery that reduces risks and increases recovery time. We must learn the lessons that predictive analytics in big data can teach us to seek out new ways to improve, grow and thrive. We must use this technology to keep our patients safer, and we must embrace rigorous and robust independent regulation that checks the checker. 

For HCA UK, this is not only a strategic imperative; it’s also a philosophical one. Our ethos is that above all else, we are committed to the care and improvement of human life. We are diagnosing diseases earlier than ever before with state-of-the-art molecular genetic testing. We are halting the progression of Multiple Sclerosis with a ground-breaking stem cell transplant. We were the first private hospital group in the UK to perform a living donor auxiliary liver transplant. We are replacing faulty aortic valves without a single stitch. For every patient living with cancer, we are investing in our clinical research arm to find the next breakthrough.

These techniques and technologies are being carried out by the pioneers in medicine who are fundamental to delivering our ambitious agenda for change. We are working more efficiently, encouraging greater transparency within the private healthcare sector and above all, delivering outcomes that are helping to change the lives of the patients we serve. 

Andrew Coombs is the Group Commercial Director at HCA Healthcare UK, part of HCA - the world’s largest provider of private healthcare. He is also the former Managing Director of AXA PPP International and Finance Director of AXA PPP Healthcare. 


1. Cooper, Terri et al, 2018 Global health care outlook: the evolution of smart healthcare, Deloitte, 2018
2. Briggs, Professor Timothy, Getting It Right First Time: Improving the Quality of Orthopaedic Care within the National Health Service in England, British Orthopaedic Association, 2012
3. Wennburg, John, Time to tackle unwarranted variations in practice, British Medical Journal, 2011
4. Cooper, Terri et al, ibid.
5. Timmins, Nicholas, Tackling variations in clinical care – assessing the Getting It Right First Time programme, The King’s Fund, 2017
6. Schneider, Eric, O’Sarnak, Dana et al, Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care, The Commonwealth Fund, 2017
7. Accurate as of October 2018. Source: www.cqc.org.uk

The Leader - Issue One

Discussing advances in medicine - from the UK's healthcare leaders

MAKO robot technology
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