Joining up the dots: Interview with Robbie Pearson

The challenges facing Scotland’s health and social care services are well documented. From an ageing population, to the increasing complexity of care, rising expectations and budgetary constraints, the issues are well known.

But while the challenges faced north of the border have grown and changed over time, so too has the work of Healthcare Improvement Scotland (HIS). In fact, as chief executive Robbie Pearson explains, since its formation in 2011 the organisation has been on a journey.

He told Holyrood: “If you go back to 2010 when the Quality Strategy was developed for Scotland, there was a really strong, cross-party consensus focused on the ambitions of safety, effectiveness and person-centredness. Ten years later, we have very much built the organisation around them, focusing on a single purpose to drive improvements in the quality of care. What we’ve done as an organisation is come together, with a series of very different parts all working together – whether it is bringing together the best available evidence, the person-centred focus of the Scottish Health Council, quality assurance or improvement programmes. We now recognise there’s a real added strategic advantage for us as an organisation from these parts not just being within Healthcare Improvement Scotland, but working in a much more connected way to help deliver the Quality Strategy across health and social care and, along with it, those three ambitions, in a more connected and coherent way.”

HIS has been providing quality assurance of healthcare through scrutiny of NHS hospitals and services, and independent healthcare services, for around a decade now, with the organisation reporting and publishing findings on performance to demonstrate the accountability of these services to the people who use them.

And it’s easy to forget that quality assurance and scrutiny actually started in Scotland through HIS, and is still relatively new. In fact, in historical terms in Scotland the concept is very new, with HIS making huge steps forward in a very short amount of time.

Pearson told Holyrood: “Take mental healthcare, for instance, which is a key national priority for the government and for the cabinet secretary. What we’d like to do in future is not just think about how one aspect of Healthcare Improvement Scotland responds, whether it is helping to reduce child and adolescent mental health waiting times, but thinking about how – across our functions and expertise – we can work in a more connected and concerted way to try and drive improvements in the experience of children and families. It might be about evidence, it might be about good practice and how that comes together, it could be about improvement support, it could be about quality assurance, but also, about giving a voice to children and young adults, and their families, in helping to improve the quality of care, which would be through the Scottish Health Council. Of course, not just in healthcare but social care also.

“So thinking about how all those three or four pieces come together to tell a more connected story about driving improvement, because we know one bit of the organisation in isolation won’t do it. It’s about how it works together in a much more coherent way. That’s about the growth and the development of the organisation, and where we’ve come from, because if you’re in England, you have four or five different organisations doing the same thing that we do. That’s a big strategic advantage in Scotland, that we have in this organisation, in helping to maximise the impact on quality of care. We actually need to spend a bit of time reflecting on that advantage, and how we really drive the impact.

“In future, we are going to have to make some choices, in terms of how we align our effort and where we focus. It shouldn’t just be an aggregation or an accumulation of things, it will probably require us to make more confident and harder choices about what we should be doing ourselves as an organisation. That’s also about how we’ve grown. All organisations will have teething problems but we’re becoming a much more confident and assertive organisation, about what we think the priorities are and how we demonstrate our contribution to that. That’s a big step for us, in terms of our thinking and our maturity as an organisation, and it’s a really good place to be.”

While the organisation has matured, Pearson has also been examining how best it can demonstrate its impact. HIS has a £30m budget and 450 staff, but how does it draw a line from the work being done by each part of the organisation and the funding it requires, to the improvement it brings?

He said: “We make a contribution through the Scottish Patient Safety Programme to the 14 per cent reduction in hospital mortality, reductions in cardiac arrests – there’s a great example in Lothian of a 44 per cent reduction – by earlier intervention, the safety checklist, improving communication and teamwork in theatres, which helped to contribute to a 36 per cent reduction in surgical mortality. Those are the sorts of really important things we can measure on the impact and the contribution we make to improvements in the quality of care. But we need to demonstrate it right across the breadth of our organisation. That’s quite a tricky thing to do, because we’re not on the frontline delivering care, we’re helping those on the frontline drive improvements in the quality of care. So, in a sense, we are trying to peel back the layers of an onion, to try and get to the heart of our impact as an organisation and we need to do more of that.”

Meanwhile, HIS’s work is expanding, either through new ministerial priorities or the creation of new legislation. And while it must respond, HIS also has a role in setting its own priorities, and where best to target its resources.

“That will be a big challenge for us, because what we do has grown into a very diverse range of things. We now maybe need to better understand where we can maximise impact.”

Meanwhile, this recognition that no one organisation, or one part of an organisation like HIS, can solve a problem on its own has led to a belief in the need for partnership working, between different agencies or groups across health, social care and the third sector. To what extent does that approach represent a solution to growing challenges?

“Partnership working, particularly in the context of an ageing population and scientific advance, and financial challenges, is going to accelerate. That’s because of a recognition you can’t do everything alone, it’s about how you respect the contributions of different organisations to drive improvement. It’s also about organisations setting aside some of their territorial boundaries and recognising that everything doesn’t come down to sovereignty, if you set aside some of those things, which are obstacles which get in the way, then you can get a more impactful result.

“Very little of that work is about legislation, and very little is about structural reform, in my experience, it’s much more about leaders working together in a collaborative fashion. Part of that is about cultural change, attitudes, and people’s ability to respect the values and contributions of partner organisations.”

Pearson recently attended the Scottish Leaders’ Forum, which brings public sector leaders from across the country to sit down together. All sorts of agencies attend, from the NHS, to local authority leaders and parts of the emergency services, alongside the Deputy First Minister and members of the cabinet.

“It’s a chance to talk about the impediments to greater collaboration and partnership working, as well as some of our successes – and a lot of those successes came down to leaders just getting on with it.

“It’s a really important part of the public sector architecture in Scotland, to bring all those leaders together in a room. And where else in the world can you get all the public sector leaders together in one place, with ministers, to talk about the challenges facing the country? We were talking about the National Performance Framework, which sets outcomes for Scotland as a country, and how we can work together more closely as organisations to make sure we deliver. It’s a great arena.”

Could this sort of approach help in other areas of health and social care? With an issue such as bed blocking, for example, a big part of the problem stemmed from people and agencies operating in individual silos, without addressing the underlying issues. Given HIS’s range of activities – which extend across the health and social care sector – Pearson is in a unique position to understand how different agencies or organisations can contribute to solving a problem. Does that partnership approach also apply internally, to the different strands of HIS’s work?

“It’s critical to our success as an organisation. Later today I will be spending time with a range of staff involved in our quality management system, which is essentially based on the understanding that improvement in quality isn’t just one dimension. There are three dimensions to it, our quality management system is about quality control, quality improvement and quality planning, and how those three things work together in a more connected way to try and drive improvement. Promoting that internal collaboration is a strategic opportunity for the organisation.”

But while the organisation moves forward, preparing to meet growing challenges, keeping the individual central to HIS’s work is critical.

Pearson said: “It’s absolutely something we need to keep central. Why are we here? Ultimately, it’s to make an impact on the experience of individuals, not just patients, but also their families. That’s an important part of our role. But it’s also in terms of testing us in how we set priorities, because unless I am able to explain what the impact is on an individual’s experience, at hospital or in the home, then we are missing the point.”.