The North East Transformation System (NETS) is the model used by NHS North East to lead continuous quality improvement and the realisation of their vision.

NETS is an approach that all NHS North East organisations are encouraged to follow and is built upon the three components of vision, compact and method.

• It is a philosophy to be applied at all levels, individual members of staff, teams, organisations and the system. Fundamentally it puts the people of the North East and patients of NHS North East at the centre of the system.
• It balances the components of vision, compact and method (see below) and delivers real change.

Vision

NHS North East has deliberately set a highly aspirational vision supported by a number of strategies that together create the common purpose that binds all of the component parts together. The NSR process was the catalyst for producing the document ‘Our Vision, Our Future’ that articulates the high level vision. NHS North East has stated the vision at the highest level in terms of zero tolerance to defects in the system, and the pursuit of ideal care. Although aspirational this vision immediately takes the NHS beyond the culture of targets and benchmarking. It has a lot of support amongst all staff and the public:

• No barriers to health and wellbeing
• No avoidable deaths, injuries or illness
• No avoidable suffering or pain
• No helplessness
• No unnecessary waiting or delays
• No waste
• No inequality

NHS North East has traditionally done well in benchmarking and the Healthcare Commission has rated services in the North East as easily the best (over 90% are good or excellent). However everyone knows from everyday experience that the service is not nearly good enough. In the eight dimensions of the NSR ‘Our Vision, Our Future’ builds upon the zero tolerance approach to produce highly aspirational but achievable strategic goals which in some ways makes it quite radical compared to others in the country (for example in maternity care the vision is to achieve 168 hours consultant cover in all labour wards. Work is actively going on to see what the implications of this are).

Compact

Whilst necessary, developing vision is clearly not sufficient and the NETS approach insists upon the vision being complimented in equal measure with a compact that aligns culture and behaviour as well as consistent method for continuous improvement.

The compact describes the unwritten rules, the behaviours and the signals that are sent by managers. Understanding those behaviours often explains why important projects fail, why people resist change, why evidence based practice does not spread as quickly as expected and so on.

NHS North East again has a good track record of managing change (for example all of the national cancer improving outcomes guidance has been delivered and implemented, modern techniques for managing heart attack with immediate coronary artery intervention has been implemented etc, all firsts in the country) but to truly transform we need to go much further. Work on ‘compact’ is primarily about aligning people and organisations to the vision.

It explicitly sets out the ‘unwritten rules’ making them written and transparent, it sets out the expectations and behaviours that are required to be more effective in delivering change and it is mutually binding and enforced.

It is a reciprocal contract for the ‘give and the get’. However, its obvious common sense application to change management does not mean it is easy or quick to achieve.

Having learned from Toyota, we can express a vision that every member of staff in the NHS, and every contractor, is both a quality inspector of the services they provide and an improvement manager. Leadership is clear and highly competent, and within the system both competition and collaboration are appropriately managed to deliver patient centred benefits as described by the vision.

Method

How change is managed and how organisations work is fundamental to achieving the vision. The North East Transformation System insists that organisations commit to ‘this is how we do things’ rather than trying to manage change in an ad hoc way. We look for method that is consistent and repeatable and becomes a set of tools and activities that deliver transformational change.

NHS North East has, through NETS, got all organisations to adopt the philosophy of equal balance between vision, compact and method. But method is a matter of choice. Some organisations are committed to ‘six sigma’, some have clear partnerships to enable them to learn (for example Newcastle Hospitals has a partnership with the academic medical centre in Pittsburgh) and seven organisations have chosen the Virginia Mason Production System to be their method.