Patient-centric Target Operating Models key to NHS services of the future

Drivers such as these are pushing NHS organisations to think differently about how they will deliver care to their patients and communities in the future. To address financial constraints while simultaneously increasing productivity, acute providers are embarking on new group models, reconfigurations, and collaborative ways of working. A further cross-section of Trusts are preparing to embark on ambitious building schemes, either as part of the New Hospitals Programme (NHP), or independently; aiming to build modern hospitals to meet the needs of their staff and patients now and in the future.

Reimaging the future of patient care is also being driven by the patients themselves. Today, patients have access to more technology and innovations enabling greater awareness of their health and wellness, and expect the NHS to respond to these changes.

So how can we best plan our NHS services for the future? The answer lies in developing a Target Operating Model (TOM) designed for patients. A TOM describes the desired state of an organisation and provides a vision for the future, explaining how the organisation needs to operate to deliver its strategy and achieve its goals efficiently. In the NHS, the process of developing a TOM helps Trusts answer the three main questions of service redesign:

• Define – What should we change?
• Design – How should we change?
• Deliver – How can we deliver and accelerate the change?

Answering these questions is not always simple. However, we have found through working closely with NHS Trusts preparing to design their new hospital infrastructure as part of the NHP, that taking a step back and favouring a patient-centric approach leads to innovative TOMs fit for the future.  So, what does this patient-centric approach look like?

• Gain insights from your data: Demographic data provides a snapshot of the community surrounding your hospital. Take time to review available demographic data to understand the diversity of your local population, and gain insights into existing challenges some groups may face in accessing healthcare services. You can then tailor future services to meet the specific needs of the population, ensuring that you’re providing the right care at the right time. For example, the Whittington Health NHS Trust introduced a 12-week discharge plan to free capacity for a specialist haematology ward – something vitally important to the Trust and its local patient population.
• Look at how the population is changing: Communities are not static – they change over time. Make note of any predicted changes or population trends such as ageing, migration, and changes in socioeconomic status, all of which can impact healthcare needs. Understanding these trends helps proactively evolve services alongside the community. For example, if the local population is ageing, investment in geriatric services, innovative models of care for proactive, multidisciplinary frailty assessments and supported discharge, and targeted support for caregivers will be high priorities.
• Look beyond your own services: Consider how the needs of your local population are met in the wider system, and how your organisation currently fits within the vision and strategy for an Integrated Care System (ICS). How might you need to change to meet future requirements or models.
• Address health inequalities: Looking at health inequality data across the local population helps to understand factors that influence behaviours, health outcomes, and motivations when accessing healthcare services. Key factors include English language skills, digital skills, education level, occupation status, financial situation, housing, and poverty indicators. By identifying these inequalities, services can be redesigned to be more inclusive and accessible.

Imagine the lived experiences of people using NHS services

When we think about redesigning services for patients that are fit for the future, we have to consider how the current digital revolution is already changing the way communities are living with technology and what this may look like for future healthcare services. Many patients are already using apps to manage their end-to-end journeys through consumer experiences, such as shopping and conveyancing, so why not their journeys as patients too? Developing a Target Operating Model provides the opportunity to reimagine how technology can transform the patient experience, supporting patients to be active participants in their care plans, and engaging with healthcare services in the ways that suit them best.

Part of this digital revolution encompasses understanding demographics, but to truly define, design, and deliver a TOM-centred around patients effectively, you’ll need to go one step further. This is where patient personas – fictional, yet realistic, profiles of potential people who will experience a service – come into play. Personas represent key attributes of the user groups they belong to and provide insight into how different groups navigate the healthcare system. This includes their challenges, needs, preferences, behaviours, and goals. Personas help humanise the data, allowing you to redesign services that are not just data-driven but also empathetic and patient-centred. Through the development of complex personas, representing a broad spectrum of the population, organisations can stress-test future pathways and services to ensure they work for all.

To develop meaningful personas, which add value to your TOM design process:

• Use demographic data on your patient population, recent activity figures, and patient and staff feedback, to develop a list of high-volume pathways and profiles to inform personas.
• Engage with patients and people with lived experience through interviews, focus groups, or surveys. Ask about their experiences when navigating their health and care. Take the time to reach out to seldom-heard groups within your community.
• Look beyond basic demographics and dive deeper into the problems and challenges communities face. What are their aspirations and goals? What motivates them and drives them to act? What pain points or challenges are they experiencing? How aware are they of the services and solutions available to them?

Once developed, use these personas to map out the typical end-to-end patient journey for each group, identifying touchpoints where patients interact with the health services. Map challenges along this journey to highlight areas where patients face frustrations or barriers. With personas and patient journeys in hand, you can then begin to redesign pathways. For example, if a group finds it difficult to manage multiple appointments, you might create a more integrated care plan that reduces their need to travel frequently. Or if another group represents parts of the community that don’t speak English as a first language, you might adopt some of the latest AI-enabled real-time translation tools.

When you use multi-faceted personas to frame redesigned services, you are more able to authentically connect with the people you serve. You will also gain a richness of insight that tests how your future service design will meet the needs of patient groups.

As services are redesigned, it’s crucial to engage with patients who have lived experience to test and refine pathways. Community feedback ensures that changes truly meet their needs and by listening, learning, and responding to them, so that we’re shaping a healthier future for everyone. As we look to the future, the NHS remains a top government priority, with increased investment committed as part of the 2024 Autumn Budget to enhance productivity. A TOM approach is instrumental in helping the NHS deliver this and work differently to address three key shifts: moving care from hospitals to the community, embracing digital transformation, and shifting from treatment to prevention.