Salus journal

Healthy Planet. Healthy People.

Healthcare / Service redesign

European Healthcare Design 2016

Humanising Healthcare: Understanding patient demand - a better way to make the NHS work

By Hamish Dibley 15 May 2019 0

This talk explores a new and refreshing approach to how we understand and improve healthcare systems. Hamish Dibley outlines this alternative approach to realising better healthcare services at less cost. It begins with looking at healthcare not from a conventional activity perspective but from a person-centred one.


The NHS must change the way it operates to effectively meet future challenges. The starting point for improved services at less cost rests on more intelligent use of data to inform future performance improvement through system and service redesign.

The NHS has exhausted other ‘misguided’ approaches – for example: standardising; over-medicalising; functionalising; and commercialising operations. Today, we need to humanise healthcare and focus as much on care needs as medical treatments.

Hamish Dibley talks about his work in applying genuine patient-centred principles to healthcare analysis and service design. This alternative approach to realising better healthcare services and less cost begins with looking at healthcare not from an activity perspective but from a person-centred one. Unlike existing practice, the work establishes time-series data to interpret the true nature of person demand for acute services, in order to better understand the root cause(s) of service challenges facing commissioners and providers alike.

Understanding patient demand is the first step in arriving at intelligent system and service redesign solutions around patient cohorts. This informs a more integrated and preventive system that will successfully alter the nature and consumption curve for care, and reduce costs across the system.

This radical and elegant approach outlines the true nature and type of patient demand facing acute trusts and clinical commissioning groups (CCGs). It provides for innovative thinking as to how to propose future improvement schemes, not only to reduce patient demand but also to better respond to, and therefore manage, such demand. This latter aim requires proof of concepts to test new approaches and processes with a small cohort of patients.

This work serves to inform and constructively challenge current cost improvement plans and quality improvement programme planning, as well as provide the basis for broader schemes, such as NHS vanguard projects or joint improvement work with CCGs. Moreover, this way of working provides a better approach to overcoming the principal performance challenges facing all healthcare economies – A&E breaches, delayed transfers of care, and waiting time lists for planned care.