Read time: 2 minutes
Date: 04/2021
Dr Nigel Lyons has more than 30 years’ experience in the NSW Health system as a clinician, manager and top-level executive. He previously led the NSW Agency for Clinical Innovation (ACI) and Hunter New England Local Health District and in his current role as Deputy Secretary, Health System Strategy and Planning, his responsibilities include strategic health policy development, inter-jurisdictional negotiations on funding strategies and system-wide planning of health services. His extensive experience working with stakeholders to successfully drive health system reform offers valuable lessons that are relevant for broader systems-change. When we met recently over Zoom, Dr Lyons shared his insights into the successes – and pitfalls – of leading large-scale system reform.
-Mary Haines
Top Tips: Dr Nigel Lyons on leading large-scale system reform
Mary Haines: What do you see as the key elements of successful large-scale system reform?
Dr Nigel Lyons: “I think large-scale system reform is a real challenge. It’s about having the right potential change that has been well-enough tested, tried, and thought through that might be appropriate to scale up and implement more broadly,” says Dr Lyons.
On top of evidence, he says there needs to be the right window, when there’s a groundswell of support from stakeholders and others to make changes to address a problem.
“So it’s not just that you’ve got to have a good evidence-base, a project that’s actually been demonstrated to deliver. It’s got to be the right fit for an issue or a problem that’s emerged at a broader scale level at a certain point in time.”
The opportunity to implement the reform might come from a political cycle, an emerging clinical problem, or a system problem that people see as critical, he suggests.
Mary Haines: So it’s this idea of a burning platform that people agree on and an environment that’s ready and ripe to move. Have you got an example of that, where all the stars lined up for you?
Work done at the ACI on value-based care is a good example, says Dr Lyons.
“So we’d done a whole lot of work at project level and had done some work within the networks to demonstrate the benefit. We’d established the case for value-based care, the principles that might be behind it.
“But then there was an opportunity at the system level to say: well, government is concerned about the trajectory that health is on; there’s a desire from clinicians to think more about clinical outcomes for patients; patients are much more attuned to the idea of being involved in their care and their experience, and what they desire from their care for chronic conditions is emerging as a key issue. “
That offered the opportunity to drive the move to value-based care to address all those issues and take the system forward, he says.
Those two key factors – having evidence to demonstrate the impact of a reform and the right opportunity to implement it – were also behind the statewide implementation of the Telestroke Service, Dr Lyons says.
The benefits of the Service, which gives emergency departments telehealth access to specialists 24/7 for urgent assessment, diagnostic and treatment advice on suspected stroke, were established by firstly implementing the program in a small area of the state.
“And then there was an opportunity to implement through a promise in the lead up to an election for an investment by government ,” he says.
“You can’t just try and force these things. It’s really got to be that you do a whole lot of work in advance to test, try, and gather evidence. And then you look for the opportunities to implement the reform.”
-Dr Nigel Lyons
Mary Haines: Given what you’ve learned throughout your career, what would you say are the biggest pitfalls for a future leader to sidestep as they contemplate large-scale reform?
Dr Nigel Lyons: “I think you’ve got to be tapped into your constituency and understand the context and make sure that your key stakeholders – the people who are going to need to deliver that change – are on board.”
“In health, it’s a human industry, so your staff, your clinicians, the people who support the managers and everybody in the system who do those things have all got to be in agreement that this is something that we need to shift.
“The second thing is you’ve got to have an investment in enabling infrastructure.”
For example, he says the ACI established a solid foundation of relationships and built evidence around potential reforms, including gathering international evidence and showing how it relates to what’s being done locally, and demonstrating the impact of the reform.
“So that enabling infrastructure to enable the partnerships, the relationships, the evidence-building, even if it’s at a micro or meso level, before you actually try starting to do it at large scale.”
Without those factors, large-scale reform is unlikely to succeed, Dr Lyons says.
He adds that failing to give large-scale reforms sufficient time to be implemented effectively and to demonstrate impact is another common pitfall.
System-level reforms need at least five years to be successfully embedded and sustained, he suggests, but many reforms are abandoned before they reach that point.
Mary Haines: In a nutshell, what are your top tips for large-scale system reform?
Dr Nigel Lyons: “I think the first thing is about understanding context, having a solid evidence base and demonstrated benefit of impact, and then having that window of opportunity where the stakeholders and the stars are aligned around this being something that’s of a high priority to address and we will all commit to investing in the change,” says Dr Lyons.
Mary Haines: What do you foresee will be enablers of large-scale system reform in the future?
Dr Nigel Lyons: “Technology is the key, and I think the integration of technology is going to be critical. And the connecting of systems through that integration of technology, particularly information technology. So, I think the connectedness of the system and linking it up in a way that enables information to be shared in real time, but also to gather the data that gives us those unique insights that go across the current silos of care.
“So we can start to see the patterns that emerge and the analytics will drive insights into things that we don’t currently see that will give us an opportunity to look for where the changes should be made and what we should invest in. That’s my sense.”
April 2021.
Interview by Mary Haines, Founder and Director of Mary Haines Consulting (MHC), a boutique consultancy specialising in strategy, implementation, research and evaluation. MHC developed the five minutes interview series as a platform for leading professionals to share their know how.
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This article was first published by Mary Haines Consulting Pty Ltd: www.maryhainesconsulting.com.au.