• Industry: Healthcare
  • Type: Survey report
  • Date: 10/8/2012

UK: Circle improves patient experience, quality and value of care through active staff performance management 

Frustrated by the perception that professionals had largely been left out of leadership and decision-making positions in UK healthcare, the founders of the British healthcare provider Circle developed an employee-owned partnership that now operates five facilities in the UK. The group provides both NHS and private health services through a model that is led and managed by clinicians supported by hospital boards consisting primarily of consultants and nurses.

United Kingdom

How it led to productivity improvement

At Circle, the primary focus is on the patients’ needs and therefore incentives for productivity and quality are aligned throughout the organization. The Circle model is characterized by five main differentiators: ownership; clinical units and leadership; continuous quality measurement and improvement; recruitment and reward.

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Ownership: With the belief that clinicians cannot deliver excellent healthcare on their own, all employees who work directly or indirectly in clinical services are offered entry into the partnership. All new clinical professionals are provided with a one-time loan to purchase a fixed amount of shares, after which additional shares are allocated each year based on performance. These partners own 49.9 percent of the company with the remaining portion owned by Circle International plc.

Clinical units and leadership: Circle’s hospitals are divided into individual clinical units consisting of between 50 to 100 people and directed by a lead consultant, nurse and administrator. Each unit has a seat on the hospital board and is solely responsible for all decisions that impact patient care including the cost and quality of care, activity volumes and balance sheets. By becoming closely engaged and developing a strong understanding of the goals and performance of their units, employees are afforded high levels of autonomy. Circle also offers clinical leaders a two-year leadership development program that aims to provide all of the necessary skills for managing a unit.

Staff performance management: Each clinical unit actively manages their staff performance on a monthly basis and measures results against four key indicators: clinical results, patient experience, value for money, and staff engagement. To support this activity, patient feedback forms are reviewed to identify potential bottlenecks which, when identified, are responded to with action plans that are generally followed up within six weeks. Patient feedback is also published – uncensored – on the Circle company website.

Employee rewards: Circle also operates an individual reward program that, on an annual basis, determines employee compensation based on performance. Two separate appraisals take place each year and are largely based on feedback from five to ten colleagues (both upward and downward) which determines the pay and share allocation for the coming year.

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Key results4

As a result of their employee-focused operating model, employee engagement and involvement has successfully been embedded into the culture of the organization and its ways of working which, in turn, has impacted all key outcome metrics. For example, the organization has experienced a productivity gain of 22 percent in a single year within their Nottingham treatment centre, and a 17 percent gain in the Midlands. At the same time, Nottingham achieved an employee satisfaction rating of 90 percent and Midlands achieved 91 percent which has greatly impacted the organization’s ability to recruit new staff.

Importantly, patient satisfaction has also improved with 99.6 percent of patients from Nottingham saying they would recommend their services, and the Midlands and Bath locations received similar results (99.1 and 98 percent respectively). And while all services and specialties maintain their own unique clinical outcome data, both the Nottingham and Midlands centers have shown a ‘return to surgery’ rate that is four times lower than the national average. Indeed, in 2010, readmissions to the Nottingham center were 5.7 times lower than the Independent Sector Treatment Centers (ISTCs) target and almost 100 percent better than the national average.

Moreover, Nottingham achieved growth in revenue per case of 7.8 percent in 2009 and 9.2 percent in 2010, helping the organization’s gross profit increase from 22 to 28 percent in 2010.

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4Circle, UK


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