SUMMARY REPORT Meeting Date: 20 March 2014 Agenda Item: 8.1 Enclosure Number: 6 Meeting: Title: Author: Accountable Director: Other meetings presented to or previously agreed at: Trust Board Transformation Update Steve Gregory, Director of Nursing Steve Gregory, Director of Nursing Committee Date Reviewed Key Points/Recommenda tion from that Committee Purpose of the report This paper updates the Board on our approach to transformation, building on the paper submitted January 2014 and what we are doing about turning the rhetoric into reality. Decision/ Approval Assurance Discussion Information Strategic Priorities this report relates to: To exceed expectations in the quality of care delivered To transform our services to offer more care closer to home more productively. To deliver wellco-ordinated effective care by working in partnership with others. To provide the best services for patients by becoming a more flexible and sustainable organisation 1 Accountable Director: Steve Gregory
Summary of key points in report What are the key issues the Board needs to consider in this report? Key Issues: National Context Barriers to Change Our Enablers Work with our Clinical Teams The Board is asked to: Discuss the content of the paper Agree timelines for CIP evaluation Agree for clinical services to consider Future State Note that there is a focused group working at strategy development Is this report relevant to compliance with any key standards? YES OR NO CQC Yes NHSLA IG Governance Toolkit Board Assurance Framework Yes No No Impacts and Implications? Patient safety & experience Financial (revenue & capital) OD/Workforce Legal YES or NO Yes No Yes No State specific standard or BAF risk If yes, what impact or implication 2 Accountable Director: Steve Gregory
TRANSFORMATION AND CIP: TODAY IS WHAT MATTERS 1 Purpose This paper updates the Board on our approach to transformation, building on the paper submitted January 2014 and what we are doing about turning the rhetoric into reality. It is evident that we need to address the challenge of less resources being readily available in a more collaborative and systemic way than we have done before. The appetite to do things differently must be realised, the service transformation board is one of the hubs for this thinking. The Organisation s vision is as follows; To be the lead local provider of high quality, innovative services near peoples homes, working closely with partners so people receive wellcoordinated, effective care. To achieve this we are actively engaging with our staff and Stakeholders. We know that creating the right environment and culture will support the achievement of our aspirations. We have recently submitted our two year plan to the NHS Trust Development Authority (TDA) and are now focusing on our five year plan that will be submitted in June 2014. 2 Context Transformation by its very nature is not a stand-alone activity; there are many dependencies and inter-dependencies. Our Transformation and CIP Board reports to the Resource and Performance Committee. We recognise the need to be as effective and efficient as possible in all that we do. 2.1 National Context There are a plethora of National documents that support the critical role of community providers to make the NHS as good as it can be. For example the recently published Kings Fund Paper (2014), Community Services; How they can transform care identifies the following key themes, Offer patients a more complete and less fragmented service Community services to reach out into communities more effectively Significant numbers of patients occupying hospital beds could be cared for in other settings Wrap services around primary care Build multi-disciplinary teams 3 Accountable Director: Steve Gregory
Other key documents that inform our approach are as follows; NHS Outcomes Framework 2014/15 NHS TDA Securing Sustainability: Planning Guidance for 2014/15 to 2018/19 NHS England: Safe compassionate care for frail older people using an integrated care pathway NHS England Everyone Counts: Planning for Patients 2014/15 to 2018/19 2.2 Local Context The two major area of work that we are involved in are Future Fit and the Better Care Fund. We are involved at all levels of the Future Fit programme and whilst the potential effect does not touch all our services there are clear synergies with our requirements. 2.3 Barriers to change The NHS identified the following six barriers (see diagram 1) to why innovation is not adopted. Our approach to transformation is proactive in nature; embedding new ideas, new ways of thinking, adopting approaches that have the potential to work in our area and implementing best practice. 4 Accountable Director: Steve Gregory
It is worth noting that 70% of strategic failures are due to poor execution of leadership, we recognise the need to invest in our leaders and equip them with the right skills. 3 Service Transformation Our approach is to use the NHS change model (see diagram 2 below) as a method of delivering the change alongside service improvement methodologies, i.e. the productive series. We recognise the need to have more impetus in business case and tender submissions. It is not possible to be sustainable and rely on solely being more efficient. The organisation as a senior leadership group that discusses a range of topics and embodies a spirit of action learning. This group discussed transformation and then identified what they felt were underpinning clinical themes. The intention is to have an owned clinical strategy that is understood by all and provides a clinical drive for our future state. Our clinical teams have already been thinking about what the future looks like for example; Community services CAMHS Community Hospitals We are going to take time-out with our clinical teams in May to shape with 5 Accountable Director: Steve Gregory
them what the future looks like and support them to develop sustainable business plans. Appendix 1 shows the process that we will work through with our teams. The key is to get people to think of how, what they do now influences the future. Appendix 2 moves this on a stage to, what are the steps that managers and leaders can make to achieve the future state. 4 Cost Improvement Programme It goes without saying that we need to have a consistent grip on our pay and non-pay spend. When we are developing our schemes to change the way we do things, we test them out against the following: Safety Experience Equality Outcomes We have a session booked on the 10 th April where those schemes that impact upon patients will be assessed against the above criteria. In May we will be taking time out with our Clinical Teams and Corporate Services to shape what the future looks like. The expectation at this stage is that there will be a credible and sustainable output from these sessions. Service business plans will be formed and shaped for the next few years. We will ensure that the patient perspective is afforded due consideration. 5 Our Enablers To deliver our clinical vision the following components are necessary and demonstrated in the diagram. A L I G N E D ESTATE WORKFORCE CLINICAL STRATEGY FINANCE IM&T It is expected that our summarized Clinical Strategy will be completed by the A G I L E 6 Accountable Director: Steve Gregory
end of April and will be contained within our Quality Account for 2014/15. Our staff will need to be equipped with different skills to lead and drive change. Organisational Development will support this agenda and consider the use of appropriate service improvement methodologies. 6 Recommendations Discuss the content of the paper Agree timelines for CIP evaluation Agree for clinical services to consider Future State Note that there is a focused group working at strategy development. 7 Accountable Director: Steve Gregory
Appendix 1 Service Redesign Model Right service first time - doing things once well Strategic Challenge of the NHS (Provision of high value, affordable and sustainable services that are shaped around users needs) Trust - vision, values, roles and goals Current State Future State Phase 1 Undertake holistic needs assessment Phase 2 Determine right clinical solution Exceptional workforce and volunteers Exemplary levels of existing services Phase 4 Shape corporate infrastructure Plan Do Study Act Phase 3 Map the clinical process required New innovative models of care Excellent clinical and corporate outcomes Excellent patient and carer experience Corporate growth and diversification Local Stakeholder Engagement Networks and Partnerships Step 1. 100% responsibility Step 2. Be action orientated The Six Steps Operational Management Model Step 3. Feel valued, Step 4. Clearly understand goals Step 5. Supporting to take action. Step 6. Seek out and act on feedback. 8 Accountable Director: Steve Gregory
Appendix 2 Transformational Change Model The means to make corporate vision a reality Every hour of every day provides us with the opportunity to make new choices and create new results. Management M Step 1. Each individual will take 100% responsibility for the results they achieve. Leadership L Step 1. Use the NHS challenge to change the Trust s paradigm. M Step 2. Be action orientated and make things happen. L Step 2. Reaffirm the Trust s vision, values, roles and goals. (Right Work Statement). M Step 3. Colleagues will feel valued, their high levels of motivation will put them on their "A-Game. L Step 3. Determine what proportion of the Trust s activity meets the right work statement. This is the Right Work Ratio (%). M Step 4. Colleagues must clearly understand what they need to achieve for the organisation. L Step 4. Raise RW to 90% Stop activity that doesn t meet a clinical need. Transfer nonacute activity to other services. Inform Commissioners of unmet needs. M Step 5. Colleagues will be supported to take action and be successful. L Step 5. Calculate value to waste ratios in high activity services. Apply waste reduction targets to all areas and increase value element to 90%. Use Service Redesign Model. M Step 6. We will all constantly seek out and act on feedback committing to never ending improvement. L Step 6. Identify new commercial opportunities to utilise freed up capacity. Virtual ward Hosp at home Ambulatory GP Clinics 9 Accountable Director: Steve Gregory