Service Improvement
in the NHS Presented
by Maggie Morgan
Cooke
NHS Context
• Need to harness learning and move on in support of next stage of
NHS reform
• Future challenges will need new approaches that are proven to
work
• Need for a culture of continuous improvement
• Need for more rapid adoption of new products and technologies
• Need for improvement and increased efficiency and to contribute to
overall efficiency and cost reduction targets
The Vision of the Institute
•
Capture worldwide best practice
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Focus on agreed priorities
•
Create high impact solutions
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Identify changes to enable the NHS to meet the big future challenges
•
Support local capability development
•
Support rapid dissemination and commercialisation of product and
technology innovations from within and outside the NHS
•
Support rapid adoption and spread through networks, guidance, tools and
facilitation
•
Anticipate the challenges of tomorrow and deliver the solutions today
NHS Institute &
Wider System
Set Direction
& Priorities
Based on
priorities agreed
with sponsors
and stakeholders
NHS Institute &
Wider System
NHS Institute Work Process
Within the Wider System
TEST &
LEARN
DEVELOP
CONCEPTS
UNDERSTAND
& REFRAME
DESIGN THE
DELIVERY
Wide
Implementation
Linked with
the mainstream
performance
& development
agenda
UNDERSTAND
STAKEHOLDERS
REFRAME
OBSERVE +
INQUIRE
PEER
REVIEW
PEER
REVIEW
PEER
REVIEW
GENERATE IDEAS
SYNTHESISE
DEVELOP
CONCEPTS
SIMULATE
PROTOTYPE
FIELD
TEST +
REFINE
CONSOLIDATE
STAKEHOLDER
REVIEW
DEVELOP
+
PACKAGE
STAKEHOLDER
REVIEW
INTRODUCE
INTO
SERVICE
Overall Reform Agenda
STAKEHOLDER ENGAGEMENT / MARKETING
KNOWLEDGE MOBILISATION
EVALUATION AND MEASUREMENT
PROGRAMME / PROJECT MANAGEMENT
RESOURCE PLANNING AND MANAGEMENT
LOGISTICS
Benefits
Realisation
Creation of
‘impact’
knowledge
Using technology to support
improvement
NHS Collaborate
A Social Networking tool
for the Practice Partner Network
What is social networking?
• Developing online social networks for people who share interests
and activities – in this case, the PPN and improvement
• Communication through blogging, discussion forums, sharing
resources and collaborative working
Connecting For Health
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Background and introduction
The NHS is changing the way it works. Its vision for the future is to have a more modern, efficient, patient-led
health service and to give patients more choice and control over their own health and care.
Key Facts
Better, safer care to patients
Enable clinicians to increase efficiency and effectiveness
Give healthcare professionals access to patient information safely, securely and easily
NHS Connecting for Health, which came into operation on 1 April 2005, is an agency of the Department of
Health. Our purpose is to support the NHS to deliver better, safer care to patients, via new computer systems
and services, that link GPs and community services to hospitals, and to maintain the national critical business
systems previously provided by the former NHS Information Authority.
Accurate information is crucial if patients are to have choice and receive the right care at the right time. A key
aim of the National Programme for IT in the NHS is to give healthcare professionals access to patient
information safely, securely and easily, whenever and wherever it is needed.
The National Programme for IT is creating a multi-billion pound infrastructure, which will improve patient care by
enabling clinicians and other NHS staff to increase their efficiency and effectiveness.
It is doing this by:
creating an NHS Care Records Service to improve the sharing of patients' records across the NHS with their
consent
making it easier and faster for GPs and other primary care staff to choose and book hospital appointments for
patients
providing a system for the electronic transmission of prescriptions
ensuring that the IT infrastructure can meet NHS needs now and in the future.
Central truths of improvement
• Every system is perfectly designed to get the results that it gets
• If we want different performance, we must change the system
• To change the system, we must think in fundamentally different
ways
What is currently in the way of
widespread transformation?
•
There is massive fatigue and frustration with the current system:
How can we use this to catalyse positive change?
•
The NHS has an abundance of knowledge, skills and techniques
used in limited ways to varying degrees of success:
How can we optimise and build on this?
•
Staff at every level trying to make service improvements repeatedly
stumble across the same obstacles:
What underpinning new ways of thinking could circumvent this and
accelerate us forward?
•
Organisations struggle to harness organisational energy around
shared goals
What ideas, strategies and tools could help?
Drivers of efficiency and quality
internal
external
voluntary
compelled
• benchmarks
• learning from best practice
• patient experience
• Foundation Trust status
• Community Enterprise status
• partnership working with the wider
health and social care community
• performance targets
• Payment by Results
• NICE / quality / NSF standards
• Patient Choice
• contestability
• commissioning / PBC
• Consultant and GP contracts
• Agenda for Change
• adverse events
• service reconfiguration
• ambition beyond national targets
• leadership systems
• clinical leadership and engagement
• patient partnership
• internal improvement methods
• investment in training / development
• culture of innovation
• performance management
• internal patient safety standards
• measurement systems
• clinical standardisation
• clinical pathways
• financial control
Meeting Patient’s Expectations
The Model for Improvement
What are we trying to
Accomplish?
How will we know that a
change is an improvement?
What change can we make
that will result in
improvement?
Act
Plan
Study
Do
Building and Using the Evidence
• Evaluation & Implementation
The 8 planet operational definition
Ambition
• Aim for perfection
• Build ambition around clinical values
• Provide space for interpretation at team level
“Targets give you permission to stop once you’ve hit them, ambition keeps
you to striving to constantly improve”
Strategies and tools
Positive energy to
respond to NHS
challenges and
opportunities
Sustainability
Why people stay,
“Only 26% of employees
consider
why people leave
themselves actively engaged in their work.”
Change is my mission
(Gallup)
Positive challenge, proactive
involvement, active leadership
How I can make a difference
Personal branding, making new
connections, influence and power
Who I am and how I influence
Self-efficacy, confidence, self belief and sense
of personal responsibility
Mobilisation
Why people join up, optimism
and hope, intent to impact
Motivating and inspiring
Connect with intrinsic motivators,
engaging for change, positive affect
Framing
Goal alignment, collective commitment to vision,
value based connections
A leadership for performance improvement mindset
From
To
focus on sorting “poor
performers”
focus on processes and systems
select for
“remedial action” or
reward
manage the volume of
patients
fire-fight
- acute problems
change the performance
of the overall system
manage variability in
the system
deal with the chronic
problems that underpin
poor performance
Transformation requires...
Leaders creating an energised context
Knowledge
and
great ideas
Power people up to accelerate
and spread NHS improvement
and provide best patient care
Individual, team and organisational belief
and know-how
Techniques
for
application
(eg Lean)
Questions for leaders at every level
•
What are our ambitions for our system and our patients?
•
How do we mobilise change to achieve this?
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How do we sustain these changes?
•
How do we liberate the latent energy and creativity of our staff to make
things better for patients?
Any Questions?
• Maggie.morgan-cooke@institute.nhs.uk