www.eastcheshire.nhs.uk
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Start The Year 2013
‘Inspiring Innovation’
Thursday 11 April 2013
Kindly Sponsored by:
With thanks to: GE Healthcare, Pennine Acute Hospitals
NHS Trust, Tesco Macclesfield, Morrison's Local Macclesfield
Inspiring
Innovation
Lynn McGill
Chairman
‘Delivering our vision.....
The best care in the right place’
A People Business
A Patient Story
Why do this differently?
How do we do more of it?
Team Work
3 key messages
1. Teamwork
2. Together
3. Smarter
Inspiring
Innovation
Thank you
John Wilbraham
Chief Executive
‘2013/14 Your Year’
New World
• New Commissioning and accountability
structures
• Higher patient expectations post Francis
• Increasing clinical standards in specifications
• National agenda of integration/specialisation
• What is our response?
What is our response?
• Disengage – Its all atoo complicated
• Keep doing what you’re doing
Keep your head down it’ll all go away
• Keep doing what you’re doing
But worker harder
• Change the way you do things
Changing the way we do things
Best Care in the
Right Place
Listening into Action
Permission to act
What are the services
we provide?
Where do we provide
them?
Clarity of accountability
Speed we make things
happen
Remove duplication
Inspiring
Innovation
Thank you
Andy Ward
GE Healthcare
Karen Bryson
QIPP Project Director
‘Start the Year Together
2013/14 QIPP’
Areas we’ll cover
• What is QIPP and what does it mean for
us and our patients?
• A quick quiz – how well do you know
your Trust?
• The challenge for this year
• Overview of the QIPP programme and
immediate focus
• How is the work led and how to get
involved ?
QIPP One Plan – we will build
on our success
• Delivered a challenging CIP
over last 2 years
• 11/12 achievement
– £8.2m recurrent
– £2.7m non recurrent
• 12/13 current forecast
• Close to achieving our
£10.4m target.
– £7.7m recurrent
– £2.5m non recurrent
Recurrent savings have
been delivered through a
broad range of schemes
which include:
• Outpatient redesign phase 1
• Theatre productivity &
efficiency facilitated through
job planning
• Business Unit restructure
• Pharmacy Production Unit
• Various procurement schemes
QIPP One Plan – getting us “fit
for the future”
• “Fit for the future” focus
• Foundation Trust status – we need to deliver
quality, performance and a balanced budget
• Changes in user need and complexity – need
to change to match this
• Changes in care system – good & bad for
East Cheshire NHS Trust, but we need to
respond quickly
• An integrated provider - our trump card!
• Need everyone involved
What will this mean for
patients?
• Focus on quality
– Better outcomes for patients
– Delivering safe, effective and personalised care
– Helping people stay healthy and independent
• Improve the patient experience
– Access
– Care co-ordination
– Remove traditional barriers between hospital based and
community based services
• Care closer to home
– Deliver the best care in the right place
Quick quiz
• Most frequent attendances at A&E in past 21 months
• Highest admissions for 1 person in 10 months
• % Increase in over 80’s at A&E
• % beds in Orthopaedics not occupied by orthopaedic
patients
• Number of non core beds open today
• Spend on Bank, Agency and Locums in 2012/13
• DNAs in Outpatients and “lost income”
• Longest stay in a bed in 2012/13
The challenge this year
Historical spend above
“Credit
12/13 budget
Card”
QIPP targets
£11,700
Efficiency &
productivity
Budget 2013/14
Savings
Budge
t
13/14
Budge
t
14/15
Budge
t
15/16
• Targets on fair shares
basis
• Reflects contributions –
cost v income
• Affects clinical, nonclinical areas &
corporate
• Discussions with
Clinical and Associate
Director budget holders
started
• Targets will cascade
through East Cheshire
NHS Trust
One Plan – focus on flow and
efficiency
Efficiency
Other
comm
functions
Home
Social
Care
AHP
PC
Flow
Orthopaedics
Unplanned
Frail Elderly
Comm
Nursing
Interme
diate
Care
Family &
Well Being
functions
A&E
Children’s
functions
OP
Theatres
Diagnostics
Beds
Home
Getting Planned activity back on track “in house”
Frail Elderly/ Over 80s – targeting high need, developing alternative
models to manage in the community
All main
pathways
Removing
unnecessary costs
Need our collective effort NOW
to take pressure off beds…
MH
Community
Nursing
Ortho
Paeds
Community
AHPs
A&E
General
Surgery
Geriatric
Medicine
Private
Sector
OP
Discharg
e
ENT
MH
PC
Intermediate
Beds
F&WB
Diagnostics
Social,
personal
networks
Others
….
Push
Pull
Social
Care
One Plan Team approach - part
of day to day work
Clinical
Lead /
Executive
Sponsor
AD
and
Responsible
Manager
leads
Service
Design,
Admin
Project Coordinators
HR,
Finance,
Analyst
You
Quarter 1 - ensuring focus and
pace
14
Mar
ONE PLAN
Establish
Structure &
Focus
Setting
business
unit targets,
developing
delivery
plans ,
strengthen
governance
Assuring
the Board
Establishing
PACE
Workstreams
agreed
Teams
agreed
Cut 1 –
target
allocation
Workstream
leads
discussion
Existing
CIPs
reviewed
Work up
high level
Mandate
s
1
May
1
April
22
Mar
1
June
Additional support
in place
Cut 2
F
i
n
a
l
v
e
r
s
i
o
n
Develop
Mandates
,
plans and
timetable
Board Reviews
of QIPP Plan ,
Wave 1
priority
programmes
Start
deliver
y as
plans
firm
up
Board
Paper
on “Plan
for Plan”
Discussions with CCGs, LA,
Other Providers, Partners
2012/13
recurrent
PLUS
Get on with existing programmes and target the CIPs we know “just need to get on an do”
Establish operational controls on resource use and spend
Start to embed a culture of accountability for, PERFORMANCE, PRODUCTIVITY &
PROFITABILITY
Position
Review at end
of Quarter 1
1
July
2 weekly
program
me
review
with
Function
al and
Pathway
Sponsors
, CD &
ADs
To get involved…
• Share ideas via Your Voice... Listening
Into Action team
• Join the work streams - Contact project
responsible officers (details are in your packs)
• Support changes being developed
• Think
– Is there a low cost / no cost alternative ?
– Is it essential?
.......so over coffee and during
the day
• We are interested in your ideas for
improving the unplanned care pathway
across the organisation
– What works well and should be adopted
across all pathway components ?
– Areas that need to improve ?
• Please note your ideas on the charts in
the coffee area
Thank you
Inspiring
Innovation
Refreshments
QIPP challenge
Your Voice...Listening Into Action
teams – inspiring the future.
Inspiring
Innovation
Staff Conversations
IT
Purchasing
Julie Owen, LIA Lead
Pennine Acute Hospitals NHS
Trust
Listening into Action
Team Briefing
at Pack on
Listening into Action (LiA)
Pennine Acute NHS Trust
Breaking paradigms, creating ambition, raising the bar
©Optimise Limited 2010 ref 1.5.4
Message from our Chief Executive
I suppose leadership at one time meant
muscles; but today it means getting
along with people.
Mahatma Gandhi
You don't lead by hitting people over
the head - that's assault, not
leadership.
Dwight D. Eisenhower
The art of communication is the
language of leadership.
James Humes
“I want leaders at every level in the
organisation to engage with and
support our staff so that they can be
really involved in making the changes
we all want to see.
This is the key to giving our patients the
care they deserve and our staff a real
pride in working here.
Nothing is more important.”
John Saxby, Chief Executive
Why Listening into Action...
• Concerns about staff survey results
• Lack of staff engagement and “low morale”
• Some bad press
• Lack of ownership and pride
© Optimise Limited 2011
Initial barriers to Listening into Action
Cynicism
© Optimise Limited 2011
Quick Wins
Car 4 Christmas raffle
© Optimise Limited 2011
The trust is having an
E-MAIL FREE
DAY!
Love your staff on
Valentine’s Day
Forget the e-mail!
Visit or telephone
instead
Thursday 14 February 2013
Certificate of Appreciation
is hereby granted to:
JOE BLOGGS
You Made a Difference
for outstanding performance in
Communication with his team
8 April, 2015
From
Ann Onymous Divisional Nurse Manager
Thank you for demonstrating the continued commitment required
to achieve excellence and success.
4/8/2015
Our First 10 Teams
•
Reduced waiting times in Out Patient Clinic by 87%
•
Reduced admission documentation by 50%
•
Reduced the number of results not viewed by clinicians from 20% to 6%
•
Saved £28,000 by reviewing and rewriting the A&E “Recipe Book”
•
Set up a mystery shopper scheme
•
Created a generic worker in Theatre by combining the roles of HCA and
Porter
•
Set up a local Paediatric Allergy Clinic
© Optimise Limited 2011
Effect on the staff
“I’m a Staff Nurse- I never thought I would be e-mailing an Exec and
asking where he was up to with the plans for the unit”
“I’ve tried for 3 years to set up this clinic – I can’t believe It’s actually
happened”
“ I didn’t think that anything would really happen but people are really
getting into this and realising what a bad attitude can do to patients
“
We went straight back from the Pass it On event and held a Sponsor
Group meeting to decide what our next project would be because we
were all as high as kites!”
“OK I have to admit……..it does work”
LIA PULSE CHECK SHOWS STAFF FEEL MORE INVOLVED AND VALUED
AND ARE MORE AWARE OF WHAT THE TRUST IS DOING
© Optimise Limited 2011
Next 20 Teams
•Improving the pathway from A&E to the Medical Admissions Unit
•Decreasing the time patients wait for discharge medications
•Setting up a Payroll Helpline for staff
•Reducing the waiting time in Obstetrics & Gynaecology Emergency Clinic
by devising and installing a patient database
•Providing a standardised Anaesthetic Room that is user friendly, efficient
and safe
•Setting up an Older People’s Assessment Team
© Optimise Limited 2011
NEXT STEPS
•8 Big Staff Conversations hosted by Executive and NonExecutive Board Members about the Francis report
•More Patient Conversations July and August
•Themed Staff Conversations for particular groups –
Health Care Assistants, A&E Junior Doctors
Thanks for listening – any questions or comments?
Moira Smith
Pennine Acute Hospitals
NHS Trust
Booking & Scheduling one of the first ten teams at The
Pennine Acute NHS Trust
Clearing the way”
“
ENT Clinics
We Set Out To Improve ENT Clinics
Our Mission :
Effectively utilise clinic templates
through improved dialogue and
process.
Strap Line
Timely Booking = Smoother Flow.
My sponsor group
Our Process
Meeting with
mentor
Identify
sponsor
group proactive
staff
pulse check
LiA
Department
notice board
and bulletin
Identifying and
engaging staff
Communicate
and prepare for
the
conversation
Staff wanting to
make a
difference
around what
matters
Three Cases for Change
The pulse
check
Our Conversation
Identified
Identified that
patients
appointments
times were not
evenly spread
throughout the
clinic
Clinic Start
Time Audit.
Patients were not
being seen on
time.
Clinics were
starting late.
The Template
Process needed
to be improved.
We Listened and took Action
Identified that
96 minutes of
clinic activity
were lost over
a four week
period.
Patient outcomes
Patients arriving at intervals throughout
the clinic. Clinics starting on time
Historically patient have waited up to 2 hours
to be seen by a doctor in the ENT clinic . The
longest waiter currently is15 minutes for
clinics where the templates have been
changed
Patient do not lose a days pay
waiting to be seen.
Staff Outcome
Fewer Complaints
Improved clinic start times.
Improved morale staff are not
challenging clinicians and clerks
don’t have to deal with patients all at
once.
Nurses know who to escalate to if clinics do not
start on time.
Trust Outcomes
Reduced
complaints
Improved Duty
of Care for
Doctors
Saving on 2nd appointments
as Patients are not leaving
due to the long wait.
Our Thoughts on LiA
Good
Process
Everyone
can be
involved
Great
Support
It Works
Ownership
It
Spreads
Improves
morale
See
results
A real
Booking &
Scheduling
Success
Story with
clinics times
evenly
spread.
Listening
into Action
Thank You
Moira Smith Listening into Action Associate 0161
– 778 -3228
Inspiring
Innovation
Thank you
Julie Owen
Pennine Acute Hospitals
NHS Trust
Effective Use of
Time
One Document in Time Saves
Nine
No Repetitive Paperwork
Better for Patients
Doctors
and Nurses
Combined Paperwork.
Doctors and Nurses
don't waste time
repeating information.
Team Mission/Goal
To eliminate repetitive
paperwork for
medical/nursing staff for
emergency care in
Medicine
Case for Change
• To produce combined paperwork so
medical/nursing staff do not waste time
repeating information
• To spend more time with patients
• To reduce any anxieties that patients
may experience when being asked the
same questions
Patient Outcome
• Improvement in patient care/ time spent with
them
• Reduce anxieties
Staff Outcomes
• Less time completing paperwork
• More time with patients
Trust Outcomes
• More effective use of medical/nursing
time
• Improvement in good quality care
• Less complaints
What impact has the Team
had?
• Made staff aware that there are people whom
are listening to what they are saying in
relation to too much paperwork and steps are
being taken to address this
• Displayed effective team work with medical
and nursing staff working closely together
• Involvement of staff from different roles within
the organisation working together
Impact cont’d
• Production of a combined document for
medical/ nursing staff to work with
• Displayed clearly that there is a huge
amount of repetition in the documents
that are currently used within the Trust
How do we measure & quantify
our success?
• Feedback from nursing documentation
group
• Effective inter-professional working
The Next Steps
• To identify areas within the Trust to pilot the
documentation
• Effective use of feedback from the pilot areas
• Make any amendments if required
• The group to continue to work together
effectively to produce the final document
• Final document to be ratified at Nursing
Documentation Group
Any Questions?
Inspiring
Innovation
Staff Conversations
Reward and Recognition
Patient Documentation
Lunch
Inspiring
Innovation
Plenary session
‘Reflections- Inspiration from today’
Inspiring
Innovation
The questions... A reminder
1. In 6 m time what will success look like?
2. What are the changes that would make a BIG
impact?
3. What will you do in the next 12 weeks to make
change happen?
Inspiration from IT Staff
Conversation
1. Taking stock – hardware, software and training needs
2. One system: central resources, mobile networks
3. Involvement – right people at the right time
Inspiration from Purchasing
Staff Conversation
1. DHL Style order and tracking system and Trust wide
‘top up’ service
2. Est. two workstreams:
a. High cost and
b. High volume
3. ‘Supplies for Dummies’ guide and what does ‘good’
looks like?
Inspiration from Reward and
Recognition Staff
Conversation
1. Thank You
2. Effective communication i.e.. Communicating
our successes in Team Brief
3. Staff- led categories for Staff Awards
Inspiration from Patient
Documentation Staff
Conversation
1. Single assessment document
2. Ability to complete at the bedside
3. Streamlining documentation
John Wilbraham
Chief Executive
‘Inspiring innovation through
staff led change’