Celebration Event
21st October 2014
Leading Across Boundaries Programme
Welcome
Agenda for today
–10.15
Welcome and Introduction
–10:45
Project Presentations x 2
–11:15
Break
–11.45
Creating sustainable leadership
–12.45
Lunch – Market Stalls and Networking
–13.45
Project Presentations
–14:15
Awards
–14:45
of
Key Note Speaker – Gavin Boyle, Chairman
–
East Midlands Leadership Academy
–16.00
Close
Leading Across
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LEADING ACROSS BOUNDARIES
CELEBRATION EVENT – 21st October 2014
Welcome
Paul O’Neill – Director of East Midlands Leadership Academy
SYSTEMS LEADERSHIP
WHAT IS IT?
#emlaAcrossBoundaries LEADERSHIP WORD 1, WORD 2, WORD 3
#emlaAcrossBoundaries SYSTEM – Definition (about 100 characters)
Good Organisational Leadership:
•Single Vision
•Aligned Strategy and Business Plan
•Focus on Quality and Finance
•Strong Governance
•Standardised policies and procedures
•Agreed measures of success
•Owned and Understood Values and beliefs
•Consistent and Positive Culture
•Distributed Leadership
•Strong team identities and effective working
Having all of these traits working well together is not very common in large
healthcare organisations.
Consider working with multiple organisations – how many of these are true?
Key findings
•Delivering system-level integration will require a combination of
a collaborative approach to leadership and directive, effective
organisational leaders.
•Both of these different leadership approaches can and ideally
should be modelled within the system, but this is challenging at
an individual level.
•Health and social care organisations are complex adaptive
systems. Successful approaches to developing system leaders
recognise this and the need for a new leadership approach,
although paradigms of ‘command and control’ leadership are
prevalent.
•Studies show that the world’s most successful health care
systems make widespread and systematic use of improvement
methods. These encourage learning by doing, using small tests
of change to observe, reflect and explore what works best for a
particular context.
David Fillingham
Belinda Weir
October 2014
Learning in a complex adaptive system
•Learning needs emerge and change
•Inter-organisational and inter-professional teams are critical to successful
change
•What works is context specific… so local organisation and health
economies will need to adapt not just adopt
•A successful change will require attention to technical aspects (‘the
anatomy’) and cultural aspects (‘the physiology’).
•(Zimmerman et al 1998)
Learning from other sectors:
markets, hierarchies, networks
Key features
Market
Hierarchy
Network
Normative basis
Contracts
Employment relationship
Complementary strengths
Means of
communication
Prices
Routines and rules
Relationships
Conflict resolution
Haggling/litigation
Administrative edict
Reciprocity seeking
win/win
Commitment among the Low
parties
Medium to high
High
Tone or climate
Suspicion
Formal bureaucratic
Open-ended mutual
benefit
Actions
Independent
Dependant
Interdependent
Source: adapted from Powell (1990)
LEARNING FROM THE PRIVATE SECTOR
•Learn to operate without the might of the hierarchy behind them and use their
individual skills rather than their formal position to achieve results
•Be able to compete in a way that enhances rather than undercuts the
competition – to do this these leaders must become successful collaborators
•Conduct their business to the highest ethical standards; trust is crucial to
successful alliance-building
•Develop a process focus – concentrating not only on what is to be achieved
but how
Knowledge and skills framework
What skills and knowledge do you need to do this?
Technical know-how
•
•
•
Service design
Governance arrangements
Innovative contracting and financial mechanisms
Improvement know-how
•
•
•
Systems thinking
Improvement science
Large-scale change
Personal effectiveness
•
•
•
Interpersonal skills and behaviours
Coaching ability
A visionary and participative style
Discuss in Pairs:
•What have you learned that you didn’t know before you did this programme?
•In what ways (if any!) have you changed the way you work with others?
Discuss in Groups:
•How successful has your project been? (score 1-10)
•How much has the learning from this programme contributed to its success?
(score 1-10)
•Add these two scores together.
•Make sure everyone on your table knows what your total score is!
Let’s get Curious!
The ability to work across boundaries and to put the
needs of the system ahead of, or at least alongside,
those of their own institution will be one of the
hallmarks of the leaders who will
thrive in the new world.
Frail Elderly Care Pathway Part 1 & 2
Chesterfield Royal Hospital NHS Foundation Trust & Derbyshire
Community Health Services NHS Trust
Integrated Care and
the Discharge to
Assess and Manage
Process
Integrated care
• ‘The current fragmented services fail to meet the needs
of the population and greater integration can improve the
patient experience and the outcomes and efficiency of
care’
• (Kings Fund, March 2013)
• The aim for Northern Derbyshire as outlined in our
System Plan is to keep people:
• Safe and Healthy – free from crisis and exacerbation
• At home – out of social and health care beds
• Independent – managing with minimum support
Right care, Right place, Right time
Patient centred wrap around care
More efficient with NO duplication
• “In a fully integrated
system, patients’ needs
not organisational
boundaries would
decide how care is
provided”
•
Nuffield Trust, 2014
Our LAB team
• Ruth Cooper – GP and Integrated Care Lead, Hardwick
CCG
• Kath Shakespeare – Consultant Geriatrician, Chesterfield
Royal Hospital (CRH)
• Lisa Falconer – Matron, Acute Frailty Unit, CRH
• Kim Ashall – General Manager, Derbyshire Community
Health Services
• Carolyn Nice – Group Manager, Adult Care, Derbyshire
County Council
• Kirsty Ball – Senior Commissioning Manager, North
Derbyshire CCG
Why are we trying to keep people
out of hospital?
Frailty Unit Pilot at Chesterfield Royal
Hospital
• Unit for the acute care &
re-ablement of frail older
patients
• MDT working with a
patient centred approach
& comprehensive geriatric
assessment
• Enables timely discharge
with coordinated and
integrated plan for
treatment & follow up
Why D2AM?
Thinking about risk differently…
Traditional Discharge Model
Medically ready for
discharge
Therapy
assessments
Care needs
ascertained
Care package
Discharge
ICT PILOT
• Two pilot sites working with two identified GP
practices of a substantial size
• Community based teams of Therapists, Nursing
Staff, Social Care and GP support
• Teams supported by the Care Co-ordinators within
the two GP practices
The teams
What went well
The Enthusi Permiss
Commu
Knowle Process Impact
teams
asm
ion
nication
dge
Even better if…
• … we had senior nurse input
• … there was one IT system and better network coverage
• … we could access equipment more quickly
• … we had more patients through the pilot
• ... we had more comprehensive services out of hours
• … the community teams had more experience managing
risk
• … the pilot was the day job
Next Steps
• Full evaluation
• Rollout from the Frailty Unit
• Roll out across Chesterfield Royal
• Discharge process at out of area acute sites
Questions for the team
Theatre Improvement
Northampton General Hospital
Leading Across Boundaries Programme
Winning
Ways
Our Great Team
Northampton General Hospital NHS Trust
•Mr Paul Jervis (ENT Consultant)
•Dr Ramaswamy Karunakaran (Consultant Anaesthetist)
•Mrs Sue McLeod (General Manager)
•Mrs Lorna Gould (IQE Advisor)
•Mrs Linda Bazeley (Theatre Improvement Project Lead)
Our football team, Northampton Town F.C; ‘The Cobblers’ statistics.
A tale of woe….
• Lots of different club Chairman
• No one counting the goals
• Couldn’t see the league table
• Lack of investment
• We didn’t hear the whistle
• We didn’t know where the goal was
• Exec team and external companies
• Poor data quality
• Theatre Dashboard not being used
• Data analysis / time/ equipment
/I.T./ training
• Start and finish times
• No shared vision
More woe….
• No Red Cards
• Behaviours unchallenged
• No set pieces
• No standardisation
• No pre-match chat
• Few planning meetings
• No post match celebrations
• Debriefs
• No plan for the season
• No capacity and demand planning
Our club strategy….
•Player / Manager
•Coaching
•Project team
• Years secondment for
Theatre Matron
• EMLA
• Learning new skills
Second half….
•Agree length of match
• Session times, 85% utilisation target
•Kick off and finish on time
• Improve start and finish times
•Improve team play
• Same teams working together
•Understand the off-side rule!
• Greater understanding of business
•Avoid relegation
• Sustainability
Thank you for listening. Any questions?
Leading Across Boundaries Programme
Break
Leading Across Boundaries Programme
Reducing Internal Waits
Royal Derby Hospital
Reducing Internal Waits
•Why did we ‘chose’ the project?
•Who we are?
•What did we expect from ‘Leading Across
Boundaries’?
•What did we need to know?
•How did we plan to do it?
•What did we find?
•How did we tackle the problem?
•How will we solve the problem?
Why did we do this project?
•Acute Trusts have constant pressure from ED 4-hour
target
•4-hour target is a whole-system measure
•Inefficient IP processes = Inadequate acute bed
capacity = Poor flow = Failed 4-hour target
•Ageing population/Complex co-morbidities
•We need to create capacity within the system
Why did we do this project?
•The Emergency Care Intensive Support Team (ECIST) reviewed all RDH inpatients with a LOS over 7 days in August 2013.
•20% of adult inpatients were only in hospital because they were awaiting a
test, specialist opinion or similar
Hypothesis
‘We can reduce length of stay for a
significant proportion of our adult in-patients
by expediting tests, assessments, specialist
opinions or similar.’
December 2013: The A team
Name
Role
Jonathan Allsop
Associate Medical Director
Chris Whale
Assistant Clinical Director
Jenny Sidle
Operations - Head Of Nursing
Penny Owens
General Manager/Lead Radiographer - Imaging Business Unit
Liz Ryalls
Transformation Programme Manager
What did we expect from LAB?
What did we need to know?
 What do patients wait for?
 Why do patients wait?
How did we plan to do it?
It’s not just about the project…..
How did we plan to do it?
How did we plan to do it?
What did we discover?
How did we measure impact?
How did we measure impact?
“No fault found”
Recurring solutions
How will we measure?
How will we measure?
How will we measure?
IT systems don’t work?
IT systems will work
“Ready to Go!”
Thanks to Joanna Klein and Rachel Jerram
Lots of work to do (Phase 2).
Comms, branding, development
Inspired by commitment.
Leadership is a journey.
Traffic jam in the rain
Open road in the sun
Leadership…a resource for the team
not a privilege for the
incumbent…should be defined and
evaluated in terms of the
performance of the team
Robert Hogan
Creating sustainable leadership
As a team consider;
•How you worked together as a team? What felt
easy? What took time to develop?
•Your highs and lows over the last 10months
•What experiences and learning will support you in
future Leading Across Boundaries working?
•How will you build on success?
Letters from the Launch Event
Take some time to reflect:
•What you have learnt about yourself from the
programme?
•How are you leading differently?
•What is your leadership goal for the future?
Leading Across Boundaries Programme
Lunch
Integrated Mental Health
Tri-Agency Triage Car
Background

East Midlands Ambulance Service cover 6425 square miles across Lincolnshire,
Nottinghamshire, Leicestershire and Rutland, Derbyshire and Northamptonshire.

We serve a population of approximately 4.86 Million people delivering both
Emergency and urgent care transport, as well as PTS within the North of
Lincolnshire.

On a daily basis EMAS receive 2155 emergency calls via 999.

Ambulance staff nationally receive limited mental health training during their
standard paramedic education.

The most probably outcomes for Mental health patients in crisis when seen by EMAS
are section 136 and ED attendance.
What is a Tri-Agency Mental Health Triage
Car?

A car with the specific function of meeting the needs of those in
mental health crisis.

Supported by three agencies, Ambulance, Mental health and Police

Unmarked Car provided by and maintained by EMAS

Trained staff man the car from ambulance and mental health services to ensure a
complete Pyscho-Social assessment is completed combining the expertise of the
two health professionals

Provides on scene support for Patients, Ambulance staff and Police

Provides telephone triage for Ambulance and Police
Current Operating Procedure

All call outs are processed through the Lincolnshire Emergency operations centre
for EMAS.

The car is staffed from 16:00 to 00:00 seven days a week and is accessible by EMAS
frontline staff and police

Police calls and 999 calls are processed through AMPDS(Card 25)

EMAS frontline staff call control for support the car then attends to provide back
up.

The car provides assessment and intervention as required and a care plan is
agreed on by the paramedic and mental health nurse.

If a police officer is present at the call then the care plan is tri-agency with
agreement from the police officer as well.

Care plans will be created with, and provided to the patient if appropriate.
Impact
Pre-car Outcomes
Current Outcomes
Who Benefits From This Outcome?

Improved outcomes for patients who are detained in the community.

Reduction in ambulance crews and police on scene time

Reduction in the use of conveyance by police and ambulance crews.

Reduction in the number of inappropriate detentions made under the s136 of Mental Health
Act.

Reduction in the call out of Forensic Medical Examiner (FME) and Approved Mental Health
Professional (AMHP) within custody.

Increased accessibility to mental health service staff beyond normal working hours.

Experimental learning due to multi agency teamwork, leading to greater understanding of
roles of other professionals within the mental health service.

Improved use of resources and multiagency working leading to financial benefit for the
National Health Service and the Criminal Justice System.
EVERYONE!
Where Do We Go From Here?

Review the hours the Lincoln Car runs

Review the need for a second car

Consider expanding the role of the car to include adolescents

Integrate the car across EMAS to improve patient services across the trust

Develop a paramedic rotation to combine time on the MH car and standard
responding.

Up-skill the Paramedics to include suturing/gluing

Expand the paramedics Mental Health knowledge and skills

Use the links developed with Mental Health services to create pathways for
Paramedics when the car is unavailable
Women’s High Secure Physical
Healthcare
Rampton Hosptial, Nottinghamshire Healthcare NHS Trust
The Jasmine Healthcare Suite for
Women in a High Secure
Psychiatric Setting
 Dr Sue Elcock (Consultant Forensic Psychiatrist)
 Mr Richard Phipps (General Manager)
 Ms Natalie Jennings (Modern Matron, Forensic Division)
 Ms Martina Griffiths (Ward Manager – Topaz Ward)
 Ms K Johnstone (Team Leader – Topaz Ward)
CLINICAL NEED
AIMS
 To develop a therapeutically appropriate and safe environment for patients to receive
physical healthcare whilst maintaining privacy and dignity e.g. palliative care
 To provide an enhanced level of staff knowledge and confidence in identifying and
managing physical health issues in patients in a psychiatric setting
 To be able to maintain ongoing psychiatric care whilst receiving appropriate physical
healthcare in their own environment to aid relational security and reduce risks
potentially associated with inpatient admissions to other hospitals
 To provide equivalent care to female patients as male patients
IMPACT
 “Whilst being nursed in the jasmine suite I felt all my needs were met and I felt I could
move around without being restricted. I had lots of amenities at hand and the staff were
brilliant. I had more quality of life on the jasmine suite than I’ve ever had being nursed
out of grounds. My transition from Bassetlaw to the Jasmine Suite went very smoothly
and there was nothing more I could of needed. Once in the Jasmine Suite I was able to
move around more freely and was able to reach all of the amenities without much
assistance. The fresh air and exercise are easily accessible and wheelchair access is
well within limits. I think fresh air is an important part of recovery. The actual suite is well
ventilated, cosy and warm, its homely and pleasant, staff were friendly and its very
spacious. I feel the Jasmine Suite is well equipped and all the amenities are well at
hand for the patient. The Jasmine suite played a very big role in my transition back to
the ward and I hope all other people that stay there will be comfortable too.”
 “I was very privileged to be part of the opening of the Jasmine Suite but I was personally
proud of the fact that after the death of a friend I had written to Dr H suggesting that we
needed an infirmary suite that catered for palliative care as well as convalesce where
recovery can be physical as well as mental. It was named by a patient who won a prize
for naming it in a competition and has been used already for a patient to recover after a
hospital stay.”
THE FUTURE
Awards
Leading Across Boundaries Programme
Coffee
Gavin Boyle,
Chief Executive Officer, Chesterfield
Royal Hospital NHS Foundation
Trust & Chairman East Midlands
Leadership Academy &
Leading Across Boundaries Programme
Close
Some simple maths
17+85+6+58+ 85 = LAB