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Delivering World Class Healthcare:
Th F Ch ll f h NHSThe Future Challenge for the NHS
Nicholas J Higgins, CEO VaLUENTiS & Dean ISHCM
NHS-Healthcare Management Practice
DrHCMI MSc Fin (LBS) MBA (OBS) MCMI
22nd June 2010
DrHCMI MSc Fin (LBS) MBA (OBS) MCMI
VaLUENTiS NHS Prime Network ‘Managing in Challenging Times’
CBI Centrepoint London
Statement from the Secretary ofy
State extract
“I began today by talking about my ambition:I began today by talking about my ambition:
for health outcomes and healthcare services in
this country to be as good as any in the world.”
Andrew Lansley, Patient-centred care, DoH 8 June 2010
CONTENTCO
NHS h t th ?NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mind the gap’Mind the gap
What is world
class, indeed?
Trust Performance I:Trust Performance I:
Taking a different
step
Trust Performance II:Trust Performance II:
‘With an outcome
here and outcome
there...’
‘Coming full circle’
NHS: Where are we now?
A retrospective
• Access
• Patient safety
• Promoting health and LTC• Promoting health and LTC
• Clinically effectivey
• Patient experience
• Equity
Effi i• Efficiency
• AccountabilityAccountability
Source: A High-performing NHS? A review of progress 1997-2010
However, productivity according to the ONS has
dropped from 1995 2008 by 3 3%dropped from 1995 – 2008 by 3.3%...
Treating diseases: Where the money goes...
Source: What Do We Want From The NHS, The Daily Telegraph, March 9 2010
One macro-perspective on national healthcare
performance (spend vs life expectancy)performance (spend vs life expectancy)
Source: Adapted from Premium Price, Poor Performance, J Levin-Scherz, Harvard Business Review April 2010 p.70
NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f ITrust Performance I:
Taking a different
step
T P f IITrust Performance II:
‘With an outcome
here and outcome
there...’
We’re talking
Q lit !‘Coming full circle’ Quality!
Donabedian’s
‘seven pillars’ ofp
quality
Source: Adapted from An Introduction to Quality Assurance in Healthcare, A Donabedian OUP 2003
Source: Adapted from An Introduction to Quality Assurance in Healthcare, A Donabedian OUP 2003
The three approaches to assessing
lit (D b di ’ SPO d l)quality care (Donabedian’s SPO model)
Cause
&
effect
The three approaches to assessing
lit (D b di ’ SPO d l)quality care (Donabedian’s SPO model)
Cause
&
effect
‘Quality accounts’ including Floodlight
ti ll breporting covers all bases
• Trust Leadership &
management
• Staff engagement
M i /CQC• Monitor/CQC
‘Financial’ rating
Quality
accounts
inc NHSc S
Floodlight
• Staff engagement
• VBM Efficiency
• VBM Effectiveness
• Patient clinical
• CQC ‘Quality’ rating • Patient experience
* Both include patient safety
parameters
Mapping the various NHS quality related
t th SPO d lassessments across the SPO model
• Trust Leadership &
management
• Staff engagement
M i /CQC• Monitor/CQC
‘Financial’ rating
Cause
&
effect
• VBM Effectiveness
• Patient clinical
• Staff engagement
• VBM Efficiency
• Patient experience
* Both include patient safety
parameters
• CQC ‘Quality’ rating
Quality
accounts
NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f ITrust Performance I:
Taking a different
step
T P f IITrust Performance II:
‘With an outcome
here and outcome
there...’
The CQC Rating:
‘Mi d th ’‘Mind the gap’‘Coming full circle’
Example CQC ‘quality’ indicators/targets:
f i l l t d bl l ?a case of single loop not double loop?
National commitment indicators Achieve Underachieve Fail
CQC Trust Performance Ratings:
‘Quality’ & Financial rating matrix‘Quality’ & Financial rating matrix
World class
‘QUALITY’
Excellent
GoodGood
Fair
Weak
FINANCIAL
Weak Fair Good Excellent World class
FINANCIAL
Quality
axis
World class
‘QUALITY’
Excellent
GoodGood
Fair
Weak
FINANCIAL
Weak Fair Good Excellent World class
Finance
Poor
f f
FINANCIAL
Finance
axis
Not fit for purpose
CQC Trust Performance Ratings distribution
2008 9 [across 392 Trusts]2008-9...[across 392 Trusts]
Q
World class
Excellent 37
9%
17
4%
3
1%
1
Good 89 53413Good 89
23%
53
14%
41
10%
3
1%
Fair
11
3%
61
16%
50
13%
6
2%
Weak 2
1%
9
2%
8
2%
1
Weak Fair Good Excellent World class F
CQC Trust Performance Ratings distribution
2008 9 [across 392 Trusts]2008-9...[across 392 Trusts]
Q
World class
Excellent 37
9%
17
4%
3
1%
1
Good 89 53413Good 89
23%
53
14%
41
10%
3
1%
Fair
11
3%
61
16%
50
13%
6
2%
Weak 2
1%
9
2%
8
2%
1
Weak Fair Good Excellent World class F
Performance Ratings versus Employee
Engagement distributionEngagement distribution
Q
World class
Excellent
GoodGood
What happens if we plot
engagement scores
against Perf Rating?
Fair Is there any correlation?
Weak
Weak Fair Good Excellent World class F
Performance Ratings versus Employee
Engagement score distributionEngagement score distribution (rebased & simplified average per box)
Q
World class
Excellent 776658 65
Good 71727358Good 71727358
Fair 6465 5255
Weak 54523925
Weak Fair Good Excellent World class F
NHSNHS
NEXT STOP:
WORLDWORLD
CLASSCLASS
NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f ITrust Performance I:
Taking a different
step
T P f IITrust Performance II:
‘With an outcome
here and outcome
there...’
What is world
l i d d?class, indeed?‘Coming full circle’
• world-class (wûrldkls) adj.
• Ranking among the foremost in the• Ranking among the foremost in the
world; of an international standard of
excellence; of the highest order.
World class ?World class....?
Healthcare: Around the world (in 80 ways)...( y )
• AUSTRALIA
• BRAZIL
• CANADA
• CHINA
• FRANCE
• GERMANY
• HOLLAND• HOLLAND
• HONG KONG
• INDIA
• ITALY... • JAPAN
• KOREA
• NEW ZEALAND• NEW ZEALAND
• NORWAY
• SINGAPORE
• SWEDEN
• SWITZERLAND
• UK
• USA
... and a host of others
12 ‘attributes’ of world class healthcare
1. Practice of Evidenced based medicine (& social care)
2. Possess integrated network of ‘fit-for-purpose’ healthcare facilities
3. Standardised access to healthcare
4. Appropriate investment and innovation on technology and drugs usepp p gy g
5. Embedded patient-centred operating culture
6. Practice of Evidenced based management
7 Utilisation of requisite skilled staff7. Utilisation of requisite skilled staff
8. Embedded data collation infrastructure:
1. Clinical
2. Patient outcomes
3. Patient experience
4. Management/staff
5. Financial costing
6. Operational
9. Practice of Financial management
10. Developed Executive intelligence measurement and reporting
11. Execute intelligence-based decision-making (governance)
12 Demonstrate value-based effectiveness12. Demonstrate value-based effectiveness
Source: Delivering world class healthcare – one small step for the NHS? VaLUENTiS whitepaper, forthcoming
The attainment of World class: A preliminary view
of the NHSof the NHS
‘World class’ attributes Weak Adequate Good Excellent
World
class
C B A AA AAA
class
NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f I
Trust
Trust Performance I:
Taking a different
step
T P f II
Trust
Performance I:
Trust Performance II:
‘With an outcome
here and outcome
there...’
Taking a
diff t ‘ t ’different ‘step’‘Coming full circle’
"We can only be sure to improve what weWe can only be sure to improve what we
can actually measure"
Lord Darzi, High Quality Care for All, June 2008
“If you cannot measure it you cannotIf you cannot measure it, you cannot
improve it.”
Original source attributed to Lord Kelvin 1824 1907Original source attributed to Lord Kelvin 1824-1907,
pioneer of physics and thermodynamics, first UK scientist
appointed to the House of Lordsappointed to the House of Lords
Data collation:Data collation:
Staff and patientp
surveys...
Current NHS staff and patient ‘compliance’
survey process
Reported for
Reported
survey process
Reported for
macro DoH
research
for macro
DoH
research
Annual staff survey
T t
Annual staff survey
T t
Normally conducted in 10-week window with 4-month turnaround
across Trust
population (sample)
across Trust
population (sample)
......
Spot target
patient
survey
......
Intermittent collection of patient feedback
Spot target
patient
survey
Reported for
macro DoH
feedback *
Flipping the current NHS staff and patient survey
process into ‘baseline’ executive intelligence
Sample for
Sample
process into baseline executive intelligence
Sample for
macro DoH
research
for macro
DoH
research
Annual staff survey
f ll T t
Quarterly
‘pulse’
Quarterly
‘pulse’
Quarterly
‘pulse’
Annual staff survey
f ll T t
Normally conducted in 2-week windows with 2-week turnarounds
across full Trust
population (census)
pulse
sample
surveys
pulse
sample
surveys
pulse
sample
surveys
across full Trust
population
......
Spot target
patient
survey
......
Intermittent collection of patient feedback
Spot target
patient
survey
Reported for
macro DoH
feedback *
From ‘Baseline to Advanced’...
Sample for
Sample
Sample for
macro DoH
research
for macro
DoH
research
Annual staff survey
f ll T t
Quarterly
‘pulse’
Quarterly
‘pulse’
Quarterly
‘pulse’
Annual staff survey
f ll T t
Normally conducted in 2-week windows with 2-week turnarounds
across full Trust
population (census)
pulse
sample
surveys
pulse
sample
surveys
pulse
sample
surveys
across full Trust
population
......
Quarterly QuarterlyQuarterly QuarterlyQuarterly QuarterlyQuarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
......
Continuous collection of patient feedback reported in quarterly ‘pulses’
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
p p q y p
Sample for Sample forp
macro DoH
feedback *
p
macro DoH
feedback
*Can be selected at any nominated point
From Advanced to World Class...
Sample for
macro DoH
research
Sample
for macro
DoH
research
Normally conducted in 2-week windows against selected samples
s
Annual staff survey
across full Trust
population (census)
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Annual staff survey
across full Trust
population
......
s
ephaseanalysis
atephaseanalysis
ephaseanalysis
ephaseanalysis
atephaseanalysis
Multivariate
Multivaria
Multivariate
Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly
Multivariate
Multivaria
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
......
Continuous collection of patient feedback reported in quarterly ‘pulses’
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
p p q y p
Sample for Sample forp
macro DoH
feedback *
p
macro DoH
feedback
Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming
*Can be selected at any nominated point
NHS staff and patient surveys :
The PULSAR® designSample for
macro DoH
research
Sample
for macro
DoH
research
The PULSAR® design
Normally conducted in 2-week windows against selected samples
s
Annual staff survey
across full Trust
population (census)
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Annual staff survey
across full Trust
population
......
s
ephaseanalysis
atephaseanalysis
ephaseanalysis
ephaseanalysis
atephaseanalysis
Synchronous phase reporting to assist in improving care/embedding engagement in Trusts
linking to clinical, quality, management and financial outcomes - see VaLUENTiS NHS
Floodlight System™ for example
Multivariate
Multivaria
Multivariate
Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly
Multivariate
Multivaria
Floodlight System for example
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
......
Continuous collection of patient feedback reported in quarterly ‘pulses’
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
p p q y p
Sample for Sample forp
macro DoH
feedback *
p
macro DoH
feedback
Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming
*Can be selected at any nominated point
Data collation (staff): Key differentiating factors
between ‘Basic’ and ‘World class’between ‘Basic’ and ‘World class’
‘Basic’ ‘World class’
• As compliance exercise
• Seen as ‘imposed task’
• As ongoing evaluation exercise
• Seen as ‘integral infrastructure’p
• Intermittent ‘past-time’ data
• Staff (and patient) data remain
g
• Continuous ‘real time’ data
• Staff (and patient) data used in( )
siloed in disparate format
• One-off action plan
( )
multivariable analysis/models
• Continual improvement project
• Rigid ‘academic’ manual
process
Infreq ent reporting
• Lean adaptive blended (cost-
effective) process
Freq ent reporting• Infrequent reporting
• Less opportunity to embed
evidence based management
• Frequent reporting
• Constantly reinforces evidence
based managementevidence based management based management
The patient
experience...
TrustReception
FoodAvailability
CarePain
management
TrustReception
FoodAvailability
CarePain
management
Data collation (patient): Key differentiating factors
between ‘Basic’ and ‘World class’between ‘Basic’ and ‘World class’
‘Basic’
• As compliance exercise
‘World class’
• As ongoing evaluation exerciseAs compliance exercise
• Seen as ‘imposed task’
• Intermittent ‘past-time’ data
As ongoing evaluation exercise
• Seen as ‘integral infrastructure’
• Continuous ‘real time’ datap
• Patient data remains siloed in
limited format
• Patient data used in multivariable
analysis/models
• One-off action plan, if any
• Limited number of question data
• Continual improvement project
• Multi-perspective question data
• Infrequent reporting
• Less opportunity to embed
patient relationship management
• Frequent reporting
• Patient-centricity core with patient
relationship management driverpatient relationship management
• Patient ‘clinical’ and patient
‘experience’ viewed separately
relationship management driver
• Patient ‘clinical’ and ‘experience’
viewed as two sides of the sameexperience viewed separately viewed as two sides of the same
coin
StaffStaff
management...
Evaluating Trust management practice:
(Management Pathfinder™ ‘radar’)
DIVERSITY
TRAINING &
DEVELOPMENT
(Management Pathfinder™ ‘radar’)
EMPLOYEE
CENTRICITY
TALENT
MANAGEMENT
DEVELOPMENT
813
EMPLOYER
BRANDREWARD
674
599 416
HR
GOVERNANCERETENTION
742
615
431
657
599
‘Out-performing’
( ld l )
HR
742 431
487
642
684
(world class)
‘Out-performing’
(peer)
‘Comparable’
(peer)
OPERATIONAL
EXCELLENCE
RESOURCING
642
628
594603
(peer)
‘Under-performing’
(peer)
LEADERSHIPPERFORMANCE
ORIENTATION
796
ORGANISATION
CLIMATEORGANISATION
COMMUNICATIONS
ORGANISATION
DESIGN
Trust management practice – composite findings
from NHS network cohortfrom NHSPRIME network cohort
You may already know that....
• 1860 – set up first nursing school at
y y
p g
St Thomas’ Hospital London (now
part of King’s College)part of King’s College)
• First female member of the Royal
Statistical Society and credited with
developing the ‘polar area diagram’developing the polar area diagram
(firstly for sources of patient
t lit ) l fmortality) –see overleaf
But did you know that...?
Nightingale’s original ‘polar area diagram’g g g p g
Thus our management radar diagrams are a
modern reincarnation of Nightingale’s PADmodern reincarnation of Nightingale’s PAD
Staff Management: Key differentiating factors
between ‘Basic’ and ‘World class’between ‘Basic’ and ‘World class’
‘Basic’
• No evaluation of organisation
‘World class’
• Management evaluation regularly
management undertaken
• Consistency of leadership/
t t l
undertaken and reported
• Reinforces consistency of leadership/
t tmanagement competence low
• Staff survey data used in
isolation
management competence
• Used in conjunction with staff survey
data and other operational dataisolation
• Only proxy metrics like
absenteeism used as evaluation
data and other operational data
• Management evaluation has many
multi-perspective measures
• Little evaluation of any
management development
p p
• Continual evaluation of management
development (including longitudinal)
• Management initiatives usually
undertaken in adhoc sequence
E id b d t
• Management initiatives in planned &
(co-)sequenced in priority manner
E id b d t• Evidence based management
practised in ‘blotches’
• Evidence based management
practised as key driver
NHS where art thou?
We’re talking quality!
T t
The CQC Rating:
‘Mi d th ’
Trust
Performance II:
‘Mind the gap’
What is world
class, indeed?
T t P f I
Performance II:
‘With an
Trust Performance I:
Taking a different
step
T P f II
With an
outcome here
Trust Performance II:
‘With an outcome
here and outcome
there...’
and an outcome
th ’there...’‘Coming full circle’
Trust Performance broken down into four
outcome componentsoutcome components
rough:uredthrlymeasmpositelCom
Performance & Productivity:y
A simple graphic
OUTCOMES
INPUTS
THROUGHPUTS
OUTPUTSOUTPUTS
Performance & Productivity:y
Simple healthcare model
OUTCOMES
INPUTS
THROUGHPUTS
Physical
Effect of
treatment
Quality of life
improvement,
THROUGHPUTSNo of doctors,
nurses,
management,
drugs,
technology, beds
re-admissions,
patient
experience, etc
OUTPUTS
etc
Financial
Healthcare
spend (direct
and indirect
costing)
System
Volume of
patients treatedp
(by class),
discharges/
consultations
etc
World Class Healthcare:
Value based management in the NHSValue based management in the NHS
‘Macro’ model version 1.21
Leadership
&
governance
Leadership
&
governance
Shareholder
value
Trust
performanceEmployer
brand
Trust
‘brand’
VBEΣx
Human
Capital
Practices
Human
Capital
Practices ExternalPatient
Value
Customer
Satisfaction
Patient
Outcome
Revenue
Growth
Quality of
provision
I di id l/
Portfolio mixSafety
X-sellingClinical treatment
Patient centric
Work valuesWork values
Line-of-sightLine-of-sight
Development EmployeeStaff
g
e1 p1-6
poΣx
QΣx
LΣx b1
Value
Proposition
Value
Proposition
PRM
Customer
Loyalty
Patient
experience ProfitabilityUse of Resources
Individual/
team
Productivity
Individual/
team
Productivity
ServicePatient centricDevelopmentDevelopment
RewardReward
Work environmentWork environment
Employee
Engagement
Staff
Engagement
Portfolio mixAccess
X-sellingEfficiency
ServiceEquity
s pe
rΣy
hcmΣy
Ef1-5
Employee
Retention
Staff retention
& utilisation
‘Local’
Management
‘Local’
Management Cost management
ComplianceCompliance
s1 peΣx
hcmΣy
RΣx
ManagementManagement
Cost controlCost management
FΣy
m1
Key: e1 = example VBM pathway
© VaLUENTiS VBM Analytics methodology
The NHS Floodlight (Internal) system
(ORIGINAL)(ORIGINAL)
Clinical Patient Financial Management
CO#1CO#6 CO#1CO#6 PO#1PO#6 PO#1PO#6 FO#1FO#6 FO#1FO#6 MO#1MO#6 MO#1MO#6
Outcomes Outcomes Outcomes
g
Outcomes
CO#5
CO#2
CO#5
CO#2
PO#5
PO#2
PO#5
PO#2
FO#5
FO#2
FO#5
FO#2
MO#5
MO#2
MO#5
MO#2
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
CO#3CO#4 CO#3CO#4 PO#3PO#4 PO#3PO#4 FO#3FO#4 FO#3FO#4 MO#3MO#4 MO#3MO#4
MM
WP#12 WP#1
MM
WP#12 WP#1EE Work
Environm
EE
ne of Sight EE Work
Environm
EE
ne of Sight
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
742
674
615
431
657
599 416
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
742
674
615
431
657
599 416
AA
MM
CCKK
BBLL
WP#3
WP#10
W
P#11
W
P#2
AA
MM
CCKK
BBLL
WP#3
WP#10
W
P#11
W
P#2
nmentLine
HR
ustom
EE
Operat
Cultu
739613
656743
nmentLine
HR
ustom
EE
Operat
Cultu
739613
656743
442
591
697729
HR
Measurement
HR
Strategy
HR
temrisk
HR
Operatio
Excellen
442
591
697729
HR
Measurement
HR
Strategy
HR
temrisk
HR
Operatio
Excellen
HR
OPERATIONAL
EXCELLENCE
LEADERSHIP
ORGANISATIONORGANISATION
PERFORMANCE
ORIENTATION
RESOURCING
796
487
642
628
594603
684
HR
OPERATIONAL
EXCELLENCE
LEADERSHIP
ORGANISATIONORGANISATION
PERFORMANCE
ORIENTATION
RESOURCING
796
487
642
628
594603
684
EE
HH FF
DD
JJ
GG
WP#9
WP#4
W
P#5
W
P#8
EE
HH FF
DD
JJ
GG
WP#9
WP#4
W
P#5
W
P#8
EE
velopmentEEReward
Cu
ing
re
598620
EE
velopmentEEReward
Cu
ing
re
598620
619663
HR
overnance
HR
Function
ROI
Syst
onal
nce
619663
HR
overnance
HR
Function
ROI
Syst
onal
nce
ORGANISATION
CLIMATEORGANISATION
COMMUNICATIONS
ORGANISATION
DESIGN
ORGANISATION
CLIMATEORGANISATION
COMMUNICATIONS
ORGANISATION
DESIGN WP#6WP#7 WP#6WP#7eveloard
eveloard
HR Function
Productivity
Leadership &
Management
Eff ti
Staff
Engagement
Workforce
Productivity
Effectiveness
The NHS Floodlight (internal) system
(REVISED)(REVISED)
Clinical Patient Patient Financial
CO#1CO#6 CO#1CO#6 PO#1PO#6 PO#1PO#6 FO#1FO#6 FO#1FO#6 MO#1MO#6 MO#1MO#6
Effectiveness Experience Safety Management
CO#5
CO#2
CO#5
CO#2
PO#5
PO#2
PO#5
PO#2
FO#5
FO#2
FO#5
FO#2
MO#5
MO#2
MO#5
MO#2
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
CO#3CO#4 CO#3CO#4 PO#3PO#4 PO#3PO#4 FO#3FO#4 FO#3FO#4 MO#3MO#4 MO#3MO#4
MM
WP#12 WP#1
MM
WP#12 WP#1EE Work
Environm
EE
ne of Sight EE Work
Environm
EE
ne of Sight
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
742
674
615
431
657
599 416
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
742
674
615
431
657
599 416
AA
MM
CCKK
BBLL
WP#3
WP#10
W
P#11
W
P#2
AA
MM
CCKK
BBLL
WP#3
WP#10
W
P#11
W
P#2
nmentLine
HR
ustom
EE
Operat
Cultu
739613
656743
nmentLine
HR
ustom
EE
Operat
Cultu
739613
656743
MO#1MO#6
MO#5
MO#2
MO#1MO#6
MO#5
MO#2
HR
OPERATIONAL
EXCELLENCE
LEADERSHIP
ORGANISATIONORGANISATION
PERFORMANCE
ORIENTATION
RESOURCING
796
487
642
628
594603
684
HR
OPERATIONAL
EXCELLENCE
LEADERSHIP
ORGANISATIONORGANISATION
PERFORMANCE
ORIENTATION
RESOURCING
796
487
642
628
594603
684
EE
HH FF
DD
JJ
GG
WP#9
WP#4
W
P#5
W
P#8
EE
HH FF
DD
JJ
GG
WP#9
WP#4
W
P#5
W
P#8
EE
velopmentEEReward
Cu
ing
re
598620
EE
velopmentEEReward
Cu
ing
re
598620
MO#3MO#4
M
2
MO#3MO#4
M
2
ORGANISATION
CLIMATEORGANISATION
COMMUNICATIONS
ORGANISATION
DESIGN
ORGANISATION
CLIMATEORGANISATION
COMMUNICATIONS
ORGANISATION
DESIGN WP#6WP#7 WP#6WP#7eveloard
eveloard
Hospital
Management
Obj ti
Leadership &
Management
Eff ti
Staff
Engagement
Hospital
Productivity
Objectives Effectiveness
The NHS Floodlight system (EXTERNAL):
Current [C]Current [C]
Cli i l P ti t P ti t Fi i lClinical
Effectiveness
Patient
Experience
Patient
Safety
Financial
Management
Hospital
Management
Objectives
Leadership &
Management
Effectiveness
Staff
Engagement
Hospital
Productivity
GWorld class
Excellent
Good
Adequate
Weak
Insufficient data
The NHS Floodlight system (EXTERNAL):
Current plus previous 2 years [C+]Current plus previous 2 years [C+]
Cli i l P ti t P ti t Fi i lClinical
Effectiveness
Patient
Experience
Patient
Safety
Financial
Management
Hospital
Management
Objectives
Leadership &
Management
Effectiveness
Staff
Engagement
Hospital
Productivity
GWorld class
Excellent
Good
Adequate
Weak
Insufficient data
Last 3 years performance
Quality Accounts: We see 3 versions developing –
Standard, Intermediate (Super8) and Advanced( p )
(SuperEight3D)
Advanced
Intermediate
Standard
ExIMR...
[Executive Intelligence
Measurement &
Reporting]Reporting]
Anal tics Ri k
Predictive
VisualisationE l ti F ti‘Real time’P fAnalytics Risk modelling
VisualisationEvaluation Forecasting‘Real-time’Performance
Too often different sourced data is not
connectedconnected...
Or, conversely, different time-series data is erroneously connected...
Real-Time Informed
Management and staffManagement and staff
AFF
CAL
NCIAL
ENT
TIONAL
STA
MEDI
FINAN
PATIE
OPERATO
ExIMR: Key differentiating factors between ‘Basic’
and ‘World class’and ‘World class’
‘Basic’ ‘World class’Basic
• Data collation and measurement
driven by ‘external demand’
World class
• Data collation and measurement
driven by ‘internal strategy’driven by external demand
• Viewed as ‘imposed task’
• Intermittent ‘past-time’ data
driven by internal strategy
• Viewed as ‘integral infrastructure’
• Continuous ‘real time’ dataIntermittent past time data
• Selected data used mainly to
support ‘chosen view’/defence
Continuous real time data
• Constant aid to decision-making
and governance
• Management meetings driven
by information swap
g
• Management meetings driven by
knowledge debate/exchange
• Tendency to think IT will solve
problem – sub-optimal efficiency
Operating c lt re still ‘target
• Measurement ethos with cost-
efficiency uppermost
Operating c lt re ‘objecti e’• Operating culture still ‘target
driven’
• Quality Accounts seen as
• Operating culture ‘objective’
driven
• Quality Accounts seen asQuality Accounts seen as
compliance exercise
Quality Accounts seen as
ongoing evaluation exercise
NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f ITrust Performance I:
Taking a different
step
T P f II
‘C i f ll
Trust Performance II:
‘With an outcome
here and outcome
there...’
‘Coming full
circle’circle‘Coming full circle’
The 12 ‘attributes’
f ld lof world class
healthcare
11
healthcare
At trust level...8
7
5
... each one is2
attainable
1
The attainment of World class: A small step of
steps within 5 years ?steps within 5 years...?
‘World class’ attributes Weak Adequate Good Excellent
World
class
C B A AA AAA
class
?
?
What’s the answer to ‘Managingg g
in Challenging Times’.....?
“BEING
SMARTER”

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VaLUENTiS delivering world class healthcare 210610 final

  • 1. Delivering World Class Healthcare: Th F Ch ll f h NHSThe Future Challenge for the NHS Nicholas J Higgins, CEO VaLUENTiS & Dean ISHCM NHS-Healthcare Management Practice DrHCMI MSc Fin (LBS) MBA (OBS) MCMI 22nd June 2010 DrHCMI MSc Fin (LBS) MBA (OBS) MCMI VaLUENTiS NHS Prime Network ‘Managing in Challenging Times’ CBI Centrepoint London
  • 2. Statement from the Secretary ofy State extract “I began today by talking about my ambition:I began today by talking about my ambition: for health outcomes and healthcare services in this country to be as good as any in the world.” Andrew Lansley, Patient-centred care, DoH 8 June 2010
  • 3. CONTENTCO NHS h t th ?NHS where art thou? We’re talking quality! The CQC Rating: ‘Mind the gap’Mind the gap What is world class, indeed? Trust Performance I:Trust Performance I: Taking a different step Trust Performance II:Trust Performance II: ‘With an outcome here and outcome there...’ ‘Coming full circle’
  • 4.
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  • 6. NHS: Where are we now? A retrospective • Access • Patient safety • Promoting health and LTC• Promoting health and LTC • Clinically effectivey • Patient experience • Equity Effi i• Efficiency • AccountabilityAccountability Source: A High-performing NHS? A review of progress 1997-2010
  • 7. However, productivity according to the ONS has dropped from 1995 2008 by 3 3%dropped from 1995 – 2008 by 3.3%...
  • 8. Treating diseases: Where the money goes... Source: What Do We Want From The NHS, The Daily Telegraph, March 9 2010
  • 9.
  • 10.
  • 11. One macro-perspective on national healthcare performance (spend vs life expectancy)performance (spend vs life expectancy) Source: Adapted from Premium Price, Poor Performance, J Levin-Scherz, Harvard Business Review April 2010 p.70
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  • 18. NHS where art thou? We’re talking quality! The CQC Rating: ‘Mi d th ’‘Mind the gap’ What is world class, indeed? T t P f ITrust Performance I: Taking a different step T P f IITrust Performance II: ‘With an outcome here and outcome there...’ We’re talking Q lit !‘Coming full circle’ Quality!
  • 19.
  • 20. Donabedian’s ‘seven pillars’ ofp quality Source: Adapted from An Introduction to Quality Assurance in Healthcare, A Donabedian OUP 2003
  • 21. Source: Adapted from An Introduction to Quality Assurance in Healthcare, A Donabedian OUP 2003
  • 22. The three approaches to assessing lit (D b di ’ SPO d l)quality care (Donabedian’s SPO model) Cause & effect
  • 23. The three approaches to assessing lit (D b di ’ SPO d l)quality care (Donabedian’s SPO model) Cause & effect
  • 24. ‘Quality accounts’ including Floodlight ti ll breporting covers all bases • Trust Leadership & management • Staff engagement M i /CQC• Monitor/CQC ‘Financial’ rating Quality accounts inc NHSc S Floodlight • Staff engagement • VBM Efficiency • VBM Effectiveness • Patient clinical • CQC ‘Quality’ rating • Patient experience * Both include patient safety parameters
  • 25. Mapping the various NHS quality related t th SPO d lassessments across the SPO model • Trust Leadership & management • Staff engagement M i /CQC• Monitor/CQC ‘Financial’ rating Cause & effect • VBM Effectiveness • Patient clinical • Staff engagement • VBM Efficiency • Patient experience * Both include patient safety parameters • CQC ‘Quality’ rating Quality accounts
  • 26. NHS where art thou? We’re talking quality! The CQC Rating: ‘Mi d th ’‘Mind the gap’ What is world class, indeed? T t P f ITrust Performance I: Taking a different step T P f IITrust Performance II: ‘With an outcome here and outcome there...’ The CQC Rating: ‘Mi d th ’‘Mind the gap’‘Coming full circle’
  • 27. Example CQC ‘quality’ indicators/targets: f i l l t d bl l ?a case of single loop not double loop? National commitment indicators Achieve Underachieve Fail
  • 28.
  • 29. CQC Trust Performance Ratings: ‘Quality’ & Financial rating matrix‘Quality’ & Financial rating matrix World class ‘QUALITY’ Excellent GoodGood Fair Weak FINANCIAL Weak Fair Good Excellent World class FINANCIAL
  • 30. Quality axis World class ‘QUALITY’ Excellent GoodGood Fair Weak FINANCIAL Weak Fair Good Excellent World class Finance Poor f f FINANCIAL Finance axis Not fit for purpose
  • 31. CQC Trust Performance Ratings distribution 2008 9 [across 392 Trusts]2008-9...[across 392 Trusts] Q World class Excellent 37 9% 17 4% 3 1% 1 Good 89 53413Good 89 23% 53 14% 41 10% 3 1% Fair 11 3% 61 16% 50 13% 6 2% Weak 2 1% 9 2% 8 2% 1 Weak Fair Good Excellent World class F
  • 32. CQC Trust Performance Ratings distribution 2008 9 [across 392 Trusts]2008-9...[across 392 Trusts] Q World class Excellent 37 9% 17 4% 3 1% 1 Good 89 53413Good 89 23% 53 14% 41 10% 3 1% Fair 11 3% 61 16% 50 13% 6 2% Weak 2 1% 9 2% 8 2% 1 Weak Fair Good Excellent World class F
  • 33. Performance Ratings versus Employee Engagement distributionEngagement distribution Q World class Excellent GoodGood What happens if we plot engagement scores against Perf Rating? Fair Is there any correlation? Weak Weak Fair Good Excellent World class F
  • 34. Performance Ratings versus Employee Engagement score distributionEngagement score distribution (rebased & simplified average per box) Q World class Excellent 776658 65 Good 71727358Good 71727358 Fair 6465 5255 Weak 54523925 Weak Fair Good Excellent World class F
  • 36. NHS where art thou? We’re talking quality! The CQC Rating: ‘Mi d th ’‘Mind the gap’ What is world class, indeed? T t P f ITrust Performance I: Taking a different step T P f IITrust Performance II: ‘With an outcome here and outcome there...’ What is world l i d d?class, indeed?‘Coming full circle’
  • 37. • world-class (wûrldkls) adj. • Ranking among the foremost in the• Ranking among the foremost in the world; of an international standard of excellence; of the highest order.
  • 38. World class ?World class....?
  • 39. Healthcare: Around the world (in 80 ways)...( y ) • AUSTRALIA • BRAZIL • CANADA • CHINA • FRANCE • GERMANY • HOLLAND• HOLLAND • HONG KONG • INDIA • ITALY... • JAPAN • KOREA • NEW ZEALAND• NEW ZEALAND • NORWAY • SINGAPORE • SWEDEN • SWITZERLAND • UK • USA ... and a host of others
  • 40. 12 ‘attributes’ of world class healthcare 1. Practice of Evidenced based medicine (& social care) 2. Possess integrated network of ‘fit-for-purpose’ healthcare facilities 3. Standardised access to healthcare 4. Appropriate investment and innovation on technology and drugs usepp p gy g 5. Embedded patient-centred operating culture 6. Practice of Evidenced based management 7 Utilisation of requisite skilled staff7. Utilisation of requisite skilled staff 8. Embedded data collation infrastructure: 1. Clinical 2. Patient outcomes 3. Patient experience 4. Management/staff 5. Financial costing 6. Operational 9. Practice of Financial management 10. Developed Executive intelligence measurement and reporting 11. Execute intelligence-based decision-making (governance) 12 Demonstrate value-based effectiveness12. Demonstrate value-based effectiveness Source: Delivering world class healthcare – one small step for the NHS? VaLUENTiS whitepaper, forthcoming
  • 41. The attainment of World class: A preliminary view of the NHSof the NHS ‘World class’ attributes Weak Adequate Good Excellent World class C B A AA AAA class
  • 42. NHS where art thou? We’re talking quality! The CQC Rating: ‘Mi d th ’‘Mind the gap’ What is world class, indeed? T t P f I Trust Trust Performance I: Taking a different step T P f II Trust Performance I: Trust Performance II: ‘With an outcome here and outcome there...’ Taking a diff t ‘ t ’different ‘step’‘Coming full circle’
  • 43. "We can only be sure to improve what weWe can only be sure to improve what we can actually measure" Lord Darzi, High Quality Care for All, June 2008 “If you cannot measure it you cannotIf you cannot measure it, you cannot improve it.” Original source attributed to Lord Kelvin 1824 1907Original source attributed to Lord Kelvin 1824-1907, pioneer of physics and thermodynamics, first UK scientist appointed to the House of Lordsappointed to the House of Lords
  • 44. Data collation:Data collation: Staff and patientp surveys...
  • 45. Current NHS staff and patient ‘compliance’ survey process Reported for Reported survey process Reported for macro DoH research for macro DoH research Annual staff survey T t Annual staff survey T t Normally conducted in 10-week window with 4-month turnaround across Trust population (sample) across Trust population (sample) ...... Spot target patient survey ...... Intermittent collection of patient feedback Spot target patient survey Reported for macro DoH feedback *
  • 46. Flipping the current NHS staff and patient survey process into ‘baseline’ executive intelligence Sample for Sample process into baseline executive intelligence Sample for macro DoH research for macro DoH research Annual staff survey f ll T t Quarterly ‘pulse’ Quarterly ‘pulse’ Quarterly ‘pulse’ Annual staff survey f ll T t Normally conducted in 2-week windows with 2-week turnarounds across full Trust population (census) pulse sample surveys pulse sample surveys pulse sample surveys across full Trust population ...... Spot target patient survey ...... Intermittent collection of patient feedback Spot target patient survey Reported for macro DoH feedback *
  • 47. From ‘Baseline to Advanced’... Sample for Sample Sample for macro DoH research for macro DoH research Annual staff survey f ll T t Quarterly ‘pulse’ Quarterly ‘pulse’ Quarterly ‘pulse’ Annual staff survey f ll T t Normally conducted in 2-week windows with 2-week turnarounds across full Trust population (census) pulse sample surveys pulse sample surveys pulse sample surveys across full Trust population ...... Quarterly QuarterlyQuarterly QuarterlyQuarterly QuarterlyQuarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting ...... Continuous collection of patient feedback reported in quarterly ‘pulses’ Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting p p q y p Sample for Sample forp macro DoH feedback * p macro DoH feedback *Can be selected at any nominated point
  • 48. From Advanced to World Class... Sample for macro DoH research Sample for macro DoH research Normally conducted in 2-week windows against selected samples s Annual staff survey across full Trust population (census) Quarterly ‘pulse’ sample surveys Quarterly ‘pulse’ sample surveys Quarterly ‘pulse’ sample surveys Annual staff survey across full Trust population ...... s ephaseanalysis atephaseanalysis ephaseanalysis ephaseanalysis atephaseanalysis Multivariate Multivaria Multivariate Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly Multivariate Multivaria Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting ...... Continuous collection of patient feedback reported in quarterly ‘pulses’ Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting p p q y p Sample for Sample forp macro DoH feedback * p macro DoH feedback Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming *Can be selected at any nominated point
  • 49. NHS staff and patient surveys : The PULSAR® designSample for macro DoH research Sample for macro DoH research The PULSAR® design Normally conducted in 2-week windows against selected samples s Annual staff survey across full Trust population (census) Quarterly ‘pulse’ sample surveys Quarterly ‘pulse’ sample surveys Quarterly ‘pulse’ sample surveys Annual staff survey across full Trust population ...... s ephaseanalysis atephaseanalysis ephaseanalysis ephaseanalysis atephaseanalysis Synchronous phase reporting to assist in improving care/embedding engagement in Trusts linking to clinical, quality, management and financial outcomes - see VaLUENTiS NHS Floodlight System™ for example Multivariate Multivaria Multivariate Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly Multivariate Multivaria Floodlight System for example Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting ...... Continuous collection of patient feedback reported in quarterly ‘pulses’ Quarterly patient ‘pulse’ reporting Quarterly patient ‘pulse’ reporting p p q y p Sample for Sample forp macro DoH feedback * p macro DoH feedback Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming *Can be selected at any nominated point
  • 50. Data collation (staff): Key differentiating factors between ‘Basic’ and ‘World class’between ‘Basic’ and ‘World class’ ‘Basic’ ‘World class’ • As compliance exercise • Seen as ‘imposed task’ • As ongoing evaluation exercise • Seen as ‘integral infrastructure’p • Intermittent ‘past-time’ data • Staff (and patient) data remain g • Continuous ‘real time’ data • Staff (and patient) data used in( ) siloed in disparate format • One-off action plan ( ) multivariable analysis/models • Continual improvement project • Rigid ‘academic’ manual process Infreq ent reporting • Lean adaptive blended (cost- effective) process Freq ent reporting• Infrequent reporting • Less opportunity to embed evidence based management • Frequent reporting • Constantly reinforces evidence based managementevidence based management based management
  • 54. Data collation (patient): Key differentiating factors between ‘Basic’ and ‘World class’between ‘Basic’ and ‘World class’ ‘Basic’ • As compliance exercise ‘World class’ • As ongoing evaluation exerciseAs compliance exercise • Seen as ‘imposed task’ • Intermittent ‘past-time’ data As ongoing evaluation exercise • Seen as ‘integral infrastructure’ • Continuous ‘real time’ datap • Patient data remains siloed in limited format • Patient data used in multivariable analysis/models • One-off action plan, if any • Limited number of question data • Continual improvement project • Multi-perspective question data • Infrequent reporting • Less opportunity to embed patient relationship management • Frequent reporting • Patient-centricity core with patient relationship management driverpatient relationship management • Patient ‘clinical’ and patient ‘experience’ viewed separately relationship management driver • Patient ‘clinical’ and ‘experience’ viewed as two sides of the sameexperience viewed separately viewed as two sides of the same coin
  • 56. Evaluating Trust management practice: (Management Pathfinder™ ‘radar’) DIVERSITY TRAINING & DEVELOPMENT (Management Pathfinder™ ‘radar’) EMPLOYEE CENTRICITY TALENT MANAGEMENT DEVELOPMENT 813 EMPLOYER BRANDREWARD 674 599 416 HR GOVERNANCERETENTION 742 615 431 657 599 ‘Out-performing’ ( ld l ) HR 742 431 487 642 684 (world class) ‘Out-performing’ (peer) ‘Comparable’ (peer) OPERATIONAL EXCELLENCE RESOURCING 642 628 594603 (peer) ‘Under-performing’ (peer) LEADERSHIPPERFORMANCE ORIENTATION 796 ORGANISATION CLIMATEORGANISATION COMMUNICATIONS ORGANISATION DESIGN
  • 57. Trust management practice – composite findings from NHS network cohortfrom NHSPRIME network cohort
  • 58.
  • 59. You may already know that.... • 1860 – set up first nursing school at y y p g St Thomas’ Hospital London (now part of King’s College)part of King’s College) • First female member of the Royal Statistical Society and credited with developing the ‘polar area diagram’developing the polar area diagram (firstly for sources of patient t lit ) l fmortality) –see overleaf But did you know that...?
  • 60. Nightingale’s original ‘polar area diagram’g g g p g
  • 61. Thus our management radar diagrams are a modern reincarnation of Nightingale’s PADmodern reincarnation of Nightingale’s PAD
  • 62. Staff Management: Key differentiating factors between ‘Basic’ and ‘World class’between ‘Basic’ and ‘World class’ ‘Basic’ • No evaluation of organisation ‘World class’ • Management evaluation regularly management undertaken • Consistency of leadership/ t t l undertaken and reported • Reinforces consistency of leadership/ t tmanagement competence low • Staff survey data used in isolation management competence • Used in conjunction with staff survey data and other operational dataisolation • Only proxy metrics like absenteeism used as evaluation data and other operational data • Management evaluation has many multi-perspective measures • Little evaluation of any management development p p • Continual evaluation of management development (including longitudinal) • Management initiatives usually undertaken in adhoc sequence E id b d t • Management initiatives in planned & (co-)sequenced in priority manner E id b d t• Evidence based management practised in ‘blotches’ • Evidence based management practised as key driver
  • 63. NHS where art thou? We’re talking quality! T t The CQC Rating: ‘Mi d th ’ Trust Performance II: ‘Mind the gap’ What is world class, indeed? T t P f I Performance II: ‘With an Trust Performance I: Taking a different step T P f II With an outcome here Trust Performance II: ‘With an outcome here and outcome there...’ and an outcome th ’there...’‘Coming full circle’
  • 64. Trust Performance broken down into four outcome componentsoutcome components rough:uredthrlymeasmpositelCom
  • 65. Performance & Productivity:y A simple graphic OUTCOMES INPUTS THROUGHPUTS OUTPUTSOUTPUTS
  • 66. Performance & Productivity:y Simple healthcare model OUTCOMES INPUTS THROUGHPUTS Physical Effect of treatment Quality of life improvement, THROUGHPUTSNo of doctors, nurses, management, drugs, technology, beds re-admissions, patient experience, etc OUTPUTS etc Financial Healthcare spend (direct and indirect costing) System Volume of patients treatedp (by class), discharges/ consultations etc
  • 67. World Class Healthcare: Value based management in the NHSValue based management in the NHS ‘Macro’ model version 1.21 Leadership & governance Leadership & governance Shareholder value Trust performanceEmployer brand Trust ‘brand’ VBEΣx Human Capital Practices Human Capital Practices ExternalPatient Value Customer Satisfaction Patient Outcome Revenue Growth Quality of provision I di id l/ Portfolio mixSafety X-sellingClinical treatment Patient centric Work valuesWork values Line-of-sightLine-of-sight Development EmployeeStaff g e1 p1-6 poΣx QΣx LΣx b1 Value Proposition Value Proposition PRM Customer Loyalty Patient experience ProfitabilityUse of Resources Individual/ team Productivity Individual/ team Productivity ServicePatient centricDevelopmentDevelopment RewardReward Work environmentWork environment Employee Engagement Staff Engagement Portfolio mixAccess X-sellingEfficiency ServiceEquity s pe rΣy hcmΣy Ef1-5 Employee Retention Staff retention & utilisation ‘Local’ Management ‘Local’ Management Cost management ComplianceCompliance s1 peΣx hcmΣy RΣx ManagementManagement Cost controlCost management FΣy m1 Key: e1 = example VBM pathway © VaLUENTiS VBM Analytics methodology
  • 68. The NHS Floodlight (Internal) system (ORIGINAL)(ORIGINAL) Clinical Patient Financial Management CO#1CO#6 CO#1CO#6 PO#1PO#6 PO#1PO#6 FO#1FO#6 FO#1FO#6 MO#1MO#6 MO#1MO#6 Outcomes Outcomes Outcomes g Outcomes CO#5 CO#2 CO#5 CO#2 PO#5 PO#2 PO#5 PO#2 FO#5 FO#2 FO#5 FO#2 MO#5 MO#2 MO#5 MO#2 DIVERSITY EMPLOYEETALENT TRAINING & DEVELOPMENT 813 DIVERSITY EMPLOYEETALENT TRAINING & DEVELOPMENT 813 CO#3CO#4 CO#3CO#4 PO#3PO#4 PO#3PO#4 FO#3FO#4 FO#3FO#4 MO#3MO#4 MO#3MO#4 MM WP#12 WP#1 MM WP#12 WP#1EE Work Environm EE ne of Sight EE Work Environm EE ne of Sight CENTRICITY EMPLOYER BRAND HR GOVERNANCERETENTION REWARD MANAGEMENT 813 742 674 615 431 657 599 416 CENTRICITY EMPLOYER BRAND HR GOVERNANCERETENTION REWARD MANAGEMENT 813 742 674 615 431 657 599 416 AA MM CCKK BBLL WP#3 WP#10 W P#11 W P#2 AA MM CCKK BBLL WP#3 WP#10 W P#11 W P#2 nmentLine HR ustom EE Operat Cultu 739613 656743 nmentLine HR ustom EE Operat Cultu 739613 656743 442 591 697729 HR Measurement HR Strategy HR temrisk HR Operatio Excellen 442 591 697729 HR Measurement HR Strategy HR temrisk HR Operatio Excellen HR OPERATIONAL EXCELLENCE LEADERSHIP ORGANISATIONORGANISATION PERFORMANCE ORIENTATION RESOURCING 796 487 642 628 594603 684 HR OPERATIONAL EXCELLENCE LEADERSHIP ORGANISATIONORGANISATION PERFORMANCE ORIENTATION RESOURCING 796 487 642 628 594603 684 EE HH FF DD JJ GG WP#9 WP#4 W P#5 W P#8 EE HH FF DD JJ GG WP#9 WP#4 W P#5 W P#8 EE velopmentEEReward Cu ing re 598620 EE velopmentEEReward Cu ing re 598620 619663 HR overnance HR Function ROI Syst onal nce 619663 HR overnance HR Function ROI Syst onal nce ORGANISATION CLIMATEORGANISATION COMMUNICATIONS ORGANISATION DESIGN ORGANISATION CLIMATEORGANISATION COMMUNICATIONS ORGANISATION DESIGN WP#6WP#7 WP#6WP#7eveloard eveloard HR Function Productivity Leadership & Management Eff ti Staff Engagement Workforce Productivity Effectiveness
  • 69. The NHS Floodlight (internal) system (REVISED)(REVISED) Clinical Patient Patient Financial CO#1CO#6 CO#1CO#6 PO#1PO#6 PO#1PO#6 FO#1FO#6 FO#1FO#6 MO#1MO#6 MO#1MO#6 Effectiveness Experience Safety Management CO#5 CO#2 CO#5 CO#2 PO#5 PO#2 PO#5 PO#2 FO#5 FO#2 FO#5 FO#2 MO#5 MO#2 MO#5 MO#2 DIVERSITY EMPLOYEETALENT TRAINING & DEVELOPMENT 813 DIVERSITY EMPLOYEETALENT TRAINING & DEVELOPMENT 813 CO#3CO#4 CO#3CO#4 PO#3PO#4 PO#3PO#4 FO#3FO#4 FO#3FO#4 MO#3MO#4 MO#3MO#4 MM WP#12 WP#1 MM WP#12 WP#1EE Work Environm EE ne of Sight EE Work Environm EE ne of Sight CENTRICITY EMPLOYER BRAND HR GOVERNANCERETENTION REWARD MANAGEMENT 813 742 674 615 431 657 599 416 CENTRICITY EMPLOYER BRAND HR GOVERNANCERETENTION REWARD MANAGEMENT 813 742 674 615 431 657 599 416 AA MM CCKK BBLL WP#3 WP#10 W P#11 W P#2 AA MM CCKK BBLL WP#3 WP#10 W P#11 W P#2 nmentLine HR ustom EE Operat Cultu 739613 656743 nmentLine HR ustom EE Operat Cultu 739613 656743 MO#1MO#6 MO#5 MO#2 MO#1MO#6 MO#5 MO#2 HR OPERATIONAL EXCELLENCE LEADERSHIP ORGANISATIONORGANISATION PERFORMANCE ORIENTATION RESOURCING 796 487 642 628 594603 684 HR OPERATIONAL EXCELLENCE LEADERSHIP ORGANISATIONORGANISATION PERFORMANCE ORIENTATION RESOURCING 796 487 642 628 594603 684 EE HH FF DD JJ GG WP#9 WP#4 W P#5 W P#8 EE HH FF DD JJ GG WP#9 WP#4 W P#5 W P#8 EE velopmentEEReward Cu ing re 598620 EE velopmentEEReward Cu ing re 598620 MO#3MO#4 M 2 MO#3MO#4 M 2 ORGANISATION CLIMATEORGANISATION COMMUNICATIONS ORGANISATION DESIGN ORGANISATION CLIMATEORGANISATION COMMUNICATIONS ORGANISATION DESIGN WP#6WP#7 WP#6WP#7eveloard eveloard Hospital Management Obj ti Leadership & Management Eff ti Staff Engagement Hospital Productivity Objectives Effectiveness
  • 70. The NHS Floodlight system (EXTERNAL): Current [C]Current [C] Cli i l P ti t P ti t Fi i lClinical Effectiveness Patient Experience Patient Safety Financial Management Hospital Management Objectives Leadership & Management Effectiveness Staff Engagement Hospital Productivity GWorld class Excellent Good Adequate Weak Insufficient data
  • 71. The NHS Floodlight system (EXTERNAL): Current plus previous 2 years [C+]Current plus previous 2 years [C+] Cli i l P ti t P ti t Fi i lClinical Effectiveness Patient Experience Patient Safety Financial Management Hospital Management Objectives Leadership & Management Effectiveness Staff Engagement Hospital Productivity GWorld class Excellent Good Adequate Weak Insufficient data Last 3 years performance
  • 72. Quality Accounts: We see 3 versions developing – Standard, Intermediate (Super8) and Advanced( p ) (SuperEight3D) Advanced Intermediate Standard
  • 73. ExIMR... [Executive Intelligence Measurement & Reporting]Reporting] Anal tics Ri k Predictive VisualisationE l ti F ti‘Real time’P fAnalytics Risk modelling VisualisationEvaluation Forecasting‘Real-time’Performance
  • 74.
  • 75. Too often different sourced data is not connectedconnected... Or, conversely, different time-series data is erroneously connected...
  • 76. Real-Time Informed Management and staffManagement and staff AFF CAL NCIAL ENT TIONAL STA MEDI FINAN PATIE OPERATO
  • 77. ExIMR: Key differentiating factors between ‘Basic’ and ‘World class’and ‘World class’ ‘Basic’ ‘World class’Basic • Data collation and measurement driven by ‘external demand’ World class • Data collation and measurement driven by ‘internal strategy’driven by external demand • Viewed as ‘imposed task’ • Intermittent ‘past-time’ data driven by internal strategy • Viewed as ‘integral infrastructure’ • Continuous ‘real time’ dataIntermittent past time data • Selected data used mainly to support ‘chosen view’/defence Continuous real time data • Constant aid to decision-making and governance • Management meetings driven by information swap g • Management meetings driven by knowledge debate/exchange • Tendency to think IT will solve problem – sub-optimal efficiency Operating c lt re still ‘target • Measurement ethos with cost- efficiency uppermost Operating c lt re ‘objecti e’• Operating culture still ‘target driven’ • Quality Accounts seen as • Operating culture ‘objective’ driven • Quality Accounts seen asQuality Accounts seen as compliance exercise Quality Accounts seen as ongoing evaluation exercise
  • 78. NHS where art thou? We’re talking quality! The CQC Rating: ‘Mi d th ’‘Mind the gap’ What is world class, indeed? T t P f ITrust Performance I: Taking a different step T P f II ‘C i f ll Trust Performance II: ‘With an outcome here and outcome there...’ ‘Coming full circle’circle‘Coming full circle’
  • 79. The 12 ‘attributes’ f ld lof world class healthcare 11 healthcare At trust level...8 7 5 ... each one is2 attainable 1
  • 80. The attainment of World class: A small step of steps within 5 years ?steps within 5 years...? ‘World class’ attributes Weak Adequate Good Excellent World class C B A AA AAA class ? ?
  • 81. What’s the answer to ‘Managingg g in Challenging Times’.....? “BEING SMARTER”