London 18th March 2016

UCL Partners

NorthumbriaCreating a clinically led Trust

A leadership journey

David Evans

Chief Executive

David.evans2@northumbria-healthcare.nhs.uk

Clinical engagement

Training to lead

System redesign to support clinical leadership

Skills for managing organisational change

Developing a new workforce

Northumbria’s clinical leadership model

What does this mean for training?

What could this mean for a career choice?

What is going on out there?

Desire to engage

Appropriate skill set – not simply clinical

Time

Systems to allow engagement

Clarity of process = open & honest

In depth Academic analysis

In depth Academic analysis

or

A slightly quirky view from a Trust that

believes it has made this happen…….

Northumbria’s numbers….

500,300 pop 2,500 sq ml 85%15%

85 ml A1 65:35 Em : El

9,300 staff 500 Docs >1,100 beds

10 I/P sites £ 440 mill 83 , 84

We are a bit odd…..

Stability with flexibility 2 CEs in 20yrs

Willingness to try…

Community Hospital decant

Adult Social Services, Northumberland CC

Rural pressures = drive for innovation

“centralise when clinically better , devolve where

clinically safe”

In the beginning , 1996

Traditional Clinical DirectoratesLeadership on rotationNo trainingNo timeNo systemNo dataMajor distrustMajor non-engagement

= Service Reviews…….& lots of data 3 clicks!

1997:

Clinical Leadership Development Programme

7 days over 9 months

2 + 1 + 1 + 2 + 1

multidisciplinary

collaborative

absolute requirement for management role

a few said “ no thanks “C 17

Trust values

Myers Briggs

CEO / DoF /MD

Change management

NHS £€£€

Business case

Law / corporate manslaughter

Scene setting PO

Peer group support

Work based project

Clinical Policy Group 1998

“ Keeper of clinical governance “

Every clinical manager = 82

+ 6 GPs

Monthly

3 cycles

NSECH

SUIs & governance

Forward thinking

Clinical Policy Group 1998

“ Keeper of clinical governance “

Every clinical manager = 82

+ 6 GPs

Monthly

3 cycles

NSECH

SUIs & governance

Forward thinking

FRANCIS = Soul & conscience

Clinical Leads Forum 2001

Informal grouping

Clinical leads from both sides

-The NHS works well here , it is in no-ones interest to destabilise that

-Any change should be based on patient pathways and for the direct benefit of patients

-No surprises please…..

Formalised 2006

- Speed of change was amazing

2004 :O & G / ITU 7/7 Centralise maternity

Extended working day 08:00 – 20:00

On-call = work Surgery / Ortho 7/7

Sole commitment is to emergency stream & emergency theatres

Rolling Consultant rounds & Rapid assessment clinics

Every patient seen every day

Medicine

Foundation Programme Pilot

Single door point of entry

Consultant led Acute Care Stream = reborn ACPs

ACP 08:00 – 22:00

Split FOH / BOH

Develop H@N Teams – NNP s

All clinically driven on Safety & Quality

7 Day Working

Re- badged ‘ Acute Care Physicians’

Started with 6…

New ways of working

‘ Blurring the boundaries’

Business Units oversee everything

‘ No surprises please ‘

No deals

No £££££

No extra staff.

42 week year

Everything annualised & in your job plan

7 Day Working

Re- badged ‘ Acute Care Physicians’

Started with 6…

New ways of working

‘ Blurring the boundaries’

Business Units oversee everything

‘ No surprises please ‘

No deals

No £££££

No extra staff.

42 week year

Everything annualised & in your job plan

2004 Consultant recruitment

Competencies of a Northumbria ConsultantDeveloped by everyone

2 days

Formal meeting BUD & GM

Psychometrics - Horgan & Neo pi

Clinical scenarios – x 2

1hr 10min structured interview@values

Weighted scoring

70% bar

Tailored welcome

Changed teamsChanged sitesMentorshipY1 PDP in placeKnow & understand strengths & weaknessesNew Consultants’ Programme30%

2006 Foundation Trust

Business Units & service line reporting

BUDs x 4 50:50

Health as a business

Financial consequences of clinicians’ actions

Cost efficiency

No deals , no surprises , no corridor conversations

Control with responsibility & accountability = freedom…

Good things happened

Captured the natural competitiveness

Business Unit..

BUD Exec Director OSM s

Matrons Clinical & site leads Nurses

Finance Data Governance

H R Pharmacist Therapists

I T Patient experience

+/- non-execs

+/- MD

+/- CE

Speciality Boards

Development & evolution:

It seems to have worked for us …..

Each one is different now….

Reports are shorter & crisper

Everyone contributes

There's a little bit of competition

Everything goes on the intranet

Accountants think differently…..

Charts vs Graphs

“ I think a rolling average would really help here “

We have invested a lot

in clinical management …

No longer the Dark Side…

Visible clinical leadership & management

Flat structures , open doors & easy access

Exec / non exec walk around

Board to Ward programme

Board development (PS 2010) Leadership ( HSJ 2013 & 2015)

Clinical lead presentations each month

“ This is the way we do business”

“No corridor conversations or backdoor deals”

Job planning:

A meaningful exercise for both parties…..

Flexibility and annual negotiation

42/52 annualised

Evening & weekend working

Teaching & training - tariff within SPA time

New starters 9:1 , most become 9:2 , some 8:3

General understanding this is not fixed or a right

Extended days , O&G , ACP, ITU …in preparation for ECC

Change of location.

CEA = quality rather than quantity

Safety & quality

LIPS x 4

Safety panels

Quality council

Safety & Quality committee

Safety walk around

Patient Safety Fridays

Feedback

Safety & quality

Mortality reviews

Ward based SPCs

Trust harm rate IHI trigger tool

Dr Foster etc…. Unexpected / high & low risk codes

Trust mortality review

Horgan

< 1% > 3 , 4 x 4

VLADs

Grow a new workforce

Advanced Neonatal Nurse Practitioners , Level II

Night Nurse PractitionersNurse PractitionersAdvanced Critical Care PractitionersSurgeons assistantsSpecialist NursesClinical PharmacistsPhlebotomists

Co-located OOH service

GP Clinical Directors 2013

New ways of working

Protocol driven = the Northumbria way

Handover + SBAR

Shared ownership eg post-op care

Fast track hip & knee

Day case > 95%

POW = POD = PO ½ D

Facilitated discharge & ‘ ticket home’

Ambulatory care

Every change or development ‘ECC proofed’

Why not be radical?….

A whole system change…..

Create a Specialist Emergency Care Centre

Split Elective / Emergency work

24/7 resident Consultant in Emergency Care

Extended working day 7/7 , 9 clinical teams

Change DGH s for elective / community care KIDD.

Develop Ambulatory Care & Frail Elderly

Direct access to palliative care

Builds on our existing decant model

Puts a building around our new ways of working

• ECC location map to do….*

Front line….Emergency Care Consultants 24 / 7 Acute Care Physicians

Surgery x 2Orthopaedics x 2Cardiology + Respiratory + Stroke + Elderly careIntensivistsO & GPaediatrics ( 8 ‘til late )

+ Nurse practitioners / ACCPs

+ Clinical Pharmacists210 beds + 6 theatres + 18 ITU + 2 x CT + MRI + 4 PFAmbulatory care + surgical assessment + mat + paedsEndoscopy + cath lab

NSECH

UK’s first dedicated emergency care centreServe 530,000Merges 3 acute streams into 1Consultant led , 24/7 , 365

9 specialist teamsLinked with Primary Care and Social ServicesHyper-acute stroke

Patient centred = Keogh MAJOR A & E

£££££ ?

£ 200 million over 10 years

£70 + FTFF £90 build

Rest from CIPs & productivity

Emergency Care Centre

2 new Community hospitals

Bed neutrality by 6 to 4 bed bays( A little bit about the politics)

£114.2 mill

2013