jo cubbon and andy mcgrath: rapid performance improvement

Nuffield Trust & NHS Institute for Innovation Conference

Rapid Hospital Wide Performance Improvement

‘How can hospitals do more with less? Implementing best practice for efficiency’

Jo Cubbon Chief Executive, Somerset and Taunton NHS Foundation Trust

Peter Colclough Chief Executive, Weston Area Healthcare NHS Trust

(and previously, Chief Executive, Royal Cornwall Hospitals NHS Trust)

Andy McGrath Chief Executive, Alamac Ltd

NHS Performance Improvement Specialists

• Introductions

• Sharing case studies and results

• How the results were achieved (intro… performanceKITBAG ™ )

• Questions from the audience

Rapid Hospital Wide Performance Improvement

What we would like to share with you today…

Nuffield Trust & NHS Institute for Innovation Conference

Rapid Hospital Wide Performance Improvement

‘How can hospitals do more with less? Implementing best practice for efficiency’

Peter Colclough Chief Executive, Weston Area Healthcare NHS Trust

(and previously, Chief Executive, Royal Cornwall Hospitals NHS Trust)

• History of finance and performance difficulty

• Historic debt

• Poor working relationships

• Difficulty sustaining improvement

• Reputation

Rapid Hospital Wide Performance Improvement Royal Cornwall Hospitals NHS Trust & Weston Area Health NHS Trust

Performance Assurance Framework • Introduced performanceKITBAG ™

– March 2011 (Royal Cornwall Hospitals NHS Trust) – October 2011 (Weston Area Health NHS Trust

• Improved operational grip

• Improved performance

Rapid Hospital Wide Performance Improvement Royal Cornwall Hospitals NHS Trust & Weston Area Health NHS Trust

• Prospective view of performance

• Framework tailored and locally agreed

• Combination of tools and coaching

• Skills transfer and capacity building

Rapid Hospital Wide Performance Improvement Royal Cornwall Hospitals NHS Trust & Weston Area Health NHS Trust

Indicators Threshold Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11

RTT backlog As per April recovery plan amended in August

1434 1279 1335 1088 955 847 678 529

RTT overall performanceAs per April recovery plan

amended in August - national target remains 90%

58.20% 62.60% 70.00% 80.50% 83.10% 90.20% 90.30% 90.10%

RTT overall activity (admitted) As per recovery plan 2198 2520 2053 2503 2821 2669 2683 2484

RTT activity per working day 109.9 109.6 114.1 125.2 128.2 127.1 122.0 128.0

Theatre activity per working day 89.3 92.6 92.8 95.0 91.4 105.0 102.6 97.1

ED performance 95% 90.98% 93.95% 92.69% 97.43% 96.87% 97.94% 95.30% 96.40%

SHA average position (across basket of indicators) out of 17 acute providers 11.1 9.4 10.3 9.4 8.8 10.3 9.9 7.2

Workforce 4726 4705 4725 4687 4672 4662 4650

SIP delivery £600 £1,300 £2,200 £3,100 £4,500 £6,800

Rapid Hospital Wide Performance Improvement Royal Cornwall Hospitals NHS Trust - Results

Nuffield Trust & NHS Institute for Innovation Conference

Rapid Hospital Wide Performance Improvement

‘How can hospitals do more with less? Implementing best practice for efficiency’

Jo Cubbon Chief Executive, Somerset and Taunton NHS Foundation Trust

Musgrove Park Hospital

• Past performance is not a prediction of future success

• Know your numbers…and how they connect

• Separate the wheat from the chaff

– Selecting the right indicators

– One size doesn’t fit all

– Get ownership from teams

– Set stretching targets…the easy way is not necessarily the right way

• Brings teams together: one common purpose…

– to be ‘Green’ (‘Performing’) and avoid the need for a performance review

Lessons learnt

Musgrove Park Hospital

• Separate outcomes from process • Focus effort at the right level of the organisation

– Directorate team Performance Assurance Framework (PAF)

– Getting clinician buy-in

The next steps

Musgrove Park Hospital

“We have a very historical view of performance, so where something is performing well you don’t know if it is going off in future” (Director)

“You can’t see individual trends so it can’t tell you which areas are failing, it just tells you about the Division” (Performance Manager)

“It focusses the mind and we agree actions as part of the PAF process” (Director)

“The PAF gives far greater visibility for Trust leaders to see where performance is waning” (Divisional Director)

“The PAF has certainly added rigour and focus to performance management” (Director)

Historic feedback

Performance Assurance Framework feedback

Musgrove Park Hospital Initial PAF

Musgrove Park Hospital Refined and tailored PAF

• The PAF increases visibility across a multitude of measures in all performance disciplines

• It is the one performance reference for Directorates and Divisions, ‘one currency’

• The Trust is currently in the process of rolling out a Directorate level PAF

• This will help operational teams manage the Hospital more effectively

A real example of an action log and PAF measure

Musgrove Park Hospital PAF is a tool for improvement

Nuffield Trust & NHS Institute for Innovation Conference

Rapid Hospital Wide Performance Improvement

‘How can hospitals do more with less? Implementing best practice for efficiency’

Andy McGrath Chief Executive, Alamac Ltd

NHS Performance Improvement Specialists

Our 3 main points...

1. Tailored, Predict, Connected, Consistent, Relentless

2. Doing things differently by seeing things differently

3. ‘Front windscreen’

You will have read almost everything there is to know…

…about performance improvement

and management…

…but sometimes we still do not get the results we want...

The definition of insanity…

…is to do the same thing over and over again

and expect the same result…!

Albert Einstein

So we must do some different things...

But we all know the pressures we face in the real world...

…and we have a complex day job to do...

…and not forgetting the daily miracles our teams perform...

“… Here is Edward Bear, coming downstairs now, bump, bump,bump, on the back of his head,behind Christopher Robin. It is,as far as he knows, the only wayof coming downstairs, but sometimeshe feels that there really is anotherway, if only he could stop bumpingfor a moment and think of it .… “

…so we need to use what we already know...

…but apply it in a different way…!

Here is Edward Bear, coming downstairs… bump, bump,

bump…

It is as far as he knows the only way of coming

downstairs…

But sometimes he feels there really must be a better way…

If only he could stop for a moment to think of it…!

So how do we do this...?

performanceKITBAG ™

Patient Safety & Quality Operations

Workforce Finance

But the performanceKITBAG ™

is not rocket science...

...we use your data...

…turn it into information...

& show your teams how to use it

… in a relentless way…!

The performanceKITBAG ™ has 3 areas of focus...

Management

Culture

Improvement

Performance…

Know your business...

Measure... Do... Measure...

Gain control...

Predict and anticipate performance...

Establish stability and assurance...

Better, quicker decisions...

Reduce waste, better patient care...

The main ethos behind the performanceKITBAG ™ approach is...

‘Stickier’ efficiency / cost improvement...

This all helps us manage the ‘business’ of health through the ‘front windscreen’...

And most importantly the performanceKITBAG ™

creates a performance culture...

Own up to what is not working to develop a ‘cross hospital’ team...

What we think, or what we know, or what we believe…

is in the end of little

consequence…

it is what we do that counts

Do what you say you will do...

John Ruskin

(1819 - 1900)

Poet

E=MC2

Albert Einstein

Action = Benefit...

Set small incremental goals to ensure we are always improving...

Be positive, be brave...

...be innovative and fail fast (!)...

But, we will always have bad days...

Balance ‘challenge’ with ‘motivation’...

Encumbered by low self-image, Bob takes a job as a speed bump... !

Through support and encouragement...

…To ensure our people can be the ‘best’ they can be...

To ultimately create a

freedom to perform...

Our 3 main points...

1. Tailored, Predict, Connected, Consistent, Relentless

2. Doing things differently by seeing things differently

3. ‘Front windscreen’

Many thanks

& Q’s...?