“TURNAROUND – WHY IT PAYS TO THINK DIFFERENTLY”

FIVE AREAS WHERE DELIVERY COULD BE IMPROVED IN THE SHORT TO MEDIUM TERM

NHS Transformation programmes are difficult; they require behavioural and attitudinal change to be effected on a scale only normally seen by governments and large consumer goods companies. Add to that the complexity of cross organisational processes, a heritage of public service and skills that are focused on improving patient well being rather than delivering large commercial change the challenge starts to become clearer.

FIVE AREAS FOR IMPROVING TRANSFORMATION DELIVERY

1. Cross Organisational working – many schemes require change to be effected in several domains of the healthcare system e.g. CCGs, Providers, the Public etc. Few schemes have joint ownership or cross organizational working

2. Change model - an effective way of changing behaviour that combines the marketing disciplines of segmentation, targeting and positioning along with an effective marketing mix, rewards and sanctions, constraints, and performance feedback.

3. Business Intelligence - Regular reporting that allows the programme to be developed and managed around individual level behavioural data

4. Programme Leadership - senior ownership of the programme with appropriate coaching and management along with defined escalation and senior intervention regimes

5. Confidence - belief amongst the team that they may and can change the behaviours of clinicians

1. ADDRESS CROSS ORGANISATIONAL WORKING

Many schemes require change to be effected in several domains of the healthcare system e.g. CCGs, Providers, the Public etc. Success will require joint ownership and planning along with cross-organizational working. Successful models can be seen in other industries such as Grocery Retail and Automotive who now comfortably embrace shared data, resources, processes and management.

1. CROSS ORGANISTIONAL WORKING

Stakeholders

Business Benefits

Work Schedule

Scope

Team

Risks

Suppliers

• Stakeholders in all organisations are identified• All are managed as separate units within a whole• Makeup of programme leadership reflects all constituencies

• Benefits are clear to all parties at a macro and entity level.• Investments are in direct proportion to potential returns• Risks are acknowledged and bourn by all parties

• Developed by all parties and accommodates different local requirements

• All parts managed as a single programme

• Remains within the influence of all declared stakeholders• Covers the full length of the process, across organisational

boundaries

• Team made up of members of all stakeholder groups• Commitment from all parties to free up time and give degree of

dedication to the programme

• Taken from the view of each stakeholder group• Managed as a single programme team

• Supplier/ customer relationship replaced by programme based partnership

Example Industries

AutomotiveConsultancies

IT/ IBMGrocery

1. CROSS ORGANISTIONAL WORKING

Stakeholders

Business Benefits

Work Schedule

Scope

Team

Risks

Suppliers

• Stakeholders in all organisations are identified• All are managed as separate units within a whole• Makeup of programme leadership reflects all constituencies

• Benefits are clear to all parties at a macro and entity level.• Investments are in direct proportion to potential returns• Risks are acknowledged and bourn by all parties

• Developed by all parties and accommodates different local requirements

• All parts managed as a single programme

• Remains within the influence of all declared stakeholders• Covers the full length of the process, across organisational

boundaries

• Team made up of members of all stakeholder groups• Commitment from all parties to free up time and give degree of

dedication to the programme

• Taken from the view of each stakeholder group• Managed as a single programme team

• Supplier/ customer relationship replaced by programme based partnership

Example Industries

AutomotiveConsultancies

IT/ IBMGrocery

2. DEVELOP AN EFFECTIVE CHANGE MODEL

For transformation to be effective specific target individuals have to change what they think and do. Plans need to understand this change and outline a way of effecting it. Many units feel that this is ‘surely impossible’, however this is what the marketing departments of Pharma and Healthcare companies successfully achieve every day. Combining the marketing disciplines of segmentation, targeting and positioning along with an effective marketing mix, rewards and sanctions, constraints, and performance feedback will achieve the required result.

2. Effective Behavioural Change Models

Thinks

Feels

Does

Has

9 | Apr 13, 2023 |

What change do we want to effect?

Where are they now?What can we do to change this? Where do we want

them to be?

Think Think

Feel Feel

Do Do

Have Have

3. BUSINESS INTELLIGENCE

The NHS is a data rich environment however little is used in the delivery of change. These internal sources, combined with selective use of external information from providers such as IMS and Cegedene will allow the Program director to devise strategies that are based on fact and evidence. Impact can also be more accurately tracked with regular reporting that allows the projects to be developed and managed as they progress.

The NHS is set to be externally focused

“Improving the outcomes for all Patients in line with the NHS Healthcare Outcomes Framework”

“Maximising the resources that are spent on Healthcare by making the NHS an exemplar in customer focus”

“Ensuring Local Area Health Policy aligns with public and patients needs and preferences.”

“Improving outcomes by designing and delivering care around the needs and choices of each individual patient by transforming patient and public participation in the NHS”

“Ensuring inequalities in access to healthcare in the area are addressed and that every person who comes in to contact with the NHS is treated fairly and equally, whether a patient or a

member of staff.”

“To become a customer service focused organisation”

“Removing areas of disadvantage from the system and guaranteeing no community is left behind or disadvantaged”

“Prioritising patients in every decision we make listening to the people and communities we serve.

“ ...... including public behavioural change through social marketing and, where appropriate, access to expert patient programs”

3. Business Intelligence and Research - illustrative

Research Data Use Possible Source

Profile All descriptive elements e.g. geo, size of practice, years experience, specialty etc.

Segmentation and targeting In HouseIMSCegedene

Usership and Attitude View on the therapy area, the centrally driven changes in clinical pathways generally etc.

Understanding how to influence and to plan messaging

IMSCommissioned

Current Behaviors What is the clinician doing with regard to the preferred behavior?

Understanding to what degree their behavior needs changing. Tracking performance.

Admissions and referral data

Media use and influence maps

Use of web sites, attitude to reps, who influences them, preferred learning environment

Ensuring that appropriate channels are used for the target community

In HouseIMS

etc

4. ENSURE SENIOR PROGRAMME LEADERSHIP

Programmes of this level of scale and organizational importance should be lead and managed at the board level. Senior ownership of the Programme with appropriate coaching and management along with defined escalation and senior intervention regimes are also necessary as are sophisticated programme management skills and tools. Investment in senior project teams with cross industry experience will be essential.

Programme Leadership and Management - The Cadence Process

Current reporting is a collation of all of the 'bits', particularly those that are broken: • Served up to the ‘accountable’ from the ‘responsible’ as a long list of problems –

‘Dead Cats’. • Takes hours to run through everything - frustrates both parties. • Seniors need to now whether the overall commitments are to be made and where

they can helpCadence is designed to support this: • Designed to roll up the full organisation in half a day• Not a status report - shows

– gaps and risks around the number that is committed to– how the responsible person is addressing any risks– need for mitigations.

• Supports a short (no more than 10-15 min) one to one call between the Accountable and the Responsible.

Weekly Cadence ReportOverall Performance

Date01-Nov-12

Summary£'000

 Demand

Management schemes

Other Schemes including new QIPP

Contracts management

Other Total

Recovery Plan Commit   35,549 19,465 33,380 0 88,394Recovery PlanBenefits completely secured and in FIMS   0 3,148 0 0 3,148Benefits completely secured not yet in FIMS   483 0 0 0 483Benefits still to be secured and in Recovery Plan   23,239 18,074 32,417 0 73,730Total planned and delivered Recovery   23,722 21,222 32,417 0 77,361

Gap 1 - Planning Gap to Sussex Recovery Plan Commitment

    (11,033)

Summary of Project RiskProject 1   (1,639) 0 0 0 (1,639)Project 2   (277) 0 0 0 (277)Project 3   (799) 0 0 0 (799)All Other Project Risk   0 0 0 0 0Risk   (4,615) 0 0 0 (4,615)

Gap 2 - As above (Net of Risk) to Sussex Recovery Plan Commitment

    (15,648)

Mitigating actions %Recovery of underspent budget   0 0 0 0 0Implementing strict spending controls   0 0 0 0 0Better working of top 20 contract performance   0 0 0 0 0Other mitigations 100 287 0 0 901 3,888Mitigations   287 0 0 901 3,888

Gap 3 to Recovery Plan Commitment (760)

The 7 Key Questions for Cadence

1. IS THE COMMIT STILL THE COMMIT?

2. DO WE HAVE A PANNING GAP?

3. WHAT ARE THE MAJOR RISKS THAT ARE EFFECTING THE SURETY OF OUR PROGRAMME

4. HOW ARE WE MITIGATING GAP 1 AND GAP 2?

5. WHICH ACTIONS DOES THE RESPONSIBLE WANT THE ACCOUNTABLE TO TAKE TO INCREASE SURETY FOR DELIVERY OF THE COMMITS?

6. WHAT SHOULD EACH PARTY TELL THE OTHER ABOUT WHAT IS COMING UP OVER THE NEXT 7 DAYS?

7. OCCASSIONAL DRILL DOWN

4. ENSURE SENIOR PROGRAMME LEADERSHIP (CONTD…)

Transformational Leadership a la Lou….

“You can't mandate it [the culture change], can't engineer it.”

“What you can do is create the conditions for transformation. You can provide incentives. You can define the marketplace realities and goals. But then you have to trust. In fact, in the end,

management doesn't change culture. Management invites the workforce itself to change the culture.”

“ I knew the leader of the revolution had to be me—I had to commit to thousands of hours of personal activity to pull off the change. I would have to be up-front”

“We started with a statement of principles. Why principles? Because I believe all high-performance companies are led and managed by principles, not by process.”

“Of course, different people are motivated by different things. Some by money. Some by advancement. Some by recognition. For some, the most effective motivator is fear —or anger. For others that doesn't work; it's learning, or the opportunity to make an impact, to see their efforts

produce concrete results. Most people can be roused by the threat of extinction. And most can be inspired by a compelling vision of the future. Over the past ten years, I've pulled most of those

levers”

5. CONFIDENCE - BELIEF AMONGST THE TEAM THAT THEY MAY AND CAN CHANGE BEHAVIOURS

Instilling Confidence - belief amongst teams that they may and can change the behaviors of clinicians, who they see as their superiors, is necessary if they are to be successful. Similar attitudinal changes have been undertaken in the airline industry as well as surgical teams within major teaching hospitals.

And the last word is Lou’s

“What you can do is create the conditions for transformation. You can provide incentives. You can define the marketplace realities and goals. But then you

have to trust. In fact, in the end, management doesn't change culture. Management invites the workforce itself to change the culture.

Perhaps the toughest nut of all to crack was getting employees to accept that invitation. Many use hierarchy as a crutch and are reluctant to take personal

responsibility for outcomes.

In the end, my deepest culture-change goal was to induce people to believe in themselves again—to believe that they had the ability to determine their

own fate, and that they already knew what they needed to know.”