valuentis delivering world class healthcare 210610 final

Delivering World Class Healthcare:Th F Ch ll f h NHSThe Future Challenge for the NHS

Nicholas J Higgins, CEO VaLUENTiS & Dean ISHCMNHS-Healthcare Management PracticeDrHCMI MSc Fin (LBS) MBA (OBS) MCMI

22nd June 2010

DrHCMI MSc Fin (LBS) MBA (OBS) MCMIVaLUENTiS NHS Prime Network ‘Managing in Challenging Times’CBI Centrepoint London

Statement from the Secretary of yState extract

“I began today by talking about my ambition:I began today by talking about my ambition:for health outcomes and healthcare services inthis 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• AccountabilityAccountabilitySource: 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?


The CQC Rating: ‘Mi d th ’‘Mind the gap’


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’ of pquality

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

‘Quality accounts’ including Floodlight ti ll breporting covers all bases

• Trust Leadership & management

• Staff engagementM i /CQC• Monitor/CQC ‘Financial’ rating

Quality accounts inc NHS c 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 engagementM 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?






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

WeakFINANCIAL

Weak Fair Good Excellent World class

FINANCIAL

Qualityaxis

World class ‘QUALITY’

Excellent

GoodGood

Fair

WeakFINANCIAL

Weak Fair Good Excellent World classFinance

Poorf f

FINANCIAL

Financeaxis

Not fit for purpose

CQC Trust Performance Ratings distribution2008 9 [across 392 Trusts]2008-9...[across 392 Trusts]

Q

World class

Excellent 379%

174%

31%

1

Good 89 53413Good 8923%

5314%

4110%

31%

Fair 113%

6116%

5013%

62%

Weak 21%

92%

82%

1

Weak Fair Good Excellent World class F

Performance Ratings versus Employee Engagement distributionEngagement distribution

Q

World class

Excellent

GoodGoodWhat happens if we plot

engagement scores against Perf Rating?

Fair Is there any correlation?

Weak


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


NHSNHSNEXT STOP:

WORLDWORLD CLASSCLASS

NHS where art thou?






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 facilities3. Standardised access to healthcare4. Appropriate investment and innovation on technology and drugs usepp p gy g5. Embedded patient-centred operating culture6. Practice of Evidenced based management7 Utilisation of requisite skilled staff7. Utilisation of requisite skilled staff 8. Embedded data collation infrastructure:

1. Clinical2. Patient outcomes3. Patient experience4. Management/staff5. Financial costing6. Operational

9. Practice of Financial management10. Developed Executive intelligence measurement and reporting11. 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?




T t P f I

TrustTrust 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 patient psurveys...

Current NHS staff and patient ‘compliance’ survey process

Reported for Reported

survey processReported 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


Reported for macro DoHfeedback *

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’




Normally conducted in 2-week windows with 2-week turnarounds

across full Trust population (census)

pulse sample surveys



across full Trust population

......


......

Intermittent collection of patient feedback


Reported for macro DoHfeedback *

From ‘Baseline to Advanced’...

Sample for Sample Sample for macro DoH

research

for macro DoH

research






Normally conducted in 2-week windows with 2-week turnarounds

across full Trust population (census)




across full Trust population

......

Quarterly QuarterlyQuarterly QuarterlyQuarterly QuarterlyQuarterly patient ‘pulse’

reporting

Quarterly patient ‘pulse’

reporting


reporting......

Continuous collection of patient feedback reported in quarterly ‘pulses’


reporting


reporting

p p q y p

Sample for Sample for pmacro DoHfeedback *

pmacro DoHfeedback

*Can be selected at any nominated point

From Advanced to World Class...Sample for macro DoH

research

Sample for macro

DoHresearch

Normally conducted in 2-week windows against selected samples

s

Annual staff survey across full Trust

population (census)

Quarterly ‘pulse’ sample surveys




population......

s

e ph

ase

anal

ysis

ate

phas

e an

alys

is

e ph

ase

anal

ysis

e ph

ase

anal

ysis

ate

phas

e an

alys

is

Mul

tivar

iate

Mul

tivar

ia

Mul

tivar

iate

Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly

Mul

tivar

iate

Mul

tivar

ia


reporting


reporting


reporting......



reporting


reporting

p p q y p


pmacro DoHfeedback

Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming


NHS staff and patient surveys : The PULSAR® design

Sample for macro DoH

research

Sample for macro

DoHresearch

The PULSAR® design

Normally conducted in 2-week windows against selected samples

s


population (census)





population......

s

e ph

ase

anal

ysis

ate

phas

e an

alys

is

e ph

ase

anal

ysis

e ph

ase

anal

ysis

ate

phas

e an

alys

is

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

Mul

tivar

iate

Mul

tivar

ia

Mul

tivar

iate

Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly

Mul

tivar

iate

Mul

tivar

iaFloodlight System for example


reporting


reporting


reporting......



reporting


reporting

p p q y p


pmacro DoHfeedback

Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming


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

processInfreq ent reporting

• Lean adaptive blended (cost-effective) processFreq 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

CarePainmanagement

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’)

DIVERSITYTRAINING &DEVELOPMENT

(Management Pathfinder™ ‘radar’)

EMPLOYEECENTRICITY

TALENTMANAGEMENT

DEVELOPMENT

813

EMPLOYERBRAND REWARD

674599 416

HRGOVERNANCE RETENTION

742

615

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‘Out-performing’ ( ld l )

HR

742 431

487

642

684

(world class)‘Out-performing’ (peer)‘Comparable’ (peer) OPERATIONAL

EXCELLENCE RESOURCING 642

628594603(peer)

‘Under-performing’ (peer)

LEADERSHIPPERFORMANCEORIENTATION

796ORGANISATION

CLIMATE ORGANISATIONCOMMUNICATIONS

ORGANISATIONDESIGN

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 gSt 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 mannerE id b d t• Evidence based management

practised in ‘blotches’• Evidence based management

practised as key driver

NHS where art thou?


T tThe CQC Rating: ‘Mi d th ’ Trust

Performance II:‘Mind the gap’


T t P f I Performance II:‘With an

Trust Performance I:Taking a different step

T P f II With an outcome here


and an outcome th ’there...’‘Coming full circle’

Trust Performance broken down into four outcome componentsoutcome components

roug

h:

ured

thr

ly m

eas

mpo

site

lC

om

Performance & Productivity:yA simple graphic

OUTCOMES

INPUTS THROUGHPUTS

OUTPUTSOUTPUTS

Performance & Productivity:ySimple healthcare model

OUTCOMES

INPUTS

THROUGHPUTSPhysical

Effect of treatmentQuality of life improvement, THROUGHPUTSNo of doctors,

nurses, management,

drugs, technology, beds

re-admissions, patient

experience, etc

OUTPUTS

etc

FinancialHealthcare

spend (direct and indirect

costing)SystemVolume of

patients treated p(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 valueTrust

performanceEmployer brandTrust

‘brand’

VBEΣx

Human Capital

Practices

Human Capital

Practices External PatientValue

Customer Satisfaction

Patient Outcome

Revenue Growth

Quality ofprovision

I di id l/

Portfolio mixSafety

X-sellingClinical treatment

Patient centric

Work valuesWork values

Line-of-sightLine-of-sight

Development EmployeeStaff

g

e1 p1-6poΣx

QΣxLΣx b1

Value

Proposition

ValueProposition

PRMCustomer

LoyaltyPatient

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

hcmΣyEf1-5

Employee Retention

Staff retention& utilisation

‘Local’ Management

‘Local’ Management Cost management

ComplianceCompliance

s1 peΣxhcmΣy

RΣx

ManagementManagementCost controlCost management

FΣym1

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 Outcomesg

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ORGANISATIONDESIGN WP#6WP#7 WP#6WP#7eveloard eveloard

HR FunctionProductivity

Leadership & Management Eff ti

StaffEngagement

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

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HospitalManagementObj ti

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Objectives Effectiveness

The NHS Floodlight system (EXTERNAL): Current [C]Current [C]

Cli i l P ti t P ti t Fi i lClinical Effectiveness

PatientExperience

PatientSafety

FinancialManagement

Hospital ManagementObjectives

Leadership & Management Effectiveness

StaffEngagement


GWorld class

Excellent

Good

Adequate

Weak

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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

PatientExperience

PatientSafety

FinancialManagement

Hospital ManagementObjectives

Leadership & Management Effectiveness

StaffEngagement


GWorld class

Excellent

Good

Adequate

Weak

Insufficient dataLast 3 years performance

Quality Accounts: We see 3 versions developing –Standard, Intermediate (Super8) and Advanced ( p )(SuperEight3D)

Advanced

Intermediate

Standard

ExIMR...[Executive IntelligenceMeasurement & Reporting]Reporting]

Anal tics Ri kPredictive

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 C

AL

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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 efficiencyOperating c lt re still ‘target

• Measurement ethos with cost-efficiency uppermostOperating 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?





T P f II

‘C i f ll


‘Coming full circle’circle

‘Coming full circle’

The 12 ‘attributes’ f ld lof world class

healthcare11

healthcare

At trust level...8

7

5

... each one is 2

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 ‘Managing g gin Challenging Times’.....?

“BEING SMARTER”

valuentis delivering world class healthcare 210610 final

Health & Medicine