The Vanguard Method in Health and Care: A special … Vanguard Method in Health and Care: A special...

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The Vanguard Method in Health and Care: A special one-day event profound results through challenging conventions

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9:30 Introduction and Welcome (Andy Brogan)

10:00 Transforming Hospital Performance (Steve Allder)

11:00 Break

11:15 Beyond Integration (Julie Boothroyd & Team)

12:30 Lunch

13:15 Commissioning Purposeful Systems (Helen Joy)

14:00 Break

14:15 Making It Stick (Steve Allder)

15:00 Open Forum / Questions to the panel

15:30 Close and Networking (Tea/coffee)

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The Vanguard Method

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Initiatives since 1997… Volume/ Action taken Green & White papers introduced 26

Parliamentary Acts 14

Funding Doubled

Medical Workforce Increased

Clinical (Nursing) Workforce Increased

NHS Real Estate/ hospitals New/ major refurbishments

Competition/ Choice Introduced and promoted

Regulatory oversight Increased

Commissioning strategy ‘World Class Commissioning’ introduced

Objective benchmarking Introduced and promoted

Consultant/ GP/ Dental Contracts Newly negotiated

…. and Agenda for change, Map of Medicine, turnaround, demand management, the improvement movement, National Service Frameworks, Evidence Based Medicine, guidelines, clinical pathways, personal budgets, Essence of Care, Energising for Excellence, Speak out Safely, Whistle-blowing legislation, Safeguarding, Benchmarking, Dr Foster, Friends and Family Tests, Any Qualified Provider, PCGs, PCTs, Practice Based Commissioning, Better Care Better Value indicators, Patient Recorded Outcome Measures, PbR, Clinical Negligence Scheme for Trusts, CQC, Clinical Support Units and procurement, CCGs, 5Cs, NHSE, European Working Time Directive, QIPP, QoF, targets, Monitor and ….

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Thinking

System

Performance

Things Better

Better Things

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Thinking

System

Performance

Start Here

Think different but the same

Get different but the same

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Changing Thinking

A Leap of Fact

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What is the purpose (outside-in)? 1

Work Design: Value plus everything else 4

Demand : T&F, V&F What matters?

2

Thinking 6

System Conditions 5

Capability of response 3

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•  Quality through specialisation and standardisation •  Economy through scale and productivity •  Control through management of cost and risk •  Improvement through plans and standards •  Accountability through attention to numerical goals

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Transforming Hospital Performance

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•  Hospitals are commonly designed for economies of scale

•  True economy is in flow not scale

•  Scale thinking is Kryptonite for flow

Op#cian  

Other  

   GP    

 Booking  centre    

 Appointment    

 Recep#on    

Recep#on  

 Wai#ng  area    

HRT  VA  

Nurse    VA/  IOP  

Nurse      IOP  

OCT  

Visual  fields  

Dila#on  

Pa#ent  educa#on  

Doctor  Optometrist  

Follow  up  appointment    Discharge    Onward  referral      Surgery  

Pharmacy  

Follow  Up  

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L = Capable of Learning to handle the demand type C = Already Competent to handle the demand type E = Expert. Capable of training others to handle the demand type

Op#cian  

Other  

   GP    

 Booking  centre    

 Appointment    

 Recep#on    

Recep#on  

 Wai#ng  area    

HRT  VA  

Nurse    VA/  IOP  

Nurse      IOP  

OCT  

Visual  fields  

Dila#on  

Pa#ent  educa#on  

Doctor  Optometrist  

Follow  up  appointment    Discharge    Onward  referral      Surgery  

Pharmacy  

Follow  Up  

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DEMAND

VALUE

EXPERTISE

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Beyond Integration

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•  Control achieved through hierarchy, rules, standards & specifications is illusory.

•  Real control requires decisions about what to do, how to do it and how to measure it to be at the interface with citizens.

•  Conventional management controls are Kryptonite for real control.

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Understanding Demand: the ‘2 Cs’

I know about demand because I know: –  Where it presents –  What it presents as –  What we did to it

I know about demand because I know:

–  Why it presents in human terms

COMMON

CRITICAL

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Commissioning Purposeful Systems

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•  A fifth of the UK Government’s total public sector deficit •  A sixth of the NHS Budget •  Almost twice the total projected spend on care for older people in 2014 •  Enough to fill the funding black hole facing local authorities projected

by 2020 with £1.6 billion to spare •  500,000 extra nurses •  570,000 extra police officers •  380,000 extra hospital consultants •  570,000 extra social workers •  725,000 extra care assistants •  50 x the amount the Audit Commission say councils could save

through “efficient assessment and review”

£16bn

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Making It Stick

Scale & P ace

Give Up & Replace

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FROM TO Economies of scale Standardisation Providing prescribed services  

Design  

Local by default

Designed against demand, variety

Helping to build social resilience  

Price Choice = choice of provider Scale Contractual, contingent Accountability for results  

Commissioning  

Cost

Choice = choice of goals

Attitude

Mutuality, problem solving

Accountability for method  

Efficiency of roles, functions, agencies Compliance with specifications, best practice and plans In the boardroom  

Management & Leadership  

Effectiveness

Achievement of purpose and method for improvement

In the work  

Standards, targets, budgets Role, function, agency centric Aggregated ‘lagging’ measures are the focus Personal and community outcome measures are absent or subordinated to lagging measures  

Measurement  

Capability to deliver purpose

Person, community, system shaped

Personal and community (not population) outcome

measures are the focus

Lagging measures of demand and cost are used to keep score, not to manage  

Decisions about: - what the work is - how the work should be done - how effectiveness should be judged are made in the hierarchy  

Decision Making  

Decisions about:

- what the work is

- how the work should be done - how effectiveness should be judged

are made at the interface between the citizen or

community to be helped and the system  

Addition and refinement Projects and themes Implementation focus  

Change  

Reconception

Purpose and experimentation

Action learning focus

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