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© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
The Vanguard Method in Health and Care: A special one-day event profound results through challenging conventions
© Vanguard Consulting Ltd www.vanguard-method.com
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)
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
The Vanguard Method
© Vanguard Consulting Ltd www.vanguard-method.com
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 ….
© Vanguard Consulting Ltd www.vanguard-method.com
Thinking
System
Performance
Things Better
Better Things
© Vanguard Consulting Ltd www.vanguard-method.com
Thinking
System
Performance
Start Here
Think different but the same
Get different but the same
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
Changing Thinking
A Leap of Fact
© Vanguard Consulting Ltd www.vanguard-method.com
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
© Vanguard Consulting Ltd www.vanguard-method.com
• 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
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
Transforming Hospital Performance
© Vanguard Consulting Ltd www.vanguard-method.com
• 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
© Vanguard Consulting Ltd www.vanguard-method.com
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
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
DEMAND
VALUE
EXPERTISE
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
Beyond Integration
© Vanguard Consulting Ltd www.vanguard-method.com
• 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.
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
© Vanguard Consulting Ltd www.vanguard-method.com
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
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
Commissioning Purposeful Systems
© Vanguard Consulting Ltd www.vanguard-method.com
• 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
© Vanguard Consulting Ltd © Vanguard Consulting Ltd www.vanguard-method.com
Making It Stick
Scale & P ace
Give Up & Replace
© Vanguard Consulting Ltd www.vanguard-method.com
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
© Vanguard Consulting Ltd www.vanguard-method.com
© Vanguard Consulting Ltd www.vanguard-method.com
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