Transforming Care for the Future - University Hospital … item 7.3.3 - transformation...Transforming Care for the Future ... programme and in 3 years’ time through a . ... scheduling

Transforming Care for the Future 2017/18 Plan and Commitments

Vanessa Gardener, Chief Transformation Officer February 2017

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Overview 3 Review of 2016/17 4 Our Priorities & Commitments for 2017/18 5 Division Commitments for 2017/18 12 Our Year Ahead 13 Our Resources 14

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Contents

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Overview Our ambition is to lead healthcare in the NHS and therefore we need to be in the top decile for quality in its broadest sense not only on outcomes and safety but patient and staff experience and operational efficiency. As a result we aspire to be recognised for excellence in patient and staff experience and use of technology, facilities and strong leadership are enablers for staff to change. This is the key driver for our transformation programme and in 3 years’ time through a culture of clinically led change we want to achieve:

Overview Our Priorities Division Commitments

Our Year Ahead Our Funding Overview Our Priorities &

Commitments Review of 2016/17

Division Commitments

Our Year Ahead Our Resource Contents

Culture for change Continue to create the right culture across each Hospital and Division to deliver change through embedding the values and behaviours and leadership

Build Capability Continue to build staff capability in leadership and change using a single methodology to support continuous improvement

Delivery Through collaborative working achieve operational excellence and excellence in patient and staff experience which will continue to deliver efficiencies through transformational change, supporting the financial strategy

Governance Comply with the governance process / PMO to ensure rigour to the work and expectations to achieve top decile for quality

Continue to build the capability of staff to understand change at a fundamental level through to advanced and expert level ensuring enough staff are adequately skilled in leadership and change to ensure a culture of continuous improvement.

Ensure we are making best use of existing resources and corporate teams to support improvement and support the clinical teams and divisions / hospitals in a coherent way.

Continue to co-ordinate projects to ensure lessons are shared - the organisation is large and therefore it becomes more important to share across the organisation as well as nationally and internationally.

The Transforming Care for the Future Programme objectives for the next 3 years are:

Operational excellence across all hospitals and community services, alongside being recognised for excellence in patient and staff experience

Fully integrated single hospital services

Effective partnerships with our Local Care Organisation, Devolution Manchester, Shelford Group and other key stakeholders

The aim of our transformation strategy is to ensure we: Continue to build upon and strengthen the transformation work

already in place.

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2016/17 Key Achievements

1047 staff engaged and trained through workshops and NHS change Day and over 100 improvement projects carried out by clinical teams during the year

£12m efficiency savings delivered through transformational improvements contributing to turnaround

Elective transformation programme has resulted in more robust scheduling and optimisation of theatre lists delivering an additional 100 patients per week within the same resources

Outpatient transformation programme has supported the reduction in Did Not Attends by 2.5% which has contributed to over £3m in efficiency savings

Continued focus on reducing LoS and improving flow has meant that the A&E improvement trajectory has been met

4 Transform Together Winners for outstanding projects on Improving Patient Experience in surgical Admissions Lounge, T-macs pathway, Reject me Not and Pre-habilitation and Enhanced Recovery

Overview Our Priorities Division Commitments

Our Year Ahead Our Funding Overview Our Priorities &

Commitments Review of 2016/17



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Outpatients

Elective

Non-Elective

7 Day Services

Creating the Culture for Change Culture for

Change

Building Capability

Successful transformation requires a prevailing culture that strives for improvement. A culture that is open about problems, receptive to change and committed to doing what is best for patients is a vital foundation for a successful and sustainable long-term transformation. We will work with the Executive Director of Finance to continue to help Divisions to generate ideas and translate into practice. We will continue to look nationally and internationally at new care models that can be adopted within our Trust and will continue to work with colleagues as part of the Shelford Group Network for transformational change to learn from each other. We will work with the Organisational Development (OD) team and the Associate Director of Equality, Diversity and Inclusion to embed the values and behaviours of the Trust through our transformation programmes of work. We will continue to run “Transform Together” quarterly as a means of sharing examples of change projects and for individuals / teams to gain recognition for their work. Each quarter there will be a winning project that will be put forward for the the Proud of You Awards. We will continue to publicise the "Transform Together Innovation Fund", providing a small amount of funding to projects that will have a big impact for our patients. We will publish case studies to share the work and look at what can be scaled up into different areas. Lead Executive Director;- Executive Director for Human and Corporate Resources

OUR 2017/18 COMMITMENTS, WE WILL:-

Publish case studies to share across the Trust

Hold quarterly Transform Together events

Support OD with staff engagement programmes and the Leadership Culture Programme run by NHS Improvement

Continue to align the Transformation, Innovation and Research agendas

Working with OD to develop a blueprint for a model hospital outlining conditions for a high performance

Implement a Single Portal for ideas generation by staff (Innovation Factor)

Provide a process for staff to access charitable funds to support innovation and change projects

Overview Review of 2015/16

Our Priorities Division Commitments

Our Year Ahead Our Funding Overview Our Priorities & Commitments

Review of 2016/17



Integrated care

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Building Capability for Continuous Improvement We will continue to work with the Organisational Development team to build and improve our organisation capability, work more efficiently and effectively, through improving our skills and ways of working. We will do this by continuing to run leadership / change programmes and as part of the programme a transformation change project will be required to demonstrate learning into practice. We will ensure these projects link to the “Transform Together” events. We will evaluate the mentoring scheme for change and continue to support staff carrying out change projects. We will work with OD to continue to implement our transformation leaders programme jointly with AQuA which is open to all staff, making available courses for foundation level, intermediate level and advanced We will work with Divisional transformation leads ensuring that each Division has enough staff trained at each level to ensure the scale of improvement required can be achieved. We will evaluate the mentoring scheme for change and continue to support staff carrying out improvement projects. We will work with partners across the health and care landscape, including those organisations with a lead role in improvement, such as NHS Improvement, AQuA, Haelo, Advisory Board, Academic Health-Science Networks, to make use of their resources to make these changes. Lead Executive Director:- Executive Director for Human and Corporate Resources


Continue to work with OD on developing our medical leaders through NAC’s Programme

Work with OD to provide targeted training for middle managers in leadership/change

Develop and increase multidisciplinary team working through encouraging team based projects

Develop with Innovation and Communications a Quality

Improvement Hub and creative space




Review of 2016/17



Outpatients

Elective

Non-Elective

7 Day Services

Culture for

Change

Building Capability

Integrated care

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CMFT Outpatient Standards Over 1 million patients are seen across our outpatient settings and for many this is the only time they will come in contact with our services. This is why we are committed to improving our outpatient services to provide the best patient experience. During 2017/18 our Hospitals will continue to implement their own improvement delivery plans against the CMFT outpatient standards. We will continue to work with the Eye Hospital to become an exemplar site through implementation of the actions agreed between staff and patients through the experience based design process and demonstrate tangible improvements in patient experience if all 12 outpatient standards are met. We will ensure best practice is shared across our Hospitals and will continue to work with the nursing team to implement an accreditation process for outpatients to ensure the standards become "business as usual". Lead Executive Directors:- Medical Director & Chief Operating Officer


Follow up experience based design within MREH working with staff and patients

Work with the nursing directorate team to roll out the outpatient accreditation scheme

Where accreditation has not taken place, outpatient teams self assess against standards to demonstrate continuous improvement

Improve patient experience and reduce DNA's and complaints, contributing to the turnaround deliverables

Work with informatics to support implementation of new e-referrals into the trust and the new PAS system

Implement new patient letter template for new and follow up appointments




Review of 2016/17



Outpatients

Elective

Non-Elective

7 Day Services

Culture for

Change

Building Capability

Integrated care

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Maximising Elective Activity Approximately 100,000 patients are treated electively within CMFT and the NHS Constitution promises patients a limit on any wait for tests, outpatient care or planned operations. Timely referrals for treatment leads to better outcomes for patients. In order to improve care for our elective patients we need to ensure that as soon as the decision is made to treat we have the most efficient and effective processes for pre-operative assessment, theatre listing and enhanced recovery. During 2017/18 our Hospitals will continue to implement their improvement plans to deliver against the Elective CMFT standards and will implement the new pre-operative assessment services proven by Gynaecology to be effective. The Transformation Team will work closely with the Surgical Division to implement new models for general surgery as part of Healthier Together with UHSM. In addition we will work with the Children’s Hospital to plan their capacity requirements for 17/18. We will support the roll out the theatre accreditation scheme. Lead Executive Directors:- Medical Director & Chief Operating Officer


Embed the new surgical pre-op process/model and ERAS+ in Division of Surgery and ensure timely decisions support discharge

Work with Surgery to implement new general surgery models of care for high risk elective surgery as part of Healthier Together

Deliver a Rapid Improvement Event for Elective Orthopaedics at Trafford

Work with the nursing team to roll out theatre accreditation for the elective standards to become “business as usual”

Reduce cancellations and support delivery of RTT by optimising our theatres/catheter Labs to deliver an additional 5000 electives cases via robust scheduling (6–4–2 process), moving from 3 ½ to 4 hr sessions and reviewing theatre templates at specialty level

Embed new elective pathway policy and action cards for staff across surgery and the children's hospital




Review of 2016/17



Outpatients

Elective

Non-Elective

7 Day Services

Culture for

Change

Building Capability

Integrated care

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Optimising the Non Elective Pathway Over 300,000 people attend our adult and children Emergency Departments every year. Emergency demand continues to rise and therefore there is a requirement to ensure collaborative working with key partners across Central Manchester to manage patients as far as possible closer to home and ensure our internal processes are efficient for patients to be safely discharged earlier. We will continue to implement year 3 of the MRI/Trafford Urgent Care Strategy focusing on streaming medical patients as outlined by good practice research and developing our rehabilitation services for stroke patients, vascular patients and those requiring general rehabilitation. We will focus on compliance with the CMFT SAFER standards for all inpatients ensuring the length of stay blueprint is being followed in order to reduce length of stay. We will work with the Medical Division to ensure that frailty is flagged on admission and more complex patients are identified early and appropriate intervention is in place. We will embed the “Heading home” discharge bundle and evaluate its effectiveness across the MRI and RMCH. We will work with the Informatics and Performance teams to monitor the 2017/18 capacity plan for MRI and RMCH on a quarterly basis and develop the 2018/19 capacity plan linking with Single Hospital Services. Lead Executive Director:- Chief Operating Officer


Review and update the MRI Urgent Care strategy and link in Single Hospital Services Integration plans

Monitor quarterly the 2017/18 capacity plan and develop the 2018/19 capacity plan linked to the Single Hospital Service

Achieve LoS reduction plans to efficiency savings equivalent to 60 beds

Implement new outliers model across the MRI

Support Informatics to implement predictive analytics for ED/ward occupancy to support patient flow across the MRI

Implement surgical ambulatory care/assessment area and accommodate high risk emergency general adult surgery on the MRI site. Ensure timely access to emergency theatres

Fully embed SAFER standards and Heading Home discharge bundle across the MRI/Trafford and implement principles across RMCH

Optimise endoscopy rooms to support SAFER standards + 6 week

diagnostics delivery




Review of 2016/17



Outpatients

Elective

Non-Elective

7 Day Services

Culture for

Change

Building Capability

Integrated care

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Supporting 7 Day Services NHS England set the intention that by November 2017 four clinical standards describing the minimum level of service that hospital patients admitted through urgent and emergency routes should expect to receive on every day of the week. After discussions with the Academy of Medical Royal Colleges NHS England prioritised the following four standards as having the most impact on reducing risk of weekend mortality. These are: time to Consultant review, access to diagnostics, access to Consultant-directed interventions, on-going review. Led by the Medical Directors Office, extensive clinical engagement followed by a gap analysis was undertaken by each Division in 2016/17. We will work with the Medical Directors Office and Lead Divisional Director to understand priority areas across the Trust and agree where, if any, transformation resource is required to assist in delivery. Lead Executive Director:- Medical Director


Work with Divisional Directors and the Medical Directors Office on providing transformational resource for changes agreed as priority areas

Focus on delivering against the best practice guidance which is aligned to existing programmes of work on SAFER and handover

Support the MRI in testing a new way of working for Junior Doctors




Review of 2016/17



Outpatients

Elective

Non-Elective

7 Day Services

Culture for

Change

Building Capability

Integrated care

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Integrated Care and Pathways OUR 2017/18 COMMITMENTS, WE WILL:-

Contribute to the Single Hospital Service process for integration of services. Use due diligence outputs to identify quick wins for improvement

Work with clinical teams to develop integration plans and new care models for Single Hospital Services

Act as link between Get It Right First Time (GIRFT) national team and clinical teams for specialty site visits. Use outcome data to identify areas for improvementt

Focus on reducing length of stay for complex patients through

working with partners across health and social care as part of the LCO programme of work




Review of 2016/17



Outpatients

Elective

Non-Elective

7 Day Services

Culture for

Change

Building Capability

Integrated care

People benefit from care that is person-centred and co-ordinated within healthcare settings, across mental and physical health and across health and social care. For care to be integrated, organisations and care professionals need to bring together all of the different elements of care that a person needs. This is taking place in the City of Manchester using the Local Care Organisation as a vehicle during 2017/18. As part of Single Hospital Services, clinical teams are working together to ensure pathways of care are integrated and delivered in the most appropriate setting. This process provides staff with the opportunity to build relationships with colleagues who provide parallel forms of care and be ambitious in planning person centred care and support, and jointly allocating resources. It is important that we work with partners and across providers to promote, enable and encourage integrated care and support in order to deliver better quality care for patients.

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Our Priorities 2016/17

Divisional Updates

Our Year Ahead

Each Division has submitted turnaround plans of which outpatients, length of stay and theatre transformation are three key workstreams. The Divisional commitments for transformation are taken from these plans with financial consequence outlined below.

Division Outpatients Schemes for Delivery

Theatres Schemes for Delivery

LOS Schemes for Delivery

DMACs • Text reminder N/A • Implement new outlier process • Introduce frailty scoring and CGA • SAFER/Heading Home • Increase Ambulatory Care Pathways • Frailty

SMS • Standardised Text Messaging • Delivery against SOPs for cashing up clinics, patient

information • Streamline outpatient services delivered at Tameside

• Cath lab productivity • Improved scheduling in Cardiac surgery increasing the number

of patient of +3 pm

• Endoscopy recovery plan • Medical workforce • Increase Daycase/Biopsy Activity • SAFER/Heading Home

Surgery • Reduced DNAs • Improved Clinic utilisation & Productivity • Review of new models of care through virtual clinics

• 3.5 to 4hr Operating Sessions • Optimisation of sessions through scheduling • Focused weeks • New pre-op model • DNA avoidance – telephone reminder

• Increase ambulatory care pathways • ACU & Ward Reconfiguration • ERAS+ roll out • Enhanced surgical medicine optimisation • 23hr Model • SAFER/Heading Home

CSS N/A

N/A

• Hot clinic for Radiology • Additional sonographer sessions Sat/Sun • 3rd MR Scanner • Maximise use of CRIS/ESCCU

TGH • Virtual Fracture Clinic

• SRFT Orthopaedics transfer to Trafford • Non-elective orthopaedic reduction in LOS by 2 days

Dental • Targeting Key specialties to reduce DNA rates from 9% to 8% for New and 12% to 11% for Follow-up

• Increase utilisation for day case and elective activity across oral Surgery, Paediatric and Restorative Dentistry

• Implement formal scheduling meeting • Additional sedation sessions

N/A

REH • Reduction in DNAs • Increase utilisation • Reconfiguration of beds from IP to DC

SMH • Optimising gynaecology lists through improved scheduling and prompt start to theatres to deliver 2 additional cases per week

• Elimination of early finishes

RMCH • Review of capacity • Optimise utilisation of clinics

• Emergency theatre list efficiency – implement electronic booking system




Review of 2016/17



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Our Priorities 2016/17

Our Year Ahead Q4 Commitments

Outpatients Elective Non-Elective Culture Change

& Capability Building

Q1

• Audit of back to basics programme • Work with the Nursing Team to develop the

Outpatient Accreditation plan and Accreditor Training • 2nd EBD event in RMEH • Divisional Self-Assessment and Improvement plans

including shared learning • Clinic templates reviewed in readiness for e-referrals

• Implement fully a new pre-op model across Division of Surgery • Support surgery to take forward recommendations from project

PAtTH2 • Deliver a rapid improvement initiative for Elective Orthopaedics at

Trafford • Review theatre templates and focus on late starts/early finishes • Work with Surgery to develop an implementation plan for delivery of

new general surgery model of care as part of Healthier Together across CMFT and UHSM

• Implement and embed new elective pathway policy across Surgery. • Re-assessment against Elective Standards • Fully embed robust scheduling and processes across Cath Labs • Consider recommendations from GIRFT for General Surgery

• Review MRI strategy for year 2 and agree priorities for year 3

• Support Single Hospital Services Integration Plan • Implement new outlier model across MRI • Support Informatics to implement predictive analytics

for ED /Ward flow • Modify and adopt SAFER/Heading Home principles

across RMCH • Quarterly updates against 17/18 Capacity Plan • Introduce frailty scoring and CGA • Support endoscopy improvement programme • Scope opportunities for integrated working across

Health & Social Care

• Launch new curriculum for building capability • Develop high performing team strategy • Transform Together Best in Class event • Cultural Survey • Staff pulse check • HSJ Awards

Q2

• Support Divisions in developing directory of services for implementation of e-referral

• Review virtual clinic models • Work with Informatics and Divisions to review admin

processes in readiness for patient centre and e-referrals

• Share learning from MREH EBD event and support improvement plans to achieve exemplar status

• Evaluate the implementation of ERAS+ across Surgery • Implement and embed new elective pathway policy across RMCH • Evaluate impact of new pre-op assessment model • Shared learning event on good practice/best in class • Work with Trafford on taking forward recommendations following the

elective pathway improvement initiative • Implement 3.5 to 4hr operating sessions across the Trust • Consider recommendations from GIRFT for Paediatric Spinal and

Cardiothoracic surgery

• Support surgery to implement new model of ambulatory care/assessment area to accommodate high risk emergency General Surgery

• Fully embed SAFER standards and Heading Home discharge bundles across the MRI/Trafford

• Evaluate Impact of SAFER across RMCH • Pilot of Trustted Assessor model utilising single

assesmsent and combined documentation

• Transform Together event • Development of QI Hub • Quarterly staff pulse check

Q3

• Implement new patient letter system working with Informatics

• E-referral system implemented • Evaluate effectiveness of text reminders • Patient portal • Outpatient Tour for Governors

• Work with the nursing team to develop the theatre accreditation framework

• Work with informatics to review scheduling solutions for the Trust • Develop Integrated plans for Urology & Vascular across CMFT &

UHSM

• Evaluate new outliers process using specialty flags • Review bed configuration in surgery to accommodate

High Risk General Surgery cases • Evaluate and roll-out Trusted Assessor and single

assessment model

• Host the Shelford network meeting • Transform Together/NHS Change Day • Cohort 9 Newly appointment Consultant

Programme commence • Quarterly staff pulse check

Q4 • Evaluate Accreditation Programme and identify

areas yet to be accredited • Evaluate progress against work programme and

agree 2018/19 plan

• Undertake re-assessment of elective standards through the revised theatre accreditation programme.

• Evaluation of progress against work programme and agree 18/19 plan

• Develop 18/19 Capacity Plan • Evaluate progress against work programme and agree

18/19 plan • Implement new model of care in General Surgery

• Publish 17/18 case studies • Transform Together event • Evaluate 127/18 capability programme • Quarterly staff pulse check

Throughout 2017/18 we will have

Reduced DNAs by 2% Financial savings of £2.5m

• Delivered an additional 5000 elective cases • Financial savings of £8.8m

• Reduced LoS to deliver efficiency savings equivalent to 60 beds across MRI

• Improved performance against 4hr standard

• Maintained staff engagement score • Demonstrated positive changes on

cultural survey • Carried out quarterly Transform Together

events




Review of 2016/17



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Review of 2016/17



The Trust Board in 2014/15 invested to develop its own internal Transformation Team. The team is led by the Chief Transformation Officer and is made up of six members of staff (see below). The Deputy Director Transformation supports the Chief Transformation Officer and is responsible for aligning the programme with quality, clinical governance, finance, informatics, innovation, OD and estates. The Head of Transformation ensures the delivery of the Transformation Work Roadmap. The Programme Manager along with Project Managers work with Divisions and clinical teams to deliver changes. In addition, the team work alongside consultants who have leadership roles aligned to the workstreams as nominated by the Medical Director or Divisional Director and work along the Single Hospital Services team on developing integration plans.

The internal governance structure is outlined above. The Transformation Operational Group focuses on delivery of the outpatient, length of stay and theatre transformational activities and report through the Operational Management Group, Trust Management Board and Board of Directors.

Documents

Transforming Care for the Future - University Hospital … item 7.3.3 - transformation...Transforming Care for the Future ... programme and in 3 years’ time through a . ... scheduling