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VaLUENTiS delivering world class healthcare 210610 final
1. Delivering World Class Healthcare:
Th F Ch ll f h NHSThe Future Challenge for the NHS
Nicholas J Higgins, CEO VaLUENTiS & Dean ISHCM
NHS-Healthcare Management Practice
DrHCMI MSc Fin (LBS) MBA (OBS) MCMI
22nd June 2010
DrHCMI MSc Fin (LBS) MBA (OBS) MCMI
VaLUENTiS NHS Prime Network ‘Managing in Challenging Times’
CBI Centrepoint London
2. Statement from the Secretary ofy
State extract
“I began today by talking about my ambition:I began today by talking about my ambition:
for health outcomes and healthcare services in
this country to be as good as any in the world.”
Andrew Lansley, Patient-centred care, DoH 8 June 2010
3. 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’
4.
5.
6. 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
• AccountabilityAccountability
Source: A High-performing NHS? A review of progress 1997-2010
8. Treating diseases: Where the money goes...
Source: What Do We Want From The NHS, The Daily Telegraph, March 9 2010
9.
10.
11. 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
12.
13.
14.
15.
16.
17.
18. NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
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!
21. Source: Adapted from An Introduction to Quality Assurance in Healthcare, A Donabedian OUP 2003
22. The three approaches to assessing
lit (D b di ’ SPO d l)quality care (Donabedian’s SPO model)
Cause
&
effect
23. The three approaches to assessing
lit (D b di ’ SPO d l)quality care (Donabedian’s SPO model)
Cause
&
effect
24. ‘Quality accounts’ including Floodlight
ti ll breporting covers all bases
• Trust Leadership &
management
• Staff engagement
M i /CQC• Monitor/CQC
‘Financial’ rating
Quality
accounts
inc NHSc S
Floodlight
• Staff engagement
• VBM Efficiency
• VBM Effectiveness
• Patient clinical
• CQC ‘Quality’ rating • Patient experience
* Both include patient safety
parameters
25. Mapping the various NHS quality related
t th SPO d lassessments across the SPO model
• Trust Leadership &
management
• Staff engagement
M 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
26. NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f ITrust Performance I:
Taking a different
step
T P f IITrust Performance II:
‘With an outcome
here and outcome
there...’
The CQC Rating:
‘Mi d th ’‘Mind the gap’‘Coming full circle’
27. 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
28.
29. CQC Trust Performance Ratings:
‘Quality’ & Financial rating matrix‘Quality’ & Financial rating matrix
World class
‘QUALITY’
Excellent
GoodGood
Fair
Weak
FINANCIAL
Weak Fair Good Excellent World class
FINANCIAL
31. CQC Trust Performance Ratings distribution
2008 9 [across 392 Trusts]2008-9...[across 392 Trusts]
Q
World class
Excellent 37
9%
17
4%
3
1%
1
Good 89 53413Good 89
23%
53
14%
41
10%
3
1%
Fair
11
3%
61
16%
50
13%
6
2%
Weak 2
1%
9
2%
8
2%
1
Weak Fair Good Excellent World class F
32. CQC Trust Performance Ratings distribution
2008 9 [across 392 Trusts]2008-9...[across 392 Trusts]
Q
World class
Excellent 37
9%
17
4%
3
1%
1
Good 89 53413Good 89
23%
53
14%
41
10%
3
1%
Fair
11
3%
61
16%
50
13%
6
2%
Weak 2
1%
9
2%
8
2%
1
Weak Fair Good Excellent World class F
33. Performance Ratings versus Employee
Engagement distributionEngagement distribution
Q
World class
Excellent
GoodGood
What happens if we plot
engagement scores
against Perf Rating?
Fair Is there any correlation?
Weak
Weak Fair Good Excellent World class F
34. 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
Weak Fair Good Excellent World class F
36. NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f ITrust Performance I:
Taking a different
step
T P f IITrust Performance II:
‘With an outcome
here and outcome
there...’
What is world
l i d d?class, indeed?‘Coming full circle’
37. • 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.
39. 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
40. 12 ‘attributes’ of world class healthcare
1. Practice of Evidenced based medicine (& social care)
2. Possess integrated network of ‘fit-for-purpose’ healthcare facilities
3. Standardised access to healthcare
4. Appropriate investment and innovation on technology and drugs usepp p gy g
5. Embedded patient-centred operating culture
6. Practice of Evidenced based management
7 Utilisation of requisite skilled staff7. Utilisation of requisite skilled staff
8. Embedded data collation infrastructure:
1. Clinical
2. Patient outcomes
3. Patient experience
4. Management/staff
5. Financial costing
6. Operational
9. Practice of Financial management
10. Developed Executive intelligence measurement and reporting
11. 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
41. 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
42. NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f I
Trust
Trust 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’
43. "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
45. Current NHS staff and patient ‘compliance’
survey process
Reported for
Reported
survey process
Reported 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
Spot target
patient
survey
Reported for
macro DoH
feedback *
46. 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’
Quarterly
‘pulse’
Quarterly
‘pulse’
Annual staff survey
f ll T t
Normally conducted in 2-week windows with 2-week turnarounds
across full Trust
population (census)
pulse
sample
surveys
pulse
sample
surveys
pulse
sample
surveys
across full Trust
population
......
Spot target
patient
survey
......
Intermittent collection of patient feedback
Spot target
patient
survey
Reported for
macro DoH
feedback *
47. From ‘Baseline to Advanced’...
Sample for
Sample
Sample for
macro DoH
research
for macro
DoH
research
Annual staff survey
f ll T t
Quarterly
‘pulse’
Quarterly
‘pulse’
Quarterly
‘pulse’
Annual staff survey
f ll T t
Normally conducted in 2-week windows with 2-week turnarounds
across full Trust
population (census)
pulse
sample
surveys
pulse
sample
surveys
pulse
sample
surveys
across full Trust
population
......
Quarterly QuarterlyQuarterly QuarterlyQuarterly QuarterlyQuarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
......
Continuous collection of patient feedback reported in quarterly ‘pulses’
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
p p q y p
Sample for Sample forp
macro DoH
feedback *
p
macro DoH
feedback
*Can be selected at any nominated point
48. From Advanced to World Class...
Sample for
macro DoH
research
Sample
for macro
DoH
research
Normally conducted in 2-week windows against selected samples
s
Annual staff survey
across full Trust
population (census)
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Annual staff survey
across full Trust
population
......
s
ephaseanalysis
atephaseanalysis
ephaseanalysis
ephaseanalysis
atephaseanalysis
Multivariate
Multivaria
Multivariate
Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly
Multivariate
Multivaria
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
......
Continuous collection of patient feedback reported in quarterly ‘pulses’
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
p p q y p
Sample for Sample forp
macro DoH
feedback *
p
macro DoH
feedback
Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming
*Can be selected at any nominated point
49. NHS staff and patient surveys :
The PULSAR® designSample for
macro DoH
research
Sample
for macro
DoH
research
The PULSAR® design
Normally conducted in 2-week windows against selected samples
s
Annual staff survey
across full Trust
population (census)
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Quarterly
‘pulse’
sample
surveys
Annual staff survey
across full Trust
population
......
s
ephaseanalysis
atephaseanalysis
ephaseanalysis
ephaseanalysis
atephaseanalysis
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
Multivariate
Multivaria
Multivariate
Quarterly QuarterlyQuarterly QuarterlyQuarterly Quarterly
Multivariate
Multivaria
Floodlight System for example
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
......
Continuous collection of patient feedback reported in quarterly ‘pulses’
Quarterly
patient
‘pulse’
reporting
Quarterly
patient
‘pulse’
reporting
p p q y p
Sample for Sample forp
macro DoH
feedback *
p
macro DoH
feedback
Source: Conducting staff and patient surveys in the NHS: A world class solution, VaLUENTiS white paper, forthcoming
*Can be selected at any nominated point
50. 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
process
Infreq ent reporting
• Lean adaptive blended (cost-
effective) process
Freq ent reporting• Infrequent reporting
• Less opportunity to embed
evidence based management
• Frequent reporting
• Constantly reinforces evidence
based managementevidence based management based management
54. 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
59. You may already know that....
• 1860 – set up first nursing school at
y y
p g
St 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...?
61. Thus our management radar diagrams are a
modern reincarnation of Nightingale’s PADmodern reincarnation of Nightingale’s PAD
62. 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 manner
E id b d t• Evidence based management
practised in ‘blotches’
• Evidence based management
practised as key driver
63. NHS where art thou?
We’re talking quality!
T t
The CQC Rating:
‘Mi d th ’
Trust
Performance II:
‘Mind the gap’
What is world
class, indeed?
T t P f I
Performance II:
‘With an
Trust Performance I:
Taking a different
step
T P f II
With an
outcome here
Trust Performance II:
‘With an outcome
here and outcome
there...’
and an outcome
th ’there...’‘Coming full circle’
64. Trust Performance broken down into four
outcome componentsoutcome components
rough:uredthrlymeasmpositelCom
68. 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 Outcomes
g
Outcomes
CO#5
CO#2
CO#5
CO#2
PO#5
PO#2
PO#5
PO#2
FO#5
FO#2
FO#5
FO#2
MO#5
MO#2
MO#5
MO#2
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
CO#3CO#4 CO#3CO#4 PO#3PO#4 PO#3PO#4 FO#3FO#4 FO#3FO#4 MO#3MO#4 MO#3MO#4
MM
WP#12 WP#1
MM
WP#12 WP#1EE Work
Environm
EE
ne of Sight EE Work
Environm
EE
ne of Sight
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
742
674
615
431
657
599 416
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
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674
615
431
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HR Function
Productivity
Leadership &
Management
Eff ti
Staff
Engagement
Workforce
Productivity
Effectiveness
69. 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
Effectiveness Experience Safety Management
CO#5
CO#2
CO#5
CO#2
PO#5
PO#2
PO#5
PO#2
FO#5
FO#2
FO#5
FO#2
MO#5
MO#2
MO#5
MO#2
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
DIVERSITY
EMPLOYEETALENT
TRAINING &
DEVELOPMENT
813
CO#3CO#4 CO#3CO#4 PO#3PO#4 PO#3PO#4 FO#3FO#4 FO#3FO#4 MO#3MO#4 MO#3MO#4
MM
WP#12 WP#1
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EE
ne of Sight
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
742
674
615
431
657
599 416
CENTRICITY
EMPLOYER
BRAND
HR
GOVERNANCERETENTION
REWARD
MANAGEMENT
813
742
674
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431
657
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487
642
628
594603
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LEADERSHIP
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RESOURCING
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ORGANISATION
DESIGN WP#6WP#7 WP#6WP#7eveloard
eveloard
Hospital
Management
Obj ti
Leadership &
Management
Eff ti
Staff
Engagement
Hospital
Productivity
Objectives Effectiveness
70. The NHS Floodlight system (EXTERNAL):
Current [C]Current [C]
Cli i l P ti t P ti t Fi i lClinical
Effectiveness
Patient
Experience
Patient
Safety
Financial
Management
Hospital
Management
Objectives
Leadership &
Management
Effectiveness
Staff
Engagement
Hospital
Productivity
GWorld class
Excellent
Good
Adequate
Weak
Insufficient data
71. 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
Patient
Experience
Patient
Safety
Financial
Management
Hospital
Management
Objectives
Leadership &
Management
Effectiveness
Staff
Engagement
Hospital
Productivity
GWorld class
Excellent
Good
Adequate
Weak
Insufficient data
Last 3 years performance
72. Quality Accounts: We see 3 versions developing –
Standard, Intermediate (Super8) and Advanced( p )
(SuperEight3D)
Advanced
Intermediate
Standard
77. 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 efficiency
Operating c lt re still ‘target
• Measurement ethos with cost-
efficiency uppermost
Operating 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
78. NHS where art thou?
We’re talking quality!
The CQC Rating:
‘Mi d th ’‘Mind the gap’
What is world
class, indeed?
T t P f ITrust Performance I:
Taking a different
step
T P f II
‘C i f ll
Trust Performance II:
‘With an outcome
here and outcome
there...’
‘Coming full
circle’circle‘Coming full circle’
79. The 12 ‘attributes’
f ld lof world class
healthcare
11
healthcare
At trust level...8
7
5
... each one is2
attainable
1
80. 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
?
?
81. What’s the answer to ‘Managingg g
in Challenging Times’.....?
“BEING
SMARTER”