– NPfIT Lessons Learned ASSIST Mark Horncastle – CSCA (

ASSIST – NPfIT Lessons Learned
Mark Horncastle
Business Change Manager – CSCA (C&M and SASHA)
Mobile – 07834 800392
9/22/2016 12:03:51 AM NHS MK5.1
C&M IM&T leads Lessons Learned
Outcomes from a workshop run in Nov 2004 across C&M SHA
• Planning and Governance
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Propose to start 2005 project engagement early
Value identified in Pre-Project planning / delivery activities
Planning and Governance needs to be strengthened
Strict mobilisation criteria
• Comms and Engagement of wider organisations
– Clinical engagement
– Visibility of Trust drivers and targets
• Product visibility
– Need to increase level of functionality delivered (more development effort)
– But want certainty of planning (set delivery timescale)
• Management of resources
– Dipping into same pool
HOW DO WE MAXIMISE THE OPPORTUNITY?
= START EARLY & INTEGRATE INITIATIVES
Lessons Learnt from Deployment projects
• Visibility of current and forthcoming initiatives within the Trust
–
Re-organisation of management structure, roles and responsibilities has meant un-certainty and
lack of clarity around governance :
• Where does NCRS fit?
• Focus elsewhere amongst the Exec Team
• Clinical engagement
–
–
Project Team made up of staff from IM&T
Time lapse to recruit clinical members to project team
• Visibility of multiple ways of working across the Trust
–
–
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Local ways of working (e.g. processes / procedures / capturing of information / generation of
letters etc.) resulting in non-standardised modes of operation
Local knowledge (on-the-job training….local best practice….or bad practice!)
Limited ‘holistic’ understanding of the operational aspects of the current services provided
across the Trusts
• Standardisation comes before ‘technical platform’
–
Change / standardise business processes before thinking about deploying a new IT system
• Project Team
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Recruit early….clinical and clerical
Lessons Learnt from Deployment projects
• Staff Empowerment
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Need for staff to attend workshops and make decisions
Broad coverage of staff to attend sessions:
• Across the Trust
• Manager and operational staff (most appropriate based on knowledge)
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Remove reliance on key personnel to be present at every session to make the decision….need
to have confidence in staff representatives to make the right decisions based on operational
knowledge
• Executive Commitment
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–
Standardisation of business processes must be endorsed by Trust boards to ensure buy-in and
commitment from staff at all levels within the organisation
Clear leadership to drive through standard ways of working
• Communication
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Communication is key to the success of the project and must be maintained….labour intensive
which requires communication champions identified across the Trust who are committed to the
project life cycle
• Champions Network
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Terms of reference is essential….staff must be committed to supporting and advocating the
project
HOW DO WE MAXIMISE THE OPPORTUNITY?
= START EARLY & INTEGRATE INITIATIVES
War stories (but no names!)
• Many projects have taken a 'passive' approach and are not
seeking to realise ‘real’ benefit from their CFH projects
• Projects are often not involving HR when they are changing
roles – this has led to Union involvement in some projects
• Some projects have placed almost total reliance on CSCA
to develop processes / operating procedures - resulting in
minimal organisational learning and buy-in. Trusts must
'own' the new processes.
• A significant proportion of projects have seen this as an IT
programme and have resourced accordingly. Engagement
has been a key issue across many projects.
Key characteristics of an 'excellent' Trust / LHC
• Board level sponsorship and engagement
• Clear and shared understanding of why projects are being progressed
• Clear understanding of initiatives which are current and proposed
– are these activities appropriate (converging, diverging, colliding?)
– how will CFH impact these
• Clear understanding of care models and how these will change in the future
• Understanding of organisational (project) requirements in terms of
– Business Change (i.e. workflow)
– Workforce (i.e. changing roles)
– Technology (i.e. data migration)
• LHC working as integrated partners - shared focus, objectives, etc
• Understands requirement for and has identified executive, management and
clinical champions
• Training strategy integrated to support Workforce Development & new ways of
working
• ……..
In summary - uses CFH as a major enabler for service
improvement - from design through to delivery
“A Another” LHC Key Drivers
The Integrated Service Improvement plan (ISIP) has helped to identify some areas where early
attention will be required to ensure delivery, they are:
•
•
•
•
Achieve financial balance and sustainable health community
Development of seamless care pathways
Reduction in diagnostic waiting time
Delivery of 18 week target
The plan has also highlighted the lack of infrastructure and joint governance between the
organisations to support delivery. The delivery of transformation will be achieved by;
• Maximising the benefits from Connecting for Health and integrating it into the care delivery
system
• Delivery of Practice Based Commissioning
• Streamlining of care pathways across health sectors and the LHC
• Focusing on joint working
Is an Integration view enough?
• CSCA work ongoing to embed best practice as standard
practice across the board for all organisations
– i.e. training workshop in C&M on 20/12
• CSCA learning lessons and looking at tools that enable NHS
and CSCA to generate improved outcomes –
– Benefits
– Process design
– Stakeholder Management & Communications
– Training
– Readiness
• Pre-deployment activity being designed into projects
• ISIP has the ability to provide a clear focus around the wider
agenda
Patient Administration System
High-level NCRS Benefits
Standards for
Better Health
Relevant High Impact
Change(s)
Summary Functionality
Key metric(s)
Registration All patients’ demographic
data, including unique NHS number, once
validated is used in all identification of
patient contacts.
Time saving of not re-entering data
Reduce risk of incorrect patient
identification
Governance
Core standard C 9
Clinic scheduling Support for direct
interface to support the national e-Booking
solution and ability to book clinics for all
HCP’s at any site, from any location at any
time. Scope
Number of clinics and number of
vacant slots
Reduced acute unit OPD waiting time
Length of referral process
Reduced DNA because of patient
choice
Reduced cost of referral
Accessible and responsive
care
Core standard C 17
Change 5
Avoid
unnecessary follow ups and
provide follow up on the right
care setting
Change 8 Improve patients
access by reducing queues
Bed Management Admission Discharge and
Transfer and bed management with
discharge planning, allows up to date
information about bed state, actual, booked
and potential discharges
Reduced last minute cancellations
Reduction in IP Waiting list
Reduced Average length of stay
Clinical
and
Effectiveness
Core standard No
Cost
Change 3 Manage variation
in the patient’s discharge
thereby reducing LOS.
Change 4 Manage variation
in the patient’s admission
process.
Waiting List Management Waiting list
management
allows
validation
and
prioritisation of patients as well as
arranging
pre
op
assessment
appointments.
Reduced waiting time
Validated waiting lists
Number of last minute cancellations
Clinical
and
effectiveness
Core standard C5
cost
Change 4 Manage variation
in the patients admission
process.
Change 8 Improve patients
access by reducing queues
Case note tracking identifies location of
notes and reduces no of absent notes for
elective appointments and for emergencies.
Number of patients seen without notes
with the attendant risk
Number of appointments cancelled
due to absent notes
Governance
Core standard C9
Coding
All patient contacts accurately
coded for contracting and workload
assessment.
Audit of coded completed contacts.
Governance
Core Standard No C7
C5
Change 9 Optimise patient
flow through service
bottlenecks using process
templates.
The measurable benefits identified are those that may be delivered through the successful implementation of a number of project types. The
extent to which benefits can be achieved will depend on the current state within a local NHS organisation or Local Health Community.
Organisations taking the lead
• Mersey Care
– Working with the executive team to develop a dependency map
of all projects and initiatives across the organisation to allow
clear prioritisation of activities to enable the achievement of
strategic objectives.
– Normalising processes ahead of the delivery of CfH
• Alder Hey
– Identifying future service models and mapping technology and
business processes onto the Model of Care to ensure effective
transition
•
•
•
•
Lancs Care
East Birmingham PCT
……..
There are many more examples
Map Key:
Timescale of initiative / programme of work
Completio
n Date
On-going Time-framed
activity
Stakeholder group directly impacted by
initiative / programme of work
Service
User
Carer
Staff
Ongoing
work
Older People’s Mental Health
Services Dependency Map
Older People’s Mental Health Services
2005
2006
National:
National guidelines
National:
Access Booking
& Choice
Single Assessment
Process (date?)
Commissioner:
Continuing Care
Commissioning
Social Services
Implement Financial
Recovery Plan (Mar 06)
National:
Knowledge & Skills
Framework
Review Provision / Model
of Day Services (Mar 06)
Service Development:
OBC Completion (May 06)
2009
Map Key:
Completion On-going
Date
On-going
work
Stakeholder group directly impacted by
initiative / programme of work
Service
User
Development of
CMHTs (Mar 07)
Delayed Discharge Review (Mar 06)
Development /
Describing Service
Models (completed)
Single Point of
Referral (Mar 07)
National:
Indicators for Older
People’s
Continuing NHS Care (Mar 06)
National:
Cross Charging
Act (2003)
2008
Timescale of initiative / programme of work
National:
NSF for Older
People (2001)
Attend ESR Project Group Meetings
Mersey Care Directorates
2007
Commissioner:
Liverpool Older People’s
Commissioning
Implement ECC (Mar 06)
Carer
Staff
Direction of impact
External Party driving initiative
OBC / FBC User Group
Implement Knowledge &
Skills Framework (Oct 06)
Finance:
Recovery Plan
Service Development:
FBC Completion (Dec 07)
Organisational Development:
Knowledge & Skills
Framework
Understand Trust priorities / dependencies / timescales….build an integrated picture of the
Finance:
changing Mersey Care landscape through:
Direct Payments (date?)
Capturing the current and planned changes across the Trust
Understanding the key drivers for each project (e.g. local, national…)
Understanding the improvement dependencies across all projects
2010
Mersey Care’s perspective on this work….
•
The Executive is seeing the importance of collective time to think strategically –
the links to operational effectiveness are clear
•
The process matched and is responsive to existing concerns about:
- The large number of projects
- The need to prioritise
- Mixed engagement with the values and aims of the Trust in everyday practice
•
The Trust has felt in control of the process
•
The gaps in organisational strategy have been revealed by the requirements of
Connecting for Health – but are owned corporately and being filled prior to
delivery of Connecting for Health
•
The process has linked into existing processes such as business planning
•
There has been some excitement about the nature of the conversations that the
process has encouraged
•
Connecting for Health is truly acting as an enabler rather than a driver
In Summary
Apply the lessons learned to our
organisations and use CFH as a major
enabler for service improvement –
from design through to delivery
Questions