nlg(17)125€¦ · improvement programme entitled the ‘improving together programme’. this...

NLG(17)125

DATE OF MEETING 28 March 2017

REPORT FOR Trust Board of Directors – Public

REPORT FROM Wendy Booth, Director of Governance Assurance and T rust Secretary

CONTACT OFFICER Kathryn Helley, Deputy Director of Governance & Ass urance and Assistant Trust Secretary and Claire Pacey, Improve ment Director, NHSI

SUBJECT Improving Together Programme

BACKGROUND DOCUMENT (IF ANY) NLG(17)024

PURPOSE OF THE PAPER: For Assurance

EXECUTIVE SUMMARY (PLEASE INCLUDE A BRIEF SUMMARY OF THE PAPER, KEY POINTS & ANY RISK ISSUES AND MITIGATING ACTIONS WHERE APPROPRIATE)

The paper attached outlines the current progress wi th the development of the Improving Together Programme. It provides deta ils of the scope of work to be undertaken by each workstream along with the progress made within the A&E and maternity projects. The paper a lso provides a first draft of the mapping of the CQC actions to the work stream projects Note: discussion are currently underway regarding ‘ ownership’ of the Sustainability Workstream, not least to ensure alig nment with the leadership of and detail of the wider financial rec overy plan

HAVE STAFF SIDE BEEN CONSULTED ON THE PROPOSALS? NOT APPLICABLE

HAVE THE RELEVANT SERVICE USERS/CARERS BEEN CONSULTED ON THE PROPOSALS?

NOT APPLICABLE

ARE THERE ANY FINANCIAL CONSEQUENCES ARISING FROM THE RECOMMENDATIONS?

YES – it is anticipated that there will be financia l requirements in order to deliver the workstream outcomes. As each project d evelops, these will be identified and raised via the appropriate channels

IF YES, HAVE THESE BEEN AGREED WITH THE RELEVANT BUDGET HOLDER AND DIRECTOR OF FINANCE, AND HAVE ANY FUNDING ISSUES BEEN RESOLVED?

NOT APPLICABLE AT THIS STAGE

ARE THERE ANY LEGAL IMPLICATIONS ARISING FROM THIS PAPER THAT THE BOARD NEED TO BE MADE AWARE OF?

NOT APPLICABLE

WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO THE NHS CONSTITUTION IN ANY DECISIONS OR ACTIONS PROPOSED?

NOT APPLICABLE

WHERE RELEVANT, HAS PROPER CONSIDERATION BEEN GIVEN TO SUSTAINABILITY IMPLICATIONS (QUALITY & FINANCIAL) & CLIMATE CHANGE?

Quality Impact Assessment will be undertaken for ea ch project at the developmental stage

THE PROPOPSALS OR ARRANGEMNTS OUTLINED IN THIS PAPER SUPPORT THE ACHIEVEMENT OF THE TRUST OBJECTIVE(S)

YES

THE PROPOSAL OR ARRANGEMENTS OUTLINED IN THIS PAPER ENSRE COMPLIANCE WITH THE REGULATORY OR GOVERNANCE REQUIREMENTS LISTED

Ensures compliance with necessary regulatory requir ements

________________________________________________________________________________________________________

THE PROPOSALS OR ARRAGEMENTS OUTLINED IN THIS PAPER TAKE ACCOUNT OF REQUIREMENTS IN RESPECT OF EQUALITY & DIVERSITY

YES

ACTION REQUIRED BY THE BOARD

The Board is asked to note the content of the repor t and identify any further actions required at this stage

1

Current Position

At the Trust Board meeting in January 2017, the Board approved the decision to develop a holistic

improvement programme entitled the ‘Improving Together Programme’. This paper also outlined

the governance and reporting process for the programme.

Since then, work has been taking place to develop the structures to support the overall programme.

Workstream scopes have been developed outlining the projects which will sit within each area.

These are attached as Appendix 1.

CQC Findings

Whilst the CQC visit findings are yet to be formally published and this is planned for the 6 April 2017,

the findings and actions which are already underway have been mapped to the workstreams and

projects within the Improving Together programme.

The full programme plan is in development and a detailed monthly report will be produced from

April 2017 to accompany it. The format of this will bring a hierarchy and therefore granularity to the

plan as outlined below.

This approach breaks the projects down into key milestones, milestones and actions so that delivery

and reporting can be effectively managed at all levels. Practically this also enables action lists to be

generated so that project activity can be delivered in a staged, methodical way rather than trying to

work through the plan as a whole.

The report will be for a full calendar month and therefore reporting to the trust board due to the

timing of the meeting will be for the previous month. e.g. The August Board and sub-committees

will receive the full report for July. This report will be used to provide information for all relevant

meetings/requests in order to reduce duplication and confusion about progress. The report will be

focused at milestone not action level and will include the agreed BRAG ratings for progress in the

month and confidence for the following period.

QDP Workstream ProjectKey

Milestone 1

Milestone 1

Action/task 1

Action/task 2

Action/task 3

Action/task 4

Milestone 2

Milestone 3

2

Workstreams will also be aligned to relevant Board sub-committees as art of their challenge and

assurance role. The reporting hierarchy is depicted below.

Action Required by the Trust Board

The Trust Board is asked to note the progress made to date and identify any further actions required

at this stage.

Trust Board

Executive Team (TWI Programme Board)

Sustainability

(Stocktake Meeting)

Organisational

Development

(Workforce Group)

Access and Flow

(Overarching Performance Group)

Quality & Safety

(group to be established)

Board Sub C

omm

ittees for assurance

1

DRAFT Together We Improve

Programme Brief

Programme Name Improving Quality

Senior Responsible Officer Tara Filby, Chief Nurse

Programme Manager Kathryn Helley, Deputy Director of Performance

Assurance

Board Sub-Committee Oversight Quality and Patient Experience Committee

Scope

To bring together under one programme the development of a safety culture, allowing quality improvement

activities being undertaken within the organisation to improve patient outcomes and experience.

Programme Objectives

• To deliver sustainable change in order to improve quality and safety, focussing on delivery of

outcomes

• To embed quality processes and systems so that they are consistently adhered to

• To streamline current processes, freeing up time to care

• To reduce variation and patient harm

• To develop robust reporting and assurance processes

Benefits

• Safe, high quality services for patients

• Lessons learned and shared across the Trust, reducing the risk of incidents and improving the quality

of care and experience for patients

• Improved systems and processes in place therefore reducing clinical/reputational risk

• Well trained and valued staff

• The Trust is compliance with CQC regulations

Projects

• Manchester Patient Safety Culture Tool (Tara Filby/TBC)

• Safe Nurse Staffing (Tara Filby/Di Hughes)

• Safe Medical Staffing (Lawrence Roberts/TBC)

• HCA/HSA Role Development (Recommending project sits outside of Improving Together)

• ‘Fit to Fly’ (Tara Filby/Sue Peckitt)

• Estates Helpdesk (Jug Johal/Malcolm Hoggart)

• Medicines Management (Lawrence Roberts/Paul Fieldhouse)

• DNACPR (Lawrence Roberts/Yousef Adcock)

• 5 Steps to Safer Surgery (Lawrence Roberts/Muzaffer Chaudhary)

• Mixed Sex Accommodation (Steve Vaughan/Claire Phillips)

• Learning Lessons (Wendy Booth/Kelly Burcham)

• Record Keeping (Lawrence Roberts/TBC following MES findings)

• Maternity (Lawrence Roberts/Mahadeva Manohar)

• Emergency Department (Tara Filby/Simon Buckley)

• Paediatrics (Tara Filby/Amanda Dexter)

• Infection Prevention and Control (Lawrence Roberts/Maurice Madeo)

• Risk Register and BAF (Wendy Booth/Jeremy Daws)

• Assurance Processes (Wendy Booth/Kathryn Helley)

• Data, Information and Dashboards (Recommending that this is an enabling project reporting direct to

Improving Together Programme Board)

• Patient Experience (Review being undertaken by Tara Filby with a view to this sitting outside of

Improving Together)

• Mental Capacity/Vulnerability (Tara Filby/Craig Ferris)

• Recognition and Escalation of the Deteriorating Patient (Tara Filby/Jenn Orton)

2

Interfaces/Dependencies

• There may be linkages and interdependences between some of the projects in this programme with

those in the other programmes.

• The cultural work being undertaken within the ‘Improving Culture and OD’ programme will support

the change management needed to deliver the projects.

Constraints

• The size of the programme and whether the staff have the capacity to deliver the necessary change

• Conflicting priorities between different workstreams

• Resources to lead the project teams and the ability to free up staff to undertake project work

• Whether staff have the necessary skills and experience to deliver the required projects

• Financial support for any changes required

Exclusions

• Business as usual activities which will be managed through existing management routes

Together We Improve

Programme Brief

Programme Name Patient Access and Flow

Senior Responsible Officer Steve Vaughan, Chief Operating Officer

Programme Manager Claire Phillips, Associate Chief Operating Officer/Jackie

France, Head of Patient Administration

Board Sub-Committee Oversight Quality and Patient Experience Committee

Scope

This programme will prioritise and focus on addressing the issues and concerns that have the widest and

greatest potential impact across our Trust and on the principles and processes that affect how we all work.


• To review and re-design the operating model and associated core/trust wide practices and processes to

enable the improvement of patient flow and enhance the patient experience.

• To review the role, functions and processes within the Operations Centre’s to ensure a whole site

approach.

• To review and co-develop best practice for the Patient Flow Policy on bed management and criteria for

declaring and managing purple alert/OPEL so clear for all concerned in temr sof actions expected.

• To ensure that the Trust is gathering, reporting and reviewing the right intelligence with the right people

in the right way at the right time - undertake a review of the existing structure and approach to evaluating

and addressing patient flow issues to enable optimal use of beds, nursing and other resources.

• To review and make recommendations for the improvement of weekend discharge.

• To review the process for discharge summaries and ensure it is sufficiently robust, and does not hinder

discharge process.

Benefits

Improved patient flow resulting in improved patient experience, less out of hour bed transfers, clear criteria

for each ward admissions, flow through ECC, and achievement of trust targets.

Projects

This programme will include 6 improvement work streams identified following an extensive and varied

engagement exercise with managerial and clinical colleagues across the Trust. These exercises focussed on

identifying the issues and concerns associated with patient flow through our hospitals and identified potential

solutions that could be explored, to ensure that we were operating as effectively as possible. A full analysis of

all the intelligence gathered during these exercises has been completed which identified a number of themes –

developed into these work streams.


Staff will continue to be engaged in the further development and implementation of the solutions identified in

earlier discussions. The nature of the changes that have been proposed through engagement exercises are

significant and as such we will need the contribution, co-operation and commitment of all our operational and

support staff to drive forward new ways of working that will help us to better understand and manage our

patient flow, as well as, most importantly, provide the patient with the best care in the best place for them.

• There may be linkages and interdependences between some of the projects in this programme with those

in the other programmes.

• The cultural work being undertaken within the ‘Improving Culture and OD’ programme will support the

change management needed to deliver the projects.

•

Constraints

• Resources to lead the project teams and the ability to free up staff to undertake project work

• Whether staff have the necessary skills and experience to deliver the required projects

• Financial support for any changes required

Exclusions


Together We Improve

Programme Brief

Programme Name We are improving OD and Culture Together

Senior Responsible Officer Jayne Adamson – Director of POE

Programme Manager Angie Davies – Deputy Director of POE.

Board Sub-Committee Oversight Workforce Sustainability and Transformation.

Scope

To bring together under one programme the Organisational Development and Culture activities planned for

and being undertaken within the organisation to improve:

• staff and patient outcomes and experience

• organisational performance

• transformational leadership and modernisation of the organisation .


• To understand the current organisational culture

• To plan for and implement sustainable improvement changes that support the aspirational

organisational development and culture.

• To embed new ways of working that are integral to the new culture of the organisation, supported by

robust workforce and learning strategies.

• To develop clear stakeholder strategies that are integrated and in partnership with the way we do

things

• To embed strategies that are about our people underpinned by our Trust vision and values at all levels

Benefits

• We improve the culture in the organisation so staff are satisfied and stay

• We improve our retention rates of staff

• We are able to attract staff as an employer of choice

• Staff experience is improved and this is reflected in good patient outcomes

• Staff are educated, are trained and the organisational knowledge and skill set improves.

• Positive stakeholder engagement contributes to organisational development and profile

• The organisation is visionary, and displays an authentic leadership style.

• Transformational activity becomes the norm

Projects

• Engagement (JA)

• Culture (including the Barratt survey for all staff) (JA)

• Medical Engagement Scale (LR)

• Accountability framework (JA)

• Internal Communications strategy (JA)

• Stakeholder management strategy and plan (JA/KD)

• CPD strategy (tbc)

• QSIR (JA)

• Management – definition and support (JA)

• Appraisals and training (tbc)

• Deanery (LR)


• All staffing projects

• Service development projects

• Estates and facilities project

• Terms and conditions project

• Learning lessons project

• All enabling recommendations

Constraints

• Currently have minimal OD resource – x1 person

• Financial position will constrain OD and development activities where funding is required.

• Current organisational culture may be a barrier to some of the improvement changes needed.

• Timescale to develop new strategies is a pressure

• Resources within the organisation to move on some of the work may be subject to change, reduction,

pressure, lack of knowledge and skill to undertake the work eg: new ways of working.

Exclusions

• All other activities that are out of the scope of this work stream and not identified within.

Together We Improve

Programme Brief

Programme Name Sustainability

Senior Responsible Officer Wendy Booth, Director of Performance and

Assurance

Programme Manager Kate Conway, Sustainability and Improvement

Manager

Board Sub-Committee Oversight Resources Committee

Scope

To bring together under one programme all of the financial sustainability (CIP) activities being undertaken

within the organisation along with the recommendations from Lord Carters ‘review of operational

productivity and performance in English NHS acute hospitals’


• To deliver sustainable change in order to achieve financial savings

• To ensure delivery of Lord Carter recommendations to reduce unwarranted variation

• To ensure ongoing robust reporting, escalation, challenge and assurance processes

Benefits

• Delivery of Trust sustainability (CIP) targets

• Improve processes to sustain achieved savings

Projects

Enabling recommendations

• People

• Governance

• Finance

• Clinical service reviews

• Digital systems

Efficiency & effectiveness workstreams

• Central and commercial

• Corporate and management

• Estates and facilities

• Medical staffing

• Non-pay and procurement

• Nurse staffing

• Operations

• Service development and income

• Terms and conditions


• There are linkages and interdependences between some of the projects in this programme with those

in the other programmes within ‘Improving Together’. These include patient access & flow and

workforce planning

Constraints

• Resources to lead the project teams and the ability to free up operational staff to support project

work

• Skills and experience to deliver the required projects

• Limited central improvement and sustainability governance support (this needs to be reviewed in

light of the overall ‘Improving Together’ Programme scope)

Exclusions


nlg(17)125€¦ · improvement programme entitled the ‘improving together programme’. this...

Documents