performance management strategy 2011-2015 · the performance management strategy seeks to ensure...

Performance Management Strategy

2013/14 – 2015/16 Date: Version: Approved by Executive Team: Approved by Trust Board: Document Control Date Version Contents Author 1/8/2013 V1.0 First draft Rachel Lonsdale 20/8//2013 V1.1 Minor amendments Nichola Fairless 23/09/2013 V1.2 Example delivery programme

and strategy schematics added following Board feedback

Rachel Lonsdale

01/10/2013 V1.3 Review by Programme Manager

Joanne Parkin

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North East Ambulance Service NHS Foundation Trust Performance Management Strategy 2013-14 - 2015-16

NORTH EAST AMBULANCE SERVICE NHS FOUNDATION TRUST

Performance Management Strategy 2013-14 - 2015-16

Contents

1 Introduction ............................................................................................................................................ 3 2 Strategic context .................................................................................................................................... 3 3 Governance and assurance reporting ................................................................................................. 4 4 Role in the Trust’s vision, values, aims and objectives ..................................................................... 7 5 Defining the approach to performance management ......................................................................... 7 6 Performance management and improvement through target, standard and milestone

setting .................................................................................................................................................... 11 7 Recognition of good performance and tackling areas of poor performance ................................ 11 8 Supporting the transition to service line autonomy ......................................................................... 12 9 A new ‘Achieving Excellence Framework’ ........................................................................................ 12 10 Conclusion ............................................................................................................................................ 14

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1 Introduction The Performance Management Strategy seeks to ensure the delivery of the Trust’s strategic and corporate objectives over the next three years, whilst instilling a culture of continuous performance improvement to achieve the Trust’s mission of ‘Right care, right place, right time’, and be compliant with Foundation Trust terms of authorisation. The strategy underpins a key element within the Trust’s Business Planning and Performance Management Framework (BPPMF) in Appendix 1, which describes the arrangements and accountabilities that lead to the translation of strategy into our everyday activities, and our workplans for driving performance improvement and delivering safe and effective care and positive experiences for our patients. The strategy set outs:

• How performance management supports the Trust’s governance arrangements through assurance reporting.

• The development of performance management to support:

- Performance improvement activity - Service line autonomy

The vision and principles for performance management are set out in Appendix 2 and remain unchanged since the first strategy prepared in 2011/12, as they are still very much relevant. As a high performing, caring and ambitious foundation trust, it is our aim to increasingly satisfy patients, service users, commissioners, regulators and employees to continuously increase return on investment, minimise costs and get to market faster with better products and services. The objective of this strategy is to ensure performance management is recognised as being integral to the Trust achieving this, its strategic aims and outcomes, and ensuring it continues to grow as a high performing organisation. Our vision for continuous performance improvement is organisational wide and it provides focus on delivering outcomes that matter most to people. It aims to foster a culture of responsibility and accountability involving everyone in the Trust. The focus on performance management is paramount as we face increased quality and regulatory standards, government changes, increased patient expectations, and increased scrutiny of our service provision by our new clinical commissioners. The strategy is to support us in the delivery of our planning and ambitions, and also evidence how we account for ourselves. This strategy sets out developments focussing on performance improvement and supporting actions to help develop service line management earned autonomy.

2 Strategic context The Board of Directors is responsible for setting the strategic direction of the Trust and has overall responsibility for monitoring performance against the agreed direction, and for ensuring corrective action is taken where necessary, with the operational day to day performance management being devolved to the Executive Team. The current environment is challenging, where targets and standards are set centrally and locally. These targets are set internally, by our commissioners, NHS England, the Department of Health, the Care Quality Commission, and Monitor. The requirements are not static and changes are implemented each year, particularly with the shift to commissioning on outcomes, rather than outputs and processes as has traditionally been the case. The Trust recognises that it is operating in a changing environment, against the backdrop of NHS reforms, including Patient Choice, a new commissioning architecture, Monitor’s assessment and new Risk Assessment Framework which replaces the former compliance framework, the second Francis Inquiry in Mid-Staffordshire Hospitals, and the publication of the ‘Everyone Counts: Planning for Patients 2013-14’ and the ‘Promise to learn – a

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commitment to act’ recommendations which all set the scene for the NHS in the years ahead. To ensure alignment, particularly with our new clinical commissioners, of our longer term aspirations for our patients in the north east, the Trust has embraced the recommendations and guidance provided to us by the wider health economy and has now fully adopted the use of the new clinical quality indicators for ambulance trusts and the change to ambulance service emergency response reporting. We continue to evidence our clinical effectiveness, our patients’ experiences, as well as our responsiveness. Improving the quality of the service we provide to patients cannot be realised without active interrogation of information that is generated for learning and risk management, as well as evidencing success or failure. Part of our governance requirements also includes the use of a quality impact assessment of all cost saving projects to both protect the existing quality of service and improve future services. Whilst the Trust Board operates at a strategic level and utilises strategic information to gain assurances, a vast range of supporting performance information is used throughout our Committee and governance structure. We are not complacent with the use of aggregated data which can in some instances camouflage variation and hide underperformance and we have many performance activities already embedded such as Root Cause Analysis Review and Audit to strengthen our approach to performance management. The current work being undertaken by our Informatics Team in developing our Enterprise Information System (EIS) will release significantly more business intelligence, unlocking the potential of all of our information systems and providing insight to our business. This strategy is underpinned by the production of high quality, accurate and relevant performance information being available. This is vital to have effective performance review for individuals and to utilise lower level metrics, to celebrate success or ‘smoke detect’ problems early. It is also dependent on the delivery of the Trust’s Organisation Development Strategy, maximising the workforce contribution and supporting them in the role they have to play in organisational performance management.

3 Governance and assurance reporting Assurance reporting is one aspect of performance management and it plays a significant part in our governance process. Figure 1 shows the overlay of current assurance reporting. Figure 1 Organisational framework and assurance reporting overlay

Fleet Strategy

Workforce Strategy

Financial Strategy

Estates Strategy

IM&T Strategy

Clinical/Quality Strategy

Integrated Business Plan

A&E Business

Plan

Contact Centre

Business Plan

PTS Business

Plan

Commercial

Business Services Business

Plan

Annual Plan (strategically mapped to IBP)

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Perf

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Impr

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Annual Report, QIPR, IQPR

Transformational programmes (incl CIP)

PMO

KPQs

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Integrated Quality and Performance Report - Monthly The Board reporting requirements are based on the Assurance Framework, so that progress of the principal objectives is reported using a suite of reporting methods. The objectives are set in the context of Trust strategy and also reflect the in-year review of performance where areas have been identified as poor performing or non-compliant. The Trust has a systematic Integrated Quality and Performance Report (IQPR) where key performance indicator review takes place every month by the Executive Team and then by the Board. The report provides a balanced view of the organisation covering: • Clinical effectiveness and outcomes; • Safety and risk management; • Service lines KPIs; • Patient experiences; • Finance; and • Model employer. The IQPR has recently been updated to incorporate a series of early warning indicators, adverse events and harm measures; in line with good practice as set out in Monitor’s Quality Governance Guidance April 2013 publication, ‘Quality governance: How does a board know that its organisation is working effectively to improve patient care? - Guidance for boards of NHS provider organisations’. The content is reviewed annually by the Board and its current development is guided by the priorities of the Trust’s long term EIS solution.

Integrated Quality and Performance Report – Quarterly This report provides qualitative assurances as well as quantitative. It is grouped using the five domains of the NHS Outcomes Framework.

• Domain 1 Preventing people from dying prematurely

• Domain 2 Enhancing quality of life for people with long-term conditions

• Domain 3 Helping people to recover from episodes of ill health or following injury

• Domain 4 Ensuring that people have a positive experience of care

• Domain 5 Treating and caring for people in a safe environment; and protecting them from avoidable harm.

The quarterly IQPR utilises a variety of sources for performance review, including available ambulance benchmarking information, the Trust’s latest position on the Care Quality Commission’s (CQC) Quality and Risk Profile (QRP) and Monitor’s current compliance framework. The report links risk and mitigation with the progress being made against Trust wide targets and standards, as well as Corporate and Director level objectives. Where there is slippage there will be the identification of action and performance improvement plans with owners identified and timescales to pro-actively monitor progress.

Key Performance Questions – quarterly, service lines only (at present) As Service Line business planning was set underway following appointment of the service line business managers and a new performance management discipline was introduced to track results of our strategic business planning efforts. The most recent methodology in strategic and/or corporate performance management at the time was the use of Key Performance Questions (KPQs). KPQs are to directly link to the strategic objectives of a business plan and are used to support management and continuous improvement and increase accountability up to the Trust Board. In responding to the key performance questions it would be expected that business managers follow a structure that requires them to:

• set out the key objectives that enables them to answer the question,

• provide a summary of current performance and, where available, make use of supporting metrics,

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• identify the key issues, risks and learning during the period (of the report)

• identify any immediate or future actions, including risk mitigation or contingency planning

• provide an overall traffic light rating and forward look.

The theory behind the methodology is that to improve performance we do this through learning and that deep and significant learning occurs as a result of reflection and reflection is not possible without a question. Therefore KPQs are useful components of good performance management. The expectation is that, over time we will use data and information alongside the use of questions, to put it into context to turn it into knowledge and learning.

Cost Improvement Programme – monthly via the PMO The Programme Management Office was established to hold the responsibility for the management of the Cost Improvement Programme (CIP). The PMO has fully embedded robust governance and active monitoring for all CIP Projects. The PMO employ the principles of Managing Successful Programmes and PRINCE II which are recognised tools to maximise project success and this is evidenced in the success attained to date in the delivery of challenging CIP targets.

Commissioner performance reporting – monthly Our external scrutiny of how we perform comes foremost from our Commissioners through formal contract management. Our lead Commissioners are Durham, Darlington, Sedgefield and Easington CCG, Sunderland CCG, North Tees CCG and Northumberland CCG. It also arises from Monitor, the CQC and NHS England. Commissioner Performance Reports are produced monthly and supplemented with additional performance reports when required.

Other internal reporting The CQC Quality and Risk Profile is also a report that is routinely monitored, reported on and acted upon. The current version is under review by the CQC and it is being proposed by the CQC to change the way they inspect and regulate our services. It is likely there will be a move from 28 regulations and 16 outcomes to five key questions which will monitor three levels of care: • Fundamentals of care • Expected standards of care; and • High quality care. When further guidance is published, reporting will be revised to accommodate any change. The new Monitor Risk Assessment Framework (RAF), from the 1st October 2013, replaces the Compliance Framework. Our reporting will be adapted accordingly and there will be new performance and governance reviews to ensure we comply. In summary these are:

• New reporting requirement covering patient and staff survey results, staff turnover and agency staff numbers – to assess ‘good governance’

• Replacement of the Financial Risk Rating with a Continuity of Services Risk Rating – to identify the level of risk to the on-going availability of key services.

• Independent review of governance - requirement every three years

The reporting of performance is currently limited to high level reports on our Internet such as the IQPR. Further work is on-going to increase the visibility of performance reporting – making it everyone’s business. The cascading of personal objectives and the setting of standards and targets within departments will help individuals to understand what is expected of them and how they contribute to the achievement of the Trust’s vision. The on-going development of the EIS will enable individuals to view high level Trust KPIs, drilling down to a granular level to review their own performance. This will enable staff to track success measures and where relevant improve their personal performance and allow them to utilise the information to prepare for one

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to ones with managers and their annual performance review. Over time an individuals on line profile will encapsulate all relevant HR information including annual leave, training attendance, sickness absence, as well as clinical records extracted from the electronic-Patient Care Record (e-PCR).

4 Role in the Trust’s vision, values, aims and objectives Performance management plays a vital role in delivering the mission and vision for the Trust. The Trust’s mission is to achieve:

‘Right care, right place, Right time’

The Trust’s vision sets out our intention:

‘To make a difference by integrating care and transport in pursuit of equity and excellence for our patients’

The Trust’s long term strategy is to strengthen and improve emergency care responses, and in line with changing national direction, to enhance the role of our front-line workforce, to integrate our range of transport services to further protect and offer increasing streamlined transport provision and to develop urgent care proposals that facilitate further integration of emergency and urgent care pathways. Delivery of cost saving initiatives and our plans to increase income through new business streams are also vital to support our financial performance aspirations and to reinvest in areas of patient care and in developing the workforce of the future. Development and management of the right performance metrics can help us to communicate our strategic plans effectively to patients and other stakeholders who play a part in both commissioning our services and using them, and they also enable us to differentiate the Trust in the market place when bidding for new work. It essential that the Trust is able to deliver on-going improvements in all aspects of performance: response times, finance, efficiency, clinical effectiveness, quality, safety, patient experience, corporate governance, service delivery and workforce, all underpinned by a high level of data quality, available at a local / individual level, evidencing we are a good organisation to do business with.

Our principle goals are:

• Achieve high standards of emergency and urgent care and responsiveness • Offer an excellent patient experience • Offer value for money services to commissioners The Performance Management Strategy will ensure the delivery of the Trust’s vision, values and objectives and contribute to the embedding of these through visible and open performance reporting and through the new Performance Review process, ensuring staff understand how they personally contribute towards delivery of the organisation’s goals and priorities.

5 Defining the approach to performance management The continuous cycle of business planning and performance management provides the necessary focus and control needed to ensure our efforts and achievements contribute to our organisational vision as shown in Figure 2, and this will continue to be a key driver of the performance management strategy.

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Figure 2 The Business Planning and Performance Management Cycle

The Trust will continue to use and develop an integrated performance approach to identify, improve, review and report all aspects of the organisation’s performance; taking a holistic view of organisational performance across operational activity and supporting functions. The aims of the business planning and performance management framework and approach to performance management are to:

• ensure a robust business planning process is in place to develop plans that enable the achievement of the Trust’s vision;

• provide accurate and timely information, outlining progress towards delivering targets, goals and organisational objectives;

• provide assurances to the Board, Governors and Managers that issues are being addressed on performance, risk, compliance and governance; and

• provide integration of planning, review, financial management alongside the improvement of current systems (and the introduction of new ones where appropriate) to enable the Board to make more informed strategic decisions and enable managers to improve services at an operational level.

The Trust’s current performance management processes have been developed in response to strengthening corporate governance through targeted metric monitoring to facilitate the production of assurance reports. Performance improvement activity has been in response to a range of scrutiny; including IQPR exception reporting, staff surveys, the QRP (and many others) and this has been documented in an annual Performance Improvement Plan (PIP). There will continue to be an overarching PIP that will ensure plans put in place by Service Lines, Directorates and Departments to actively address any performance issues and also identify areas of exemplar performance to capture learning from best practice. The PIP will be compiled annually to inform annual planning, drawing on the following sources of information; CQC Quality and Risk Profile, IQPR Exception reporting, NHSLA assessment, Monitor Compliance Framework reporting, staff surveys, patient experiences reports, root cause analysis themes, CQUIN and Quality Account priority indicators. This list is not exhaustive. The PIP will ensure that compliance and assurance issues are prioritised to safeguard

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compliance with all of our statutory and regulatory requirements and that we address areas of risk and weakness and planned improvements are effectively targeted. All transformational planning (through strategies identified in Annual Plans) have been ‘performance managed’ through the use of key milestones and reporting tailored for the Board in their role of strategic performance delivery. A schematic of the desired state, to have a highly effective corporate performance management system, is shown in Figure 3. Not all aspects are fully embedded and this strategy starts to address the necessary developments.

Figure 3 Corporate performance management

The Trust’s approach to performance improvement has been developing over the last two to three years and is constantly being enhanced and it will still primarily be driven by effective measurement. This strategy refresh now starts to progress performance management towards performance improvement and the embedding of the performance improvement cycle at all levels in the organisation. Figure 4 shows the performance improvement cycle used by Monitor in describing ‘good service line management’.

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Figure 4 Performance improvement in five steps

There will still be a focus on strategic assurance reporting but over time it will tend towards ‘light touch’, as more detailed reporting and assurances are undertaken within a service line. Corporately, reports will be refreshed in line with the latest guidance and this will be effectively cascaded by the performance team. The areas of on-going development will be to support the organisation in equipping ourselves with the right tools to improve performance. The areas of development are:

• Information produced in an unequivocal and timely fashion – placing emphasis and reliance on improved information systems and data quality.

• Improve project performance – widen the scope of the principles put in place by the PMO to encapsulate non-CIP projects and transformational programmes, providing greater performance management support on organisational strategies and their delivery. Benefits realisation will also be the tool of choice to evaluate transformational programmes, utilising the expertise within the Programme Management Office (PMO).

• Improve success of change programmes – effective leadership and teamwork, ‘compacts’ with staff, underpinned by the Trust’s Organisational Development Strategy

• Increased visibility of performance – engaging people in performance

• Achieving excellence framework – establishing a formal framework for driving performance improvement and addressing poor performance, using the right improvement methodologies

• ‘Light touch’ performance management – to truly facilitate autonomous practice within the organisation, the ‘license to practice’ will be based on a ‘performance review approach’, which is currently under development. Testing the robustness of the governance structure below the service line management team could for example form part of the review.

A longer term development is the enhancement of our analytical competencies to analyse our data (which is increasing in volume and will be significantly easier to manage through EIS) and to extract insights – helping to make our decisions clear and stark. A broader list of deliverables is detailed in Appendix 3 which will inform the performance team’s future work plan.

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6 Performance management and improvement through target, standard and milestone setting

Where national targets exist, from the Department of Health, NHS England, CQC or Monitor, these are to be adopted by the Trust. As part of the annual business planning cycle, the Trust will decide whether to set itself more stretching targets and service standards to deliver improved value for money, quality or added value to its commissioners and patients. The Trust will also review any known national targets due to come into effect, and include these where appropriate. In addition to national targets, the Trust will agree contractual measures with commissioners which will feature in the annual Performance Improvement Plan. The Trust will review its strategic objectives on an annual basis and ensure that all reporting metrics and standards are agreed that will result in the successful delivery of those objectives.

7 Recognition of good performance and tackling areas of poor performance As corporate and individual performance becomes more visible the Trust’s arrangements need to be strengthened to demonstrate how it will be both rewarded and corrected where required. This is being introduced through the new Performance Review process, operating in a shadow format, and it supports the following aspects of individual performance management:

• The cascading of objectives and performance metrics to individuals and providing the ability to enable them to monitor their own performance – this will help to strengthen the Trust’s approach to recognising good performance and learning from it and promoting best practice, and also in tackling areas of poor performance.

• Individuals will know what is expected of them from the outset and will know where they are highly performing and also where they are not performing, as will their managers.

There are a number of existing approaches to tackle individual poor performance through audit findings and additional training support and the Trust has in place a Managing Capability Policy and supporting documentation. Awareness raising of this policy will occur in line with the new Performance Review process and details of when this may be invoked will be explained where necessary. The policy is written to help both employees and managers in that it provides a fair, supportive and consistent framework for dealing with non-achievement of the required standards and HR advice should be sought. This strategy supports further development of the Performance Review process: • Facilitating constructive conversations amongst, individuals, teams and service lines

to ensure they know how they contribute to strategic objectives (directly or indirectly) - through visible and accessible performance reporting

• Facilitate peer review – through appropriate metrics and mechanisms being put in place

• Facilitate self-assessment – through access to workforce information and training records through performance profile information.

Areas that individuals will be encouraged to self-assess include: • Progress against set objectives and expected behaviours • Performance compared to peers, where measurable, reviewing performance in

upper and lower quartiles • Sickness absence • Review of error/judgement • Personal development – training attendance • Audit pass rates • Team working • Working relationships; and • Moral conduct.

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The on-going development of EIS and e-PCR reporting will facilitate many of the aspects of self-assessment and the process is to be underpinned by policy. The element of reward and recognition can be multi-faceted and may be tailored to individual needs. Corporate and individual reward and recognition is an area that is developing in the organisation. Long service awards and the Above and Beyond the Call of Duty (ABCD), a more recent award process are reviewed annually and will be further reviewed as part of our Organisational Development function. The Organisational Development Strategy, Performance Review Policy and Guidance covers the theory and actions needed to support managers in the area of recognition and reward. It is not within the scope of this strategy to identify tangible reward and recognition as they could be quite vast.

8 Supporting the transition to service line autonomy To further strengthen the opportunity for Service Lines to take responsibility for their own performance as they move towards achieving earned autonomy, this strategy proposes a shift towards ‘light touch’ performance, performance improvement support and strengthened assurances, through increased visibility and cascading of strategic objectives and corporate /legislative requirements. The performance team will provide support, tools and techniques to assist the workforce in the Service Lines. For example, it is important that the use of measurement to manage is appropriate:

• What do they want to manage – you can’t manage what you don’t measure

• Do they understand their data and performance indicators – if information is not well understood then it won’t instigate any change in behaviour

• Is their performance information dynamic and relevant – indicators have a natural lifecycle and what they measure today may not be what needs to measure in a years’ time

• Is their performance information put into context – controls must be in place to understand if performance is good or bad

• Is the data of a quality standard, valid and accurate – Informatics support is required to test validity, accuracy and quality of data

• Is performance information produced or utilised in isolation - it should be taken into context and triangulated with information from the rest of the organisation

• How many performance indicators are being monitored – focus is lost if there are too many metrics

• Can action be taken based on information – it needs to be timely to enable intervention to improve performance.

The ‘license’ for autonomous practice requires further development. A review of integrated dashboard content will assure that the right things are being monitored and routine review of operational governance (in line with Monitor’s Risk Assessment Framework), could be two areas of annual performance review. The ‘light touch’ performance and strengthened governance will be areas of on-going development, working very closely with the service lines and other key support functions. The timeline of a fully embedded earned autonomy approach is out with the scope of this strategy and any necessary developments will be prioritised when a timeline does emerge.

9 A new ‘Achieving Excellence Framework’ The transition towards earned autonomy is to also be supported by the introduction of an ‘Achieving Excellence Framework’. The aim of this framework is to make provision for the performance team to be effectively engaged with service line activity, making provision for a supportive or ‘critical friend’ intervention.

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The performance and informatics teams will provide advice and expertise to ensure performance information provides valuable evidence for simplified decision-making and more efficient planning. The team will promote focus and alignment to strategy, facilitate performance communications, so that people are encouraged to change their behaviour in a way which is consistent with the organisation’s values. The framework depicted below describes the flow of performance management and improvement activity. Figure 5 Achieving Excellence Framework

INPUTS

Demand predictions

New metric development

Performance trajectories and predictions (regression analysis)

Benchmarking

Strategy, planning

Review

External scrutiny

Corporate Integrated dashboards

Service Line/ Corporate Services

StandardsControlsTargets

Exception reporting

ContradictionsConnectionsCuriosity

RISK ASSESSMENT

Governance review

Reporting

Survey results

ACTION

Agreed approach of training and support

ToolkitExcellence models

Audit and survey

Service evaluationCost benefit analysis….

….….

Performance management and improvement

Move to

light touch

Supportearned

autonomy

The framework requires the development of a number of elements shown in Figure 3: A highly effective corporate performance management system. It is the intention to be proactive in providing a variety of information/inputs into the service lines and corporate services to influence the development of organisational integrated dashboards. The emphasis of the shift of the performance team from assurance reporting to proactive performance improvement is in recognition of the development of earned autonomous practice. It is the intention that light touch will consist of overview and analysis and that joint risk assessment will identified opportunities to improve areas of performance. The risk assessment tiered metric tool is an example of how performance improvement action could be triggered. Any intervention will be proportionate to the risk and will be aimed at supporting recovery, sustaining performance or delivery of stretch targets. The tiered structure is proposed as follows:

• Any individual indicator in tier 3 given a red rating is not likely to be considered a ‘serious performance concern’ other than in exceptional circumstances but will be subject to monthly monitoring.

• Any indicator in tier 2 given a red rating, will be deemed to be a ‘performance concern’ and will therefore be escalated in line within an agreed escalation framework/process.

• Any red rating for tier 1 will be regarded as a ‘serious performance concern’.

Actions can be triggered by serious performance concerns against individual ’key’ indicators, systematic underperformance or a trend of performance deterioration against a range of

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indicators. The process will be further developed and should be viewed as an enabling process and supportive tool. Example ‘triggers’ and responses are shown in Figure 6. Figure 6 Performance triggers and example responses

Triggers Example responses Example potential monitoring at service line, Committee or Board level

• Challenging stretch targets, slippage on performance trajectories, performance deterioration

• Performance concern • Serious performance

concern

• Systemic

underperformance /deterioration

• Working closely with the performance team a performance management approach will be agreed with the ‘target’ ‘performance issue’ owner(s).

• This may involve a series of processes which could include route cause analysis, benchmarking, pareto analysis, ishikawa diagram (cause and effect), use of other proven performance improvement techniques such as matrix analysis, SPC, regression analysis as well as the tools that we have introduced through service improvement: 5s, kaizen/RPIW and there is also a range of management and planning tools such as the affinity tool, process decision program chart, tree diagram, matrix diagram, activity network diagram etc.

• Utilising the ‘productive series’ where appropriate

• High Impact Actions • Weekly /fortnightly/monthly

performance review meetings (Frequency dependent on trigger and in agreement with ‘owner’ and performance team)

• Task and finish groups • Kaizen /RPIW activity

(This list is not exhaustive)

• Action planning • Risk quantification • New metric reporting • KPQs • Balanced scorecards • Exception reporting • Performance trajectory setting • Forecasting • Recovery plans • SPC controls • Analysis of data

intelligence/user experiences to ensure services have improved

• Spread and scale

The performance team will provide support in identifying the best method and approach to tackle the issue presented. We anticipate that these tools will be used routinely within departments through transfer of skills and knowledge, and escalation will become light touch and targeted towards assurance over the longer term as earned autonomy becomes established. The majority of the improvement tools used in NHS and industry rely on workforce engagement and embracing the desire to change or improve, therefore it is anticipated that this work will be fully supported through the ongoing implementation of the Trust’s organisational development plans.

10 Conclusion This document has described the existing performance management arrangements and the way they aim to deliver the Trust’s strategic and corporate objectives and outlines a number of enhancements to those arrangements. The Trust remains committed to adopting a culture where performance management is used proactively to assist the wider management and improvement of services rather than narrowly monitoring compliance with set performance targets. Assurance focus is not lost, it is well established and requires devolvement.

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North East Ambulance Service NHS Foundation Trust APPENDIX 1

NEAS: Business Planning and Performance FrameworkAnnual Planning Cycle

APRILPublish our plan, publish service line

plansCascading of objectives

MAYPublish our Annual Report and

Quality Report

JULYLay accounts to Monitor

AUGUST - OCTOBERStart planning process, external review

Strategic direction review

NOVEMBER - FEBRUARYBudget reviews,

Financial planning, contract negotiations and agree CQUIN scheme

Annual objectives setBoard Assurance Framework

MARCHFinalise annual plan and submit to Monitor, finalise Quality priorities

Performance Improvement Planning DeliveryCorporate

Performance and Risk Management

Performance Review

Corporate induction/EAT

ReviewService reviewsSelf assessment

Internal auditInspectionsComplaints/ compliments

Peer challengesScrutiny & Challenge

BoardOSCs, CQC

Executive TeamDirectorate

ManagementCommissioners

Qtrly reporting to Monitor

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A vision and principles for performance management To be a high performing organisation we need to be able to demonstrate how high performing our Trust actually is, and that performance is continually improving.

In developing and further embedding performance management the following principles are to be adhered to:

• Performance management initiatives are seen as enabling and empowering

• We focus on the measures that matter, and we can explain why they are important, and do not merely exist

• Performance initiatives are linked to healthcare outcomes, they are key levers to improve healthcare delivery (effectiveness, patient safety and experience)

• Staff are involved in designing performance management systems, measures and initiatives

• There is a clear focus on delivery with clear lines of accountability where individuals are empowered

• Performance management is an integral component of organisational development and across all disciplines with evaluation and learning promoted across the Trust

• Staff are kept informed about performance

• Measures/metrics need to take account of the ‘whole system’, acknowledging that the achievement of a target may not be within the control of the owner, or in fact just NEAS

• Decisions will be based on high quality, timely and reliable information

• An open and honest approach is used for dealing with poor performance

• Service Line performance is reviewed against the criteria for earned autonomy contained with ‘a seven dimensions of quality’ approach for each SL

• Targets provide a balanced view of performance including finance, efficiency, quality, patient experience and workforce

• An emphasis on learning from mistakes rather than a blame culture

• Board level information is broken down to service line, station, team and individual level with all staff understanding the reporting hierarchy and the ultimate accountability for performance in the organisation

• Performance information will be shown in trends using historical data and include forecasts where possible

• A culture of continuous improvement that supports ethics and candour will continue to be embedded.

These principles are consistent with those set out in ‘The Intelligent Board’, and will support the further implementation of Service Line Management.

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Objectives to be translated into a workplan Clarity - knowing the goals • Effective strategic mapping of Service Lines and Departmental Delivery Plans to the

Trust’s vision and a shared understanding within the whole organisation of performance requirements

• Promote the use of Key Performance Questions further throughout the organisation, linking to department’s /function’s contribution towards strategy

• Robust alignment of the IQPR and Quarterly IQPR to the organisation’s strategy Commitment - buying into goals • Develop an external performance communication system to update the public on

organisational performance showing visibility and openness • ‘Hard’ data that can be measured must be supported by ‘soft’ performance measurement

that involves more personal and subjective interaction and measurement throughout the organisation e.g. buddying of non-executive directors with service lines and formalisation of quality walk arounds, to ensure staff have clarity as to who is taking an interest in their performance and where there is a visible information route to the Board.

• Evaluate the effectiveness of changes to individual performance management arrangements (via the new Performance Review process) on organisational performance and drive any necessary improvement activity.

Translation into action – knowing what we want to achieve • Analysis of the wider health economy, the influences, causes and effects on demand, gap

analysis, and the effect of our initiatives and performance on other providers • Provision of opportunities for ‘future horizon scanning’ and preparing for the future,

anticipating future trends rather than reporting historical failures

Enabling and synergy – removing barriers and working together to deliver shared goals • A fully implemented Business Intelligence Platform (SharePoint supported by the

Enterprise Information System [EIS] which includes a data warehouse), providing comprehensive activity and performance, clinical effectiveness, finance and staffing resources reporting, which will provide performance management tools to all staff electronically.

• Embedding of Microsoft Reporting Services (SSRS) which is a self-service reporting tool which aims to contain information that meets all internal and external performance reporting requirements.

• Individual performance is fully linked to the business strategy and individuals take responsibility for their own performance and understand how areas of their poor performance may be addressed

• Service Line dashboard reporting goes live to enable bottom-up explanation for any variances and any necessary mitigation taken as a result as well as identification of best practice to assist with continuous improvement.

• Online drill down functionality with the IQPR with electronic access to real-time dashboards that show how the trust is performing against its priorities on any one day

• Performance reporting which enables departments to measure, understand, plan and improve the quality of their services, clinical care , service efficiency and productivity and that which extends beyond our own organisation

• Decisions to be based on high quality timely and reliable information. Data quality dashboards will be produced to support SLM dashboards and the monthly IQPR with a data quality review against the six dimensions of data quality as referenced in Monitor’s

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Quality Governance Guidance, which include accuracy, validity, reliability, timeliness, relevance and completeness

• An embedded culture of performance management throughout the organisation. Routine use of improvement methodologies and continued development of strategy maps, cause-and-effect tools and geographical mapping amongst others at an individual, team and department level with guidance from the Performance Team on which tool to utilise in which situation.

• Routine review of patient and user feedback through a variety of means and not just satisfaction surveys e.g. Annual Planning working group, Quality Report working group and Governor meetings

• Support delivery of the Trust’s strategy through reporting that informs proactive business decisions that are required to adapt to changes in service demand

• To provide timely and accurate performance information and analysis for all NEAS contracts, and to support the provision of new contracted services through delivery of timely and robust performance information. A comprehensive suite of performance information will be produced to support the internal management of operations and inform external reporting.

Accountability – accounting for our commitments • All business critical/ high profile (including non-CIP) project delivery plans to be effectively

monitored and managed through the Programme Management Office. Benefits realisation to be embedded in the organisation with visibility across the organisation.

• Initiation of cross health economy working, devising whole system metrics, ensuring we maximise our contribution to efficiency and quality

• Comparison and triangulation across quality, performance, workforce, productivity and finance metrics at a service line level.

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performance management strategy 2011-2015 · the performance management strategy seeks to ensure...

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