Transformation & QIPP Assurance Monitoring Report. 3 rd November 2010

Transcription

1 Transformation & QIPP Assurance Monitoring Report 3 rd November 2010

2 Table of Contents 1. Overview 2. Organisational Enabling Projects 2.1 Corporate Infrastructure Board Leadership Management Structure Transformation Project Resources 2.2 Medical Management & Clinical Engagement 2.3 Service Line Reporting 3. Transformation Project Monitoring 3.1 Workforce 3.2 Productivity 3.3 Innovation 3.4 Quality 4. Financial Monitoring (Appendix 1) 5. Foundation Trust application update RNOH Transformation & QIPP Monitoring Report

3 1.0 Overview Evidence of Project Delivery 1.1m year to date savings delivered ahead of target of 0.98m 1st phase productive wards initiative in place - changes implemented in 6 wards First patients through Enhanced Recovery Programme in October - ahead of schedule Clinical engagement - clinical leads in place ; new outpatient templates in place, full utilisation of new theatre activity repatriated from private sector) What could be better? Detailed project by project communication Enhancing project resources to accelerate delivery Simplification of monitoring documentation - currently overly complex and disjointed Further improvements in clinical engagement and leadership Demand and capacity planning in place - maintaining focus on reducing access backlogs - additional capacity in place e.g. theatres & outpatients; improved referral maangement within clinical teams Improved data analysis support to ensure project by project KPI's realistic & monitoring in place Productive theatre project plan in place Actions from last NCL meeting Cleare link between QIPP and Transformation established Weekly meetings put in place Develop and compile a report on productivity and transformation for NCL/NHSL Complete a paper on RNOH organisational re-structure Designed a Gantt chart detailing projects by project milestomes & timelines Clinical confidence in digital dictation roll out plan Further activities undertaken Productive theatre - Measures set and data collection in progress Project dashboard development complete New computers installed in theatres for real time data entry Established stock control project group in theatres to reduce procurement costs and waste refreshed surgical conversion rate data to inform demand & capacity planning Key activities for next meeting Productive theatre - present data analysis and audits within the Trust Refine KPI's and trajectory reporting Deep dive into day case rates Audit of patients who go to HDU post op Establish clinical staff meetings with RH & LH and team job planning Set up interviews for remaining vacancies from management Agreement for super Saturday additional capacity Overall rating Weekly Actions Rating Transformation/QIPP Programme Delivery Key to QIPP Programme Delivery: Performing (>75%) Performing Underperforming (>50%) Underperforming Not Performing (<50%) Not Performing Project Not Started Up Down No Change RNOH Transformation & QIPP Monitoring Report

4 2.0 Organisational Enablers 2.1 Corporate Infrastructure Board Leadership Implemented since initiation March 2010 Non Executive Changes 1. New Chairman appointed (Professor Tony Goldstone) appointed October 2010 for formal start date 1st February 2011 although will be involved in the run up to this with a particular focus on medical management/leadership issues and academic network across UCL Partners. New Executive Team being put in place since March Transformation Director established March New Chief Nurse (started August 2010) 3. New Operations Director (started September 2010) 4. New Finance Director commencing January/February Current fixed term Finance Director to continue as Finance Project Lead (FT & Transformation) to minimum June 2011 to support continuity and enhance resources 5. Medical leadership responsibilities re-established and Clinical Directors re-appointed to support new management structure Action plan summary - Next steps in progress 1. Director of Workforce & Corporate Affairs being advertised for replacement November 2011 for replacement February/March 2011 RNOH Transformation & QIPP Monitoring Report

5 2.1.2 Management Structure (see below for current & new structure) Implemented since initiation March Apr-July: Agreement of new management structure reducing general managers & increasing service managers to facilitate:- Performance management by clinical unit Improved alignment of service management with clinical leads/clinical directors Consistency with Service Line Reporting & Management Action plan summary - Next steps in progress 1. November: interview and recruitment of 1 general manager and 5 service manager posts estimated start dates 3 months 2. Interim appointments/secondments to cover transition to new service managers being in place. 2. August-September: Consultation with affected staff 3. October: Implementation and recruitment. 1 General Manager appointed, the other 2 existing managers either did not apply or were not successful in their application. Transition structure put in place. RNOH Transformation & QIPP Monitoring Report

6 2.1.2 Management Structure Old clinical management and management structure Chief Nurse Professional Lead Director of Operations Medical Director Spinal and Paeds Directorate Joint Reconstruction and Sarcoma Directorate Directorate of Therapy Services Clinical Support Services Directorate Outpatients and Children s Services Directorate General Manager Clinical Director General Manager Clinical Director Head of Therapies & Professional Lead General Manager Clinical Director Matron / General Manager Children s Clinical Director Degenerative Spine Spinal Deformity Paediatric Surgery PNI SCIC Degenerative Spine Clinical Leads Spinal Deformity Clinical Leads Spinal Business manager Paediatrics Clinical Lead SCIC Clinical Lead SCIC Matron Medicine Rheumatology Rehabilitation Pain Sarcoma/Joint Reconstruction Cancer Upper Limb Foot & Ankle Limb Fitting Site Management Physician Clinical Lead Pain Clinical Lead JRU/BTU Clinical Lead Cancer Manager Shoulder Clinical Lead Foot & Ankle Clinical Lead Limb Fitting Manager Adult Ward Matron Physiotherapy Lead Occupational Therapy Lead SALT Lead Dietetic Lead Rehab Ward Sister Anaesthetics Theatres TSSU HDU/Outreach Pharmacy Imaging Pathology (Contract) Gait Lab Anaesthetic Clinical Lead Theatre Manager TSSU Manager Senior Nurse HDU Chief Pharmacist Imaging Clinical Lead Imaging Manager Pathology Manager Gait Lab Manager Outpatient Department Pre- Operative Assessment Transport Central Booking, Appointment Scheduling Medical Records Children s Wards Outpatient Sisters Pre - Operative Sister Admin Admin Med Records Manager Bed manager Clinical Engineering Senior MTO Histopathology Histopathology Manager RNOH Transformation & QIPP Monitoring Report

7 2.1.2 Management Structure New Structure Direct Care Division RNOH Transformation & QIPP Monitoring Report

8 2.1.2 Management Structure New Structure Clinical Support Services Division RNOH Transformation & QIPP Monitoring Report

9 2.1.3 Corporate Infrastructure Implemented since initiation March Clinical Lead for all relevant projects appointed 2. Project resources ( 0.5m annual) investment in place from March 2010:- *1 Programme Director *2 Project Managers *1 Administrative support *1 procurement manager *8 identified clinical leads ring fenced time 3. Internal reporting Progress exception reports reviewed weekly by Exec Team and monthly review by Transformation Committee Overview KPIs and monthly performance trajectories Action Plan Summary Next steps in progress 1. Internal Reporting Monthly project by project KPI trajectory and quantification completing 3rd November External reporting Format & content of external reporting assurance to North Central London Sector and NHS London being agreed 8th November 2010 for weekly review to December Programme resources additional infrastructure proposed to accelerate delivery - 380k (see attached) RNOH Transformation & QIPP Monitoring Report

10 2.1.3 Transformation Project Resources Additional resources required to accelerate implementation / benefits realisation. Requirement Project Manager Senior Nurse Investment Benefit accelerating delivery CNS role review Nursing skill mix review/new band 4 role Rehabilitation assistants role CNS staff/non-ward nurses working on wards FYE Cost (band) 70k (8b) Project Manager General Length of stay Pre-operative assessment Outsourcing back office functions Admin review next stage 48k (7) Information Analyst Enhancing reporting / monitoring Project by project information support 60k (8a) Financial Management/Analyst Project by project cost/benefit analysis and evaluation Enhancing monthly tracking process 82k (8c) Clinical project leads PAs Enhanced ring fenced clinical time to lead on individual project implementation to embed ownership 120k (10PAs) Total 380k RNOH Transformation & QIPP Monitoring Report

11 2.2 Medical Management & Clinical Engagement Implemented since initiation March 2010 Medical Management blueprint agreed by Medical and Clinical Directors Clinical Directors appointed to new management structure Clinical Directors attendance of Kings Fund Clinical Leadership course Summary Action Plan - Next steps in progress 1. Chief Exec led Individual consultant review meetings taking place September December to cover:- Consultant by consultant review of individual job plans, team job plans and associated consultant productivity indicators Assigning Supporting Professional Activity (SPA) time to align with RNOH and NHS strategic imperatives:- -Clinical lead SPA transformation -Clinical lead SPA management -Academic SPA aligned to UCL Joint Academic Plan translational team 2. Workforce strategy analysis of medical staff establishment and demand & capacity plans to inform the establishment of clinical unit succession plans, initially within Clinical Directorate Business Plans (December 2010) and ultimately Clinical Unit Business Plans (April 2011) RNOH Transformation & QIPP Monitoring Report

12 2.3 Service Line Reporting Implemented since initiation March 2010 Progress with the new system since April 2010 has been at a rapid pace and the Trust has effectively completed the majority of its cost allocation work, although ongoing work is required to refine some of the apportionment methods applied. The system currently produces monthly information and successfully links activity and cost to arrive at a surplus or deficit position by each of the following categories: Service Line Service Specialty PCT Consultant HRG Patient level (not yet on Trust s business intelligence desktop) GP (not yet on Trust s business intelligence desktop) Once the monthly processing is completed by SAPPs, all output information is accessed via the Trust s business intelligence software, Insight. A selection of reports have been created and are available to Trust staff to allow interrogation of information within the levels identified above and across each month. Further reports will be developed as the need is identified including reporting against plan positions as well as previous years. A steering group, chaired by one of the Trust s Clinical Directors, has been established to review all data inputs and information outputs. The group will be making recommendations on how improvements can be introduced to eliminate data quality issues and whether the cost allocation methodology accurately reflects the way the Trust delivers its services. An example of a cost allocation area that requires further analysis is within theatres, where the patient journey currently attracts costs based on the time spent in theatre. Recognition of the complexity of the procedure needs to be introduced so that the more complex operations attract a larger proportion of costs to reflect the additional number, type and seniority of individuals engaged in that particular procedure. Summary Action Plan - Next steps in progress The system still requires further development and refinement. In particular, the volume of data is such that processing is very time-consuming and prone to error and system failure. A software update is due for release within the next 6 months which will improve the robustness and timeliness of information going forward. In the meantime, the following issues have been indentified for further review and refinement by the Trust s SLR steering group in its action plan for September - March: 1. Data quality issues to be resolved in theatres & pathology services; 2. The timeliness and accuracy of date recording, highlighting areas of poor performance needs to be driven forward; 3. Access to service line reports across Trust to be managed within a phased rollout programme providing training to understand results where necessary; 4. Cost base assumptions and benchmark results to be interrogated further to allow a better understanding of service costs. This will be delivered with the input of Clinicians and General managers, who will be challenged to confirm their data; 5. Enhancing the Trust-wide and Strategic Orthopaedic Alliance (SOA) service benchmarking process; 6. Engage Clinicians in understanding SLR and benchmarked results to establish what can be delivered differently to improve profitability whilst maintaining the quality of services. In the meantime, the Trust is continuing to use the current service line reporting information with the caveat of further work being required to refine the results. For information, a presentation of initial service line reporting results to the July 2010 Trust Board are highlighted below. RNOH Transformation & QIPP Monitoring Report

13 2.3 Service Line Reporting Output examples ( bubble size=income; x axis=profit/loss; y axis= relative size compared to Specialist Orthopaedic Trust average) Profit and Loss portfolio of service lines 1600% 25,000,000 Profit/(Loss) Service Type R e l a ti v e s i z e o f s e r v i c e l i n e to S O A A v e r a g e 1400% Medical & Rehab 1200% 1000% 800% Pain Management 600% 400% Paediatric PNI Foot & Ankle Upper Limb 20,000,000 15,000,000 10,000,000 5,000,000 Income Cost Profit/(Loss) Spinal Injury 200% Private Patients % Spinal Surgical Sarcoma & Joint Recon -200% 0 Day Case Inpatient Outpatient -400% Profit/-Loss -5,000,000 RNOH Transformation & QIPP Monitoring Report

14 3.0 Transformation Project Monitoring Work stream Efficiency Driver Key metric / measures (KPIs) Current Performance Benefits fully on stream (date) Project monitored by (to which Group) Project stage - SU/I/D/C Links LTFM Idea Enablers E1 19 Organisation Restructure labour productivity Executive lead Project manager / Ops lead Dir Ops E2 1316/17 Medical Management & clinical leadership enabler Dir HR RH/MV CP11 7 Service Line Reporting Workforce WF7 17 Evaluate Physician's Assistant Role WF11 9 Reduce Staff Turnover 1% annually WF4 12 CNS Review reduced wastage and costs labour productivity reduced wastage and costs labour productivity Dir Fin LH AK Achievement of all access and fiance targets Identity clinical leads and define team job plans To understand cost base and productivity at unit level Benefits start (date) KPI Variance RNOH Transformation & QIPP Monitoring Report Finance rating (RAG) Overall rating Oct-10 Apr-11 EMT/Trust board Jan-11 Apr-11 EMT/Trust board Oct-10 Jan-11 EMT/Trust board I SU I Project update On track and recruitment in progress. Induction and office set up organised. Consultants jobs plans under review and database developed. Clinical leads incorporated into restructure On trajectory against timelines and went operational in October Dir HR TW none N/A Jan-11 Mar-11 HR I This project was b/fwd from 2013/14. Pilot evaluation demonstrates added value of role - project group determining impact of rolling out across all specialties. Business case submissions from Oct 10 - Feb 11 Dir HR WF13 50 Rationalise Staff Training & Expenses Reduce costs Dir HR JS/JM WF14 10 Reduce Sickness Absence from 4% to 3.5% labour productivity JM To reduce turnover by 1% to reach a target of 11% 11.3% Jul-10 Mar-11 HR D Sickness rate for September 11.3% which is ahead of trajectory Dir Nurs CW Jan-11 Mar-11 HR SU Project brief to be completed for next STC approval. Head of Transformation & Dir Nurs meeting 3/11/10 to scope project Dir HR JM Cost efficient training programme - Jan-11 Jan-11 HR I Project implementation on track. Monetary benefits not realised until Jan 11 value for money 3.5% by March % Jan-10 Mar-11 HR D Project ahead of trajectory WF15 14/44 Back office functions (outsourcing) staffing Dir Fin C Morgan Value for money HR/Fin SU Project brief approved by Oct STC. Project documentation to be completed and timescale agreed Productivity CP10 PS7 25/30 Stock Control System for Theatre supply chain Dir Fin KA PS1 PS3 1/8 Pre-Operative Assessment productivity Dir Ops JV Value for money. Efficient stock control and count 95% pts screened. Cancelled ops due awaiting data from to unfit from 5% - IM 4% by Apr 11. (100 ops per annum) TBA Jan-11 Mar-11 TPOT I Stock storage complete. Electronic system to be implemented. Monetary impact and savings to be determined. Clinical leads agreed - initial meetings taking place between 1/11 & 12/11/10 Jan-11 Mar-11 POA project group PS12 PS10 5 Reduce DNA OUT & IP productivity Dir IM&T JV New <5% 3.2 Apr-10 Mar-11 OPD project group PS12 PS10 5 Reduce DNA OUT & IP productivity Dir IM&T JV FU <10% 10.6 Apr-10 Mar-11 OPD project group PS12 PS7 5 Reduce DNA OUT & IP productivity Dir IM&T JV IP <1% 0.80% Apr-10 Mar-11 OPD project group PS3i PS2 1/3/4/36 Reduce LOS - elective productivity Dir Ops CE Apr-10 Mar-11 PS3ii PS2 1/3/4/36 Reduce LOS - non-elective productivity Dir Ops CE Apr-10 Mar-11 I D D D Project implementation in progress. Data collection requested Performing Performing Performing OMG D Performing - b/fwd from Mar 12 OMG D Performing - b/fwd from Mar 12 PS3iii PS2 1/3/36 Day Case Rate Review & Extension productivity Dir Ops CE 60% as per BADS 50.0% Apr-10 Mar-11 OMG I Collating data on BADS for analysis to determine scope and impact of project PS4 PS3 1/4 Extend Hospital at Home - Medihome productivity Dir Ops CE Reduce LOS Aug-10 Mar-11 OMG SU Behind trajectory - not delivering

15 PS7 PS7 PS7 PS7 CP5/ CP10 CP5/ CP10 CP5/ CP10 CP5/ CP10 97% session 22/55/8 TPOT productivity Dir Ops AB/JH 94% utilisation Dec-10 Mar-11 22/55/8 TPOT productivity Dir Ops AB/JH 80% slot utilisation 63% Dec-10 Mar-11 22/55/8 TPOT productivity Dir Ops AB/JH 22/55/8 TPOT productivity Dir Ops AB/JH WF12 PS7 22 Reduce Theatre Bank & Agency Recruitment CP5 PS7C P10 28/29 Procurement Prostheses CP1 27 Repatriation of IS Capacity reduced expenditure Dir HR JM 0.8% non-clinical cancellations 2% clinical cancellations Unit agency usage <10% TPOT I Refining data collection TPOT I Refining data collection - not delivering 1.2% Dec-10 Mar-11 TPOT I Monitored via TPOT and linked to Stock control and procurement projects no data Dec-10 Mar-11 TPOT SU Establishing data collection and analysis no data Oct-10 Mar-11 Rationalisation of stock, cost Dir Fin KA Cost savings TBC Jan-11 Mar-11 savings and price negotiation reduce expenditure Dir Fin LH No cases to IS from Oct Joints & 3 spines Oct 10 Oct-10 Mar-11 PS10i PS10 6 New & Follow-Up Ratio productivity Dir Ops JV Apr-10 Mar-11 OPD project group Dir Estates LW Budget reduction complete Apr-10 Mar-11 CP13 51 Postage Cost Reduction CP14 52 Telephone Cost Reduction CP7 33/34 Orthotics & Limb Fitting - combine procurement reduce expenditure reduce expenditure procurement efficiencies CP8 33/35/54 Orthotics & limb fitting - off site solution productivity Dir Estates LW Budget reduction Budget reduction Apr-10 Mar-11 Dir Fin AK Budget reduction Budget reduction Apr-10 Jun-10 Dir Ops/ Estates PW Increase RNOH footprint and reduce costs CP3 43/53 Transport - retendering cost savings Dir Ops SLM Budget reduction Behind trajectory Apr-10 Mar-11 CP4 48 PP Activity - case mix CP18 24/26 Pharmacy Innovation PS10 PS12 5/6 OPD Improvement Project PS2 PS3 1/3/4/36 ERP Enhanced Recovery Programme Quality increased revenue Prescribing & purchasing savings efficiencies /pt flow Quality/ financial & productivity HR SU Project brief approved at Oct. STC. Scheme b/fwd from Mar 11 TPOT SU B/fwd from Mar weeks I B/fwd Mar 11 RNOH Transformation & QIPP Monitoring Report I Delivering Estates C Delivered Estates C Delivered Finance C Project B/fwd to 10/11 and delivered Nov-10 TBA OMG SU B/fwd from Mar 2013 Finance D All costs not being captured - finance investigating Dir Fin AK Increase revenue Oct-10 Mar-11 OMG SU PP manager to be supported by external consultant. Package prices to be agreed. B/fwd from Mar 12 Dir Fin SPI cost savings behind trajectory Apr-10 Mar-11 Finance D Predicted savings unlikely to be met due to unforeseen costs of in house service Dir Ops Dir Ops JV AB/JV WF9 15 Digital Dictation & CDL Quality Dir IM&T CW/JM Improved patient and staff experience. Improved pt flows LOS/reduced bed numbers/ reduce N/FU ratio Turnaround 24hrs urgent with 48hrs routine PS13 Choose & Book Quality Dir Ops GH DoS quality <2 2.0 May-10 Dec-10 PS13 Choose & Book Quality Dir Ops GH ASI's <2% 0% May-10 Dec-10 TBA Oct-10 Mar-12 OMG SU Project plan in development. A number of PDSA projects to be trialled 4.0 Dec-10 Mar-12 OMG SU/I 1st tranche of patients have been through programme for hip & knee. B/fwd from Mar 12 Turnaround times being achieved. Phase 2 data warehouse will on target Aug-10 Mar-11 IM & T I/D be rolled out by April 2011 and secretarial savings will then be pursued. OMG D Target achieved May 10 OMG D ASI's in April % - achieved 0% by June 10 PS13 Choose & Book Quality Dir Ops GH Smartcard 100% 10% May-10 Dec-10 OMG D Smartcard registration behind schedule but sessions in place Nov 10. PS13 Choose & Book Quality Dir Ops GH 100% services on line PS13 Choose & Book Quality Dir Ops GH Advice & Guidance 100% May-10 Dec-10 PS6 Productive Ward Quality Dir Nurs K Corder Improved patient and staff experience. 100% May-10 Dec-10 OMG D Main stream services went live in May and 2 week waits in September 10 limited KPI's in place Apr-10 Mar-12 PW sterring group OMG D On track for delivery by Dec 10 I 2nd phase being launched Dec. 10. Discussions re KPI's with new Dir Nursing

16 3.0 Transformation Project Monitoring Project Summary Gantt Charts RNOH Transformation & QIPP Monitoring Report

17 3.0 Transformation Project Monitoring Project Summary Gantt Charts RNOH Transformation & QIPP Monitoring Report

18 4.0 Financial Monitoring See Appendix 1 RNOH Transformation & QIPP Monitoring Report

19 5.0 Foundation Trust Application This section provides an overview of the work underway and achievements we have made to progress our Foundation Trust application. Project Team for FT The project team has been in place since We have reconfigured key roles in the Trust to ensure that we have sufficient management and administrative support for our FT project and beyond. Consultation and governance We undertook a three month consultation on our FT proposals in 2007, from which we revised our proposed structure (attached). The Trust Board has approved the following: FT constitution approved in September 2009 Governance Rationale approved in November 2008 Membership Strategy approved in July 2008 We are considering whether we need to refresh our consultation although we undertook a comprehensive process in 2007 and have presented the structure twice to FT members at events since the consultation. Trust Board To strengthen our leadership team, we have recruited to key executive director posts Operations, Nursing and Finance (the latter recently, with significant FT experience). We have undertaken regular Board development sessions to respond to a training needs analysis and have secured a Board development partner to support our Board development activities and support the new executive team. We are planning our Board development programme for 2011, ensuring that it is tailored to support our application and Monitor assessment. The vacancy for the role of Director of Workforce and Corporate Resources is currently being advertised. RNOH Transformation & QIPP Monitoring Report

20 Integrated Business Plan The Integrated Business Plan has been drafted and is being reviewed in light of independent feedback and the views of NHS London on our executive summary/summary IBP submitted in September We have undertaken an FRP/Mock DD process and have completed an associated action plan. We have also revised and submitted our LTFM to NHS London. Membership We have recruited over 3000 public/patient FT members and established a programme of popular FT events. We are planning our FT members events for 2011, ensuring that there is a mix of input regarding current performance of the Trust, an insight into our services and our plans for FT. We are undertaking an analysis of our membership to ensure appropriate representation. Staff engagement We held recently a very successful staff engagement event, providing information and seeking involvement in FT, redevelopment and service transformation. Going forward The meeting with NHS London on 04 November will provide feedback on our Integrated Business Plan and will inform our project timetable and finalising of our IBP. RNOH Transformation & QIPP Monitoring Report