Board of Directors Meeting

Transcription

1 Board of Directors Meeting Date: 25 March 2009 Agenda item: Title: Prepared by: Presented by: Action required: 8.3 Part I Suzanne Tracey, Director of Finance and Business Development Suzanne Tracey, Director of Finance and Business Development Noting Monitoring Information Healthcare Standards CORE Standard numbers Please specify HC standard numbers and tick other boxes as appropriate Healthcare Standards DEVELOPMENTAL Standard numbers Monitor Finance Service Development Strategy Local Delivery Plan Assurance Framework Performance Management Business Planning Complaints Equality, diversity, human rights implications assessed Other (please specify) 25 March of 10

2 1. PURPOSE 1.1 The purpose of the following report is to update the Board of Directors on progress to develop Service Line Management (SLM) at the RD&E and to provide a timetable of future activities to ensure this is achieved by March BACKGROUND 2.1 A progress report was provided to the board in June 2008 highlighting that work had been undertaken in a number of specialities including Ophthalmology, Respiratory Medicine, Plastic Surgery, Cardiology and Obstetrics and Gynaecology. Whilst the same SLM tools were used within these areas, the total roll out of SLM as a Trust wide way of functioning had not yet been achieved. The Trust needed to address a number of key issues in order that an organisational wide approach could be taken. Firstly, system developments were required to ensure service line reporting could be delivered on an automated rather than manual basis for all specialities. Secondly, some permanent resource was required to support this initiative, the work to date had been undertaken by a contracted member of staff working on a part time basis to act as Programme Manager. Furthermore, as well as technical developments, organisational developments were needed to embed SLM across the Trust. 3. KEY ISSUES 3.1 Since the last report there has been some loss of impetus progressing the rollout of SLM due to: the changeover of Directors of Finance the loss of the temporary contracted member of staff delays in the system implementation of the patient level costing system (PLICS) required to support service level reporting. 3.2 These issues have now been addressed as follows: a permanent member of staff has been appointed as Head of Financial Development from 5 January 2009 this post holder will act as project lead for SLM problems with the implementation of the PLICS system have been resolved and a revised delivery date of June 2009 agreed with Ardentia, the system supplier. The delivery of this system is rightly managed through the Ardentia Project Board chaired by the Director of Finance. a new Project Board has been formed with Executive Director input, together with a SLM Steering Group to deliver key aspects of the project. 3.3 The Trusts stated strategic objective was to roll out SLM to all specialities across the Trust by March The June 2008 report highlighted there was a serious risk that this would not be achieved and indicated that the patient level costing system was a key dependency to achieve roll out. Given the problems outlined above, it has not been possible to achieve the timescale of March The attached report proposes a revised timetable and summarises the plan that is in place to ensure SLM rollout is fully achieved during 2009/ March of 10

3 4. PROPOSALS 4.1 The SLM Project Board has considered the approach required to fully embed SLM across the Trust. The Board concluded that SLM will not be fully embedded in Divisions unless the Trust s supporting business systems are fully aligned. The Project Board therefore proposes a three stage approach as follows: Development of an over arching framework within which SLM can operate Creating the tools required to support SLM Roll out of tools and working practices across the organisation on a speciality by speciality basis A timetable to achieve this approach is detailed in the attached report. 5. FINANCIAL/OTHER IMPLICATIONS 5.1 There are no further financial implications other than those already approved. 6. RECOMMENDATIONS The board of Directors are requested to note the current position in respect of the rollout of SLM across the Trust, to endorse the approach proposed by the SLM Project Board and to approve the revised timetable for delivery of this project. 25 March of 10

4 Report March Introduction 1.1 The purpose of this report is to provide an update to the Board of Directors on the roll out of Service Line Management. 1.2 The last report to the Board was in June Since that time work has stalled for a number of reasons, including a lack of resources to apply to SLM work, but the Trust is now refocusing on this important initiative and making progress once more. 2 SLM background 2.1 Service Line Management is a way of working which enables the devolution of ownership to the front line - where the capabilities, information, and patient relationships reside that enables the trust to fulfil its overall objectives (Monitor). It is concerned with developing policies, processes and tools that allow service leaders to drive high quality cost effective care. It promotes an integrated approach to managing services. 2.2 The RD&E s strategic objective was to roll out SLM to all specialties by March 2009 with the right processes and tools in place to support integrated and devolved management of efficient high quality services. 3 Previous work at the RDE 3.1 In 2007 with the support of external consultants some initial pilot work was undertaken in Ophthalmology which was useful in proving the potential value of an SLM style of working. It showed how information can be used to better understand the services performance in financial and clinical terms and how this can then be used in setting objectives and strategic planning. The development of a scorecard showed how performance could be monitored in an integrated way to aid decision making. 3.2 The consultants produced an outline of a way forward for implementing SLM at the RDE. This was followed up by some further roll out of SLM style work in Respiratory Medicine, Plastic Surgery, Cardiology and Obstetrics and Gynaecology. 3.3 Some work has continued and pockets of good SLM practice have emerged and developed. For examples, in Child and Women s Health there is some use of the performance scorecard method of analysing and monitoring performance to aid service management and decision making. 3.4 Although this work has been valuable, it has been about trialling SLM techniques rather than embedding them within the Trust. It has served as useful organisational learning and allowed us to understand what the next steps need to be. 4 Issues impacting on the full rollout of SLM 4.1 A number of issues have impacted on progress with SLM and delayed its full roll out across the Trust. Most notably: Short delay due to the changeover to a new Director of Finance 25 March of 10

5 Loss of the temporary contracted programme manager Delays to system implementation in relation to Patient Level Information and Costing (PLICS) 4.2 The SLM programme manager left the Trust in early September This resulted in a loss of momentum and capacity for SLM work but this has now been addressed through the appointment of a Head of Financial Development who began work in January 2009 and will act as project lead on SLM. 4.3 The implementation of PLICS has proved problematic. The system procured from Ardentia (a health service IT systems supplier) was believed to be a proven solution but in fact has been seen to be a work in progress. The Trust has had to devote considerable time and finance expertise to developing the system to a state where it will be fit for purpose. This work is now well advanced and a project plan is in place to complete the final development stages. The Trust has also negotiated a reduction in the contract price to reflect the difficulties experienced and the input provided on our part. 5 Project Structure 5.1 Some good developmental work has continued over the last six months so the Trust has continued to position its self to roll out SLM fully. In Finance, the work is well advanced now on developing the Patient Level Costing System to provide better financial management information for an SLM context. In Information Management & Technology, work to implement a Data Warehouse Solution to organise and deliver management information has made good progress. 5.2 Despite the work done so far, the overarching framework to govern an SLM way of working across the Trust has not been developed and fundamental questions need to be addressed, including questions around levels of devolved autonomy and incentives. Also, the tools and processes needed to operate an effective SLM style of management need to be developed further and there remains much to be done, for example on a systems solution to producing performance scorecards. 5.3 A project governance structure is now in place to lead and manage SLM work as we move forward. An SLM Project Board has been established and will be supported by an SLM steering group. 5.4 The Project Board has a clear purpose to provide overall direction for SLM, make key decisions, take responsibility for successful implementation and act as a voice for the project to the rest of the organisation. It has met twice already in 2009 in order to pick up momentum. It is a senior level group with the following membership: Suzanne Tracey Alan Welch Elaine Hobson Vaughan Pearce/Iain Wilson Peter Adey Mathew Moore Lynn Lane Marie-Noelle Orzel Director of Finance (SLM Project Board Chair) Head of Financial Development (SLM Project Manager) Chief Operating Officer Medical Director Divisional Manager-Child and Women s Health Clinical Director Specialist Surgery Director of HR Director of Nursing 5.5 This Project Board has endorsed an approach to move forward with SLM which is described at point 7 below. 25 March of 10

6 5.6 The SLM steering group has been formed to support the work of the Project Board and its purpose will be to take on tasks for the Board and make recommendations to help develop the practical solutions needed, to inform and influence the project and support the project lead. It will meet for the first time in March 2009 with the following Membership: Paul Southard Alan Welch Leanne Gladwin Christian Hamilton Wendy Ware Steve Roffe Anne McCluskey Mark Gill Jane Viner Ann Goodridge Neil Liversedge Finance (Chair of Steering Group) SLM Project Lead Finance DM Surgery IM&T IM&T HR HR Nursing Performance Lead Clinician C&WH 5.7 There is still a significant appetite and enthusiasm around the organisation for SLM but the case for doing it needs to be made clear and high expectations around timescales and potential benefits need to be managed carefully. 6 Potential Barriers to progress 6.1 The SLM Project has huge scope and complexity. It involves implementing change across the organisation which will have an impact on many levels ranging from strategic planning and organisational culture down to IT systems and financial analysis. 6.2 The project has previously stalled and encountered delay due to resource availability and other complications. The Trust must recognise at this stage the potential barriers to progress and act to deal with them if we are to move the SLM agenda forward in the RD&E. The Project Board is beginning to consider the barriers and how to tackle them. 7 The approach moving forward 7.1 Learning from past experiences and building on the good work done so far, the Project Board has endorsed an approach to move forward which is based around three core stages of work: a) Developing the over-arching framework within which SLM can work b) Creating the tools needed to do the job c) Rolling out the working methods across the organisation The framework and tools can be developed concurrently before rolling out is attempted. 7.2 A first draft project plan is attached at Appendix A. The plan will be developed and refined over the coming weeks. 25 March of 10

7 8 Summary 8.1 The Trust remains committed to implementing SLM. Some good work has been done but there remains much to do. The enthusiasm for SLM remains high in many areas and some additional resources have been identified to move the initiative forward but more is likely to be required. 8.2 There are several potential barriers to progress which the Trust must recognise and act to address. 8.3 An outline plan on how to move forward has been drafted and will be further refined. 25 March of 10

8 Appendix A SERVICE LINE MANAGEMENT PROJECT BOARD 16 th March 2009 Draft Project Plan Recommendation That the Project Board note this project plan as a first draft and acknowledge that it will be further refined in the coming weeks based on the discussion at the Project Board and Project Steering Group. 1 Plan Description 1.1 This draft plan sets out the work packages envisaged to be necessary to deliver the framework, tools and outcomes required of the SLM Project. 1.2 A later version will be approved by the SLM Project Board and implemented and monitored by the SLM Project Manager. 2 Prerequisites 2.1 For the plan to be implemented successfully the following will be required: Backing, commitment and support from the highest level in the Trust including the Trust Board, the Executive Team and the SLM Project Board Sufficient project management resources. Sufficient resources in the wider Trust environment e.g. Clinical Leads, Divisional Managers A high level of engagement from colleagues, particularly through the Project Steering Group to map out how SLM will work in practice 3 Planning assumptions 3.1 In proceeding with the SLM project at this time it is assumed that: The original case/current case for implementing SLM remains valid. The initial focus needs to shift from rolling out some SLM techniques to individual Divisions to addressing over arching matters and developing the tools/systems required. 4. Risks 4.1 A range of risks are faced by the project and these will need to be managed. At a later stage it may be necessary to develop and maintain a risk register to identify risks and the associated mitigating actions. 5. Project Plan 5.1 To date there has not been a clear project plan for the implementation of SLM. Early on there was a broad outline of what success would look like which set a 2 year time frame on the work to be completed. 25 March of 10

9 5.2 This project plan aims to set out an indicative set of broad milestones which can later be developed in to a detailed plan of work with clear tasks, deadlines and ownership. 5.3 Once the Project Board is clear on exactly what benefits are to be achieved and how we want SLM to look and function, then the milestones can be refined and detailed plans developed. 5.4 It is envisaged that work should be organised around three phases or chunks : a) Overarching framework for SLM. This chunk of work naturally should come as the first priority. It is about getting the framework within which SLM should operate agreed before we go further in to rolling it out. It might be described as getting the rules of the game in place before we start trying to engage in it. Work to include resolving roles, links to other processes, decision rights, autonomy, incentives etc. b) Creating the tools. This chunk of work is about ensuring that Service Line Managers and others will have the tools and information to hand that they will need to work in an SLM style. It seems reasonable that there should be a focus on equipping the organisation to do SLM before we actually try to do it. In terms of timing, this work can happen concurrently with the work on chunk a) described above and should not be delayed. Work to include developing the Patient Level Costing System, scorecard development and production etc. c) Rolling out the working methods Once a) and b) above are complete it will be possible to move to a phased roll out of the SLM way of working. Work to include training and support, financial analysis, scorecard use, embedding working practices etc. 5.5 At this first draft stage it is only possible to give broad indicative milestones which reflect what it is hoped should be possible and are based on various assumptions as to what is required. As the Project evolves these milestones must be refined both in terms of the content and timings. However, the Project Board will need to agree and commit to a final version of this plan at some stage and as soon as possible to facilitate good governance of the project 25 March of 10

10 5.6 The broad milestones envisaged at this first draft stage are set out in the table below: Milestone Start Finish a) Over-arching framework Role of Service Line Manager defined and agreed April 2009 Sept 2009 Autonomy framework defined and agreed April 2009 Sept 2009 Incentives defined and agreed April 2009 Sept 2009 Links to strategic and budget planning defined. Process developed Links to performance management regime defined. Process developed. Service Line Manager training pathway defined and agreed April 2009 Sept 2009 April 2009 Sept 2009 April 2009 Sept 2009 b) Creating the tools PLICS operational. Reports ready to be trialled. In progress August 2009 Data warehouse fully operational In progress August 2009 Scorecards format agreed and production processes in place April 2009 Nov 2009 Trialling and refining tools Sept 2009 Nov 2009 c) Rolling out the working method Service Line Manager training delivered Oct 2009 Nov 2009 Start with earlier pilot areas and complete the full roll out of SLM to them (Ophthalmology, Plastic Surgery, Respiratory Medicine, Cardiology, Obs and Gynaecology) Dec 2009 Feb 2010 Continue roll out to other areas Jan 2010 Mar 2010 Roll out to support functions Mar 2010 April 2010 Evaluation and review of SLM Sept 2010 Sept March of 10