Board of Directors Meeting

Transcription

1 Board of Directors Meeting Date: 30 September 2009 Agenda item: Title: Prepared by: Presented by: Action required: 7.1 Part I Alan Welch, Head of Financial 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) 30 September of 7

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. 2. BACKGROUND 2.1 A progress report was provided to the Board in June 2009 which provided an update on the project to implement SLM at the Trust. Since then further progress has been made and the Project Board and Steering Group have continued to meet to guide the project and develop solutions. The Project has been considering the complex detail of what SLM will involve and how it can be implemented successfully at the RD&E. The focus has continued to be on developing the tools required but the strategic level focus has shifted away from developing the over-arching SLM framework to establishing the way in which Service Line Reporting will operate in the first instance. 3. KEY ISSUES 3.1 Since the last report significant progress has been made: The Project Board, Steering Group and Working Groups have continued to meet regularly to guide the project and bring together the required expertise. The draft SLM Operating Framework has been considered in more detail to help clarify issues and discussions with clinicians have been useful in taking this forward. This has now been set aside in favour of focusing on the detail of how Service Line Reporting will operate as this will precede SLM. Work on developing the management tools required is progressing significantly: o o Patient Level Costing and Information System further developed and although continuing to proving difficult it has been possible to produce the first Service Line Reports for testing. During September reports will be issued to Ophthalmology, Plastic Surgery and Obstetrics and Gynaecology for initial review. Performance Scorecard solution has been considered, the content and form are now clearer and development of an IT solution is underway which is a significant step forward. In shifting our focus to the detail of SLR, a draft SLR policy and procedure document has been produced. This is an important step towards clarifying how SLR will actually work in practice and can now form the basis for further internal consultation and refinement. Work to review the impact of SLR/SLM on job roles and responsibilities is well advanced and consideration of training implications is also underway. A draft communication plan has been prepared to ensure the projects benefits and impacts are understood across the Trust. A number of presentations have been made to staff groups to begin building awareness and understanding and more of this is planned. 3.2 The Project Board has continued to debate in more detail some of the implications of adopting SLM and decided: It makes more sense now focus efforts on clarifying how SLR will work in practice 30 September of 7

3 It is difficult to do further work on an SLM Operating Framework until SLR information and processes have been defined. As implementation of SLR is planned for April 2010 this should be the development priority with SLM implemented in The Project Plan has been updated to reflect a focus on SLR now and an intention to return to developing the SLM Operating Framework later. 3.3 The attached report sets out in more detail the progress made in recent months and the work planned to take the project forward. 4. PROPOSALS 4.1 The SLM Project continues to be based on an approach involving three stages as follows Development of an over arching framework within which SLM can operate (although the focus of this work is now on the SLR element) Creating the tools required to produce SLR information to support the SLM concept Roll out of tools and working practices across the organisation on a speciality by speciality basis The timetable to achieve this approach has been updated to reflect recent progress and thinking and is detailed in the attached report. 5. FINANCIAL/OTHER IMPLICATIONS 5.1 No new implications. 6. RECOMMENDATIONS The Board of Directors are requested to note the current position in respect of the rollout of SLM across the Trust and to approve the updated timetable for delivery of this project. 30 September of 7

4 Report June Introduction 1.1 The purpose of this report is to provide an update to the Board of Directors on the progress of the Service Line Management Project. 1.2 The last report to the Board was in June Since then further progress has been made and a need to shift focus identified to ensure the key milestones are met. 2 SLM / SLR 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. Adopting SLM is a strategic objective of the Trust. 2.2 Service Line Reporting will involve the production of financial and other performance information to help Service Line Managers in their decision making. SLR will allow an understanding of profitability at Service Line Level, it is the fundamental information which is a prerequisite to SLM and will underpin the SLM way of managing services. 2.3 Of paramount importance is always the desire to introduce new management information and practices that contribute to delivering high quality care to patients. 3 Progress since the last report 3.1 The SLM Project Board has been meeting monthly to oversee and guide the project with support from the SLM Steering Group which has also been meeting monthly to consider issues and develop solutions. 3.2 The Working Groups which are tackling detailed issues and reporting to the Steering Group are making good progress as shown below. HR Working Group The job descriptions of key clinical and managerial roles have been reviewed against the requirements of SLR/SLM and compared to descriptions developed in another Trust who previously conducted a similar review. Proposed amendments to job descriptions are now being reviewed and the training requirements which naturally flow from these are also being considered. Planning and Performance Working Group This group has contributed to the SLM operating framework by describing how SLM could link to the existing planning and performance regime in the Trust. The group has also contributed thinking to how planning and performance work could be improved. 30 September of 7

5 Performance Scorecard Working Group The purpose of performance scorecards, their form and content have been considered and draft solutions presented to the SLM Steering Group and Project Board. A large number of performance indicators will underpin a consolidated scorecard to help Service Line Managers in their management of services and to assist their decision making. It will also be possible to consolidate this information further for use at Directorate and Trust level to aid performance management processes. A style has been designed which will make the information easy to interpret and allow its efficient use by clinicians and managers. Finance Working Group Consideration has been given to the financial elements of the SLM operating framework, although further work on this has been set aside for now so that efforts can be focused on developing the more pressing SLR policy and procedure. A first draft of the SLR policy and procedures has been produced and is now forming the basis for further discussion to ensure we can adopt a practical approach to SLR which contributes to good financial, performance and service management. Discussions with clinicians have helped develop an understanding of the devolved decision making rights that might be desired. 3.3 The draft SLM Operating Framework has been considered in more detail to help clarify issues and discussions with clinicians have been useful in taking this forward. This has now been set aside in favour of focusing on the detail of how Service Line Reporting will operate as this will precede SLM. Developing the first draft of the framework has been valuable and the effort involved has helped us progress our thinking and we will return to this document to develop it further at a more appropriate stage. 3.4 Work to develop the Patient Level Information and Costing System (PLICS) has progressed and is continuing to be managed as part of the Business Intelligence System Project. The system will provide financial information essential to the SLM way of working as it will enable the reporting of Service Line profitability. The system is not yet developed to our full satisfaction but has been developed to a point where the first Service line reports have now been produced for testing in a few pilot specialty areas. Learning from these initial reports will be fed back in to further development of the system and to allow reports for further specialties to gradually be produced so that the system becomes ready for live use from April In order to describe our approach to SLR and to address the practical issues, a draft SLR policy and procedure document has been produced. It seeks to explain how SLR will actually work and is an important step forward which can now form the basis for further internal consultation and refinement. 3.6 It is important that those managing the project consider the communication issues that need to be addressed, particularly how to build awareness and understanding in the organisation of the work being done, its intended benefits and how it will affect staff and the way they work. To address this in a structured way a draft communications plan has been produced and is now forming the basis for further consideration. In support of this, a range of presentations have been made to 30 September of 7

6 various staff groups to begin the process of awareness building and more are planned. 3.7 As previously reported, rolling out Service Line Reporting (the information and analysis tools and techniques that underpin SLM) in the first instance is the first priority before a full roll out of SLM, where autonomy and incentives would then be associated with that information. This will allow for a manageable move towards SLM where familiarity with the information can precede the devolved responsibility which could eventually accompany it. 3.8 It is still intended to pilot our SLM principles in a few areas during 2010/11 to ensure they can operate effectively, but we now envisage doing this a little later instead of at the beginning of that financial year. This is to allow time to first understand how SLR is working in practice before we try to further develop our approach to the wider SLM concept. 4 Potential Barriers to progress 4.1 The SLM Project has huge scope and complexity and potential barriers to progress have been identified. The Project Board is continuing to monitor these and take action where necessary to ensure the project continues to progress. 5 The approach moving forward 5.1 The project continues along an approach based around three core stages of work: a) Developing the over-arching framework within which SLM can work (although the focus of this work is now on the SLR element) b) Creating the tools needed to do the job c) Rolling out the working methods across the organisation 5.2 The project milestones provided in the last report in June have been updated to reflect recent progress and thinking and these are shown at Appendix A. Although some milestones have been extended to reflect the change in approach, the overall aims to rollout SLR in April 2010 and SLM in April 2011 remain on track. 6 Summary 6.1 The Trust continues to work towards implementing SLM. Some good work has been completed and more is underway but still there remains much to do. 6.2 There are several potential barriers to progress which the Trust must recognise, monitor and act to address as necessary. 6.3 The project milestones have been updated to reflect recent progress and thinking. 30 September of 7

7 Revised Project Milestones September 2009 Milestone Start Finish * Revised a) Over-arching framework Roles of those involved in Service Line Reporting reviewed and changes agreed April 2009 Nov 2009 Autonomy framework defined and agreed April 2009 Oct 2009 Deferred to Incentives defined and agreed April 2009 Oct 2009 Deferred to 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 Service Line Reporting Policy and Procedures defined and agreed April 2009 Nov 2009 Deferred to April 2009 Nov 2009 Deferred to April 2009 Jan 2010 Jan 2010 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 Complete by Feb 2010 for SLR Roll out SLR as precursor to full SLM April 2010 Pilot - Start with earlier pilot areas and complete a more extensive pilot to trial SLM concepts (Ophthalmology, Plastic Surgery, Respiratory Medicine, Cardiology, Obs and Gynaecology) Dec /11 Continue full SLM roll out to other areas Jan 2010 April 2011 Roll out to support functions Mar 2010 Consider in 2011 Evaluation and review of SLM Sept 2010 Dec 2011 *As approved May September of 7