ANEURIN BEVAN HEALTH BOARD ORGANISATIONAL DEVELOPMENT STRATEGY

Transcription

1 ANEURIN BEVAN HEALTH BOARD ORGANISATIONAL DEVELOPMENT STRATEGY JULY

2 ANEURIN BEVAN LOCAL HEALTH BOARD ORGANISATIONAL DEVELOPMENT STRATEGY Section No. Section Title CONTENTS Page No (s) 1. Purpose 3 2. Strategic Priorities Fourteen High Value Opportunities Financial Challenge 5 5. Organisational Development Interventions to Date 6. Organisational Objectives 6 7. Organisational and Service Alignment Patient Safety Organisational Learning 7 9. Organisational Partnerships and Employee Engagement 10. Partnership Information and Communications Technology Service Improvement The Way Forward Annex 1 Organisational Objectives / Annex 2 Organisational Development Action Plan Organisational Development Strategy July Page 2 of 26

3 ANEURIN BEVAN LOCAL HEALTH BOARD 1.0 PURPOSE ORGANISATIONAL DEVELOPMENT STRATEGY The purpose of the Aneurin Bevan Health Board Organisational Development Strategy is to deliver a sustainable, organisational wide, developmental approach to the delivery and continuous improvement of patient care and services and the development of our staff. It identifies the overarching principles, which will enable the Health Board to achieve continuous improvement and change through development of structure, processes, people and culture. The focus on improvement in all aspects of care and service delivery is a vital cornerstone to the new organisation. This Strategy will be underpinned by a number of strategic documents and frameworks, most notably the Five Year Service, Workforce and Financial Strategic Framework, Annual Plan, Financial Plan and the Standards for Health Services (SHS). As such, this Strategy aims to identify the interrelationship of local and national imperatives providing a clear plan to support delivery and improvement within the Organisation in terms of the structure, process and culture. It will support the development aspects of organisational change and the achievement of organisational objectives identified within the Annual Plan. These objectives are attached in Appendix 1 for reference. The Strategy Action Plan detailed in Appendix 2 highlights the organisational priorities for organisational development for the next two years. 2.0 STRATEGIC PRIORITIES The Aneurin Bevan Health Board s mission statement is: Working with you for a healthier community, whilst caring for you when you need us and aiming for excellence in all we do The Board has also identified the following five specific priorities: Focusing on Public Health Delivering patient centred services Ensuring staff are enabled and empowered Achieving better use of resources Organisational Development Strategy July Page 3 of 26

4 ANEURIN BEVAN LOCAL HEALTH BOARD Ensuring quality and excellence These are reflected in the priority areas highlighted in the Annual Plan for -11, which in turn are reflected in the organisational objectives. The Annual Plan identifies the more detailed priorities for Aneurin Bevan Health Board for /2011 and beyond, these are as follows: Integrating our System: taking all opportunities to organise services around the citizen and balancing our whole system of care Focusing on Safety and Quality: we have a responsibility to ensure that patients and the population we serve receive the best quality, evidence-based care we can provide and also to ensure we deliver the basics exceptionally well Empowering our Staff: we can only deliver by trusting our staff, supporting them to make the right decisions close to the patient and to find innovative ways of developing the workforce. Developing Sustainable Solutions: whatever changes we make and wherever we deliver care, we must do this in line with best practice, within the resources we receive and with confidence that improvements can be maintained. The aim of this Strategy and Action Plan is to identify key areas of work required in the next eighteen months of Aneurin Bevan Health Board. The Strategy will align the people, processes and structures of the Health Board to achieve maximum benefit for patients, staff and citizens whilst enabling the key financial strategic work programme. It details the actions that will need to be taken and led across the Organisation and the respective Director functions. 3.0 FOURTEEN HIGH VALUE OPPORTUNITIES The Annual Plan identifies fourteen areas of opportunity as a result of All Wales work on the Five Year Framework. These are as follows: Capture the opportunity of integrated care Develop new settings of care and improve long-term care 1 pathways Improve quality of continuing care through health and social care 2 integration 3 Develop improved unscheduled care pathways 4 Implement cross-system patient information and informatics Improving quality and financial sustainability by reducing harm, waste and variation 5 Stop wasteful clinical interventions Organisational Development Strategy July Page 4 of 26

5 ANEURIN BEVAN LOCAL HEALTH BOARD 6 Improve acute care performance and decrease length of stay 7 Improve primary and community care performance 8 Improve mental health service position 9 Manage medicines more effectively 10 Improve procurement and supply chain 11 Drive highest-value prevention campaigns Empower the front line 12 Streamline and refocus the centre 13 Establish service line management and patient-level costing 14 Modernise the workforce The Health Board recognises that a paradigm shift towards improvement of quality and financial sustainability, by reducing harm, waste and variation, is required in /2011. Efforts will shift from the traditional triad approach to building the bedrock of sustainability around the fourteen high value opportunities. These will concentrate initially on those likely to remove waste earlier in their lifetime. 4.0 FINANCIAL CHALLENGE A detailed assessment of the potential financial gap for /2011 has been undertaken. This is set out in greater detail within the framework of the Annual and Financial Plans. This Organisational Development Strategy reflects the significant financial challenge currently facing the organisation. The Strategy aims to support the delivery of cost reduction by improving services, reducing duplication and improving efficiencies in both services and the workforce. 5.0 ORGANISATIONAL DEVELOPMENT INTERVENTIONS TO DATE The principle Organisational Development interventions to date have been to design new structures and organisational infrastructures at Tier 2, 3 and 4 to deliver the integration of the six predecessor organisations. This work is ongoing and it is likely to take 12 months for the whole Organisation to be fully aligned with clear accountabilities. As such, a technical work programme has begun which needs to be supported by a cultural and political work programme. Before this can begin, however, the Health Board must make explicit its expected outcomes and evaluation criteria in terms of measuring success. The development of clearly measurable organisational objectives, which can be translated throughout the Organisation into delivery and change programmes, will be necessary in terms of articulating the expectations of Organisational Development Strategy July Page 5 of 26

6 ANEURIN BEVAN LOCAL HEALTH BOARD the organisation. To support the cultural and political aspects of this change, leadership development and the development of a team working culture will be pivotal at all levels. 6.0 ACHIEVING OUR ORGANISATIONAL OBJECTIVES Aneurin Bevan Health Board has produced its Annual Plan identifying a number of organisational objectives and priorities. The objectives must: Be translated into SMART (Specific Measurable Attainable, Relevant, Time-bound) improvement actions Have identified expectations for delivery Facilitate performance management Articulate what difference the improvement actions will make The process to measure performance must be made explicit at a corporate level, Divisional/Locality level and departmental level. This must be cascaded to team and individual level. Each objective needs a clear deployment process within the organisation. Some will be relevant throughout the Organisation and should be discussed as part of every employee s personal review with related personal objectives being recorded on the e-ksf tool. Others will be targeted at certain services and functions or management/clinical areas. The achievement of organisational objectives at a local level must be through the individual performance management system. 7.0 ORGANISATIONAL AND SERVICE ALIGNMENT As already identified, the focus of work to date has been on organisational structures and developing an alignment to ensure that the new Health Board can run effectively. The focus of leadership in the Health Board is on a clinically led organisation and structures at all levels will facilitate this aim. It is recognised, structures will need realigning and will be subject to modification to support service configuration and health improvement. On an individual level, the full implementation of the Knowledge and Skills Framework linked to competency based job descriptions ensures each member of staff is able to contribute effectively to the delivery of services whilst gaining real job satisfaction. A fundamental aspect of this Organisational Development Strategy will be the development of strategic and local service models as part of the Organisational Development Strategy July Page 6 of 26

7 ANEURIN BEVAN LOCAL HEALTH BOARD strategic planning framework. This model will affect all future organisational alignments from a clinical, managerial and staffing viewpoint. The Health Board will progress the development of its workforce plan and overarching modernisation strategy to ensure sustainable and affordable workforce arrangements, fully integrated with the service and financial planning framework. The challenges facing the Health Board require evidence-based innovative solutions to challenge existing ways of working along the patient journey, ensuring increased integration between health, local authority and `third sector voluntary services. This will be achieved through the development of a comprehensive Service Strategy. 8.0 PATIENT SAFETY ORGANISATIONAL LEARNING Aneurin Bevan Health Board has established an Organisational Learning Strategy to support its vision to become a learning Organisation. It describes how the Organisation will learn from near misses and adverse events, the 1000 Lives initiative and methods for improvement. This will allow the Organisation to develop and mature as a learning Organisation using a whole systems approach. The high-level measures will be implemented using small tests of change using the plan, do, study, act, (PDSA) cycle. The Health Board is committed to improving patient outcomes, patient/staff safety and increasing patient/staff satisfaction. The new Organisation will create structures, functions and processes, which focus on patient/staff safety and learning. This will rely on an open and fair culture in dealing with concerns to ensure that they: Are reported, acted upon and responded to in an appropriate and timely manner; Are handled and investigated openly, effectively and by those appropriately skilled to do so; And that the organisation: Offers patients, service users and their carers support including advocacy and where appropriate redress; Provides appropriate support to staff; Learns and share lessons from local and national reviews to improve services. Work will be undertaken across the organisation, informed by data provided from incidents, complaints and claims. The key aim of this work will be to facilitate learning using the processes that support the culture of patient safety and improvement. This will allow trends to be analysed and the key issues that are leading to patient harm to be identified, so Organisational Development Strategy July Page 7 of 26

8 ANEURIN BEVAN LOCAL HEALTH BOARD that evidence based actions to address them can be developed, tested and spread across the organisation. Organisational learning will seek to promote the following values across the Health Board: Understand, value and develop staff to help care for people. Look for new ways to achieve excellence. Celebrate success and share learning with others. Be outward facing, open and transparent. Act with honesty and integrity - especially when difficult decisions need to be made. Aneurin Bevan Health Board will actively seek to transfer and adopt best practise to the delivery of patient care in the organisation. This will be supported by the continual involvement in the Safer Patient Initiative and the 1000 Lives Plus. 9.0 ORGANISATIONAL PARTNERSHIPS AND EMPLOYEE ENGAGEMENT Effective staff engagement and appropriate structure should support the organisation to achieve its objectives. We will need systematic controls assurance, a robust communication process and employee and trade union engagement. This will help to identify and spread the key behaviours that underpin cultural change, and support the delivery of continuous improvement and innovation. Staff and Trade Union engagement in all aspects of service improvement and performance improvement will be a core component of an empowered engaged workforce PARTNERSHIP We will collaborate with partners across health and social care to make further system wide progress in the delivery of care. Our partners will include local authorities, third sector providers and the independent sector. Within this, there is a need to further develop more joint service planning, closely linked management and leadership structures, ensuring cross-sector stakeholder engagement and improved recognition and harmonisation of cultural differences. We recognise that these partnerships must be underpinned by sound governance arrangements. Partnerships will also need to be built upon and strengthened with education providers, the Welsh Assembly Government and most importantly the citizens that we serve. This will require clear communication with our partners to ensure a shared understanding and ownership of the changes required. Organisational Development Strategy July Page 8 of 26

9 ANEURIN BEVAN LOCAL HEALTH BOARD 11.0 INFORMATION AND COMMUNICATIONS TECHNOLOGY Informatics and information and communications technology (ICT) will need to underpin and enable the delivery of this Organisational Development Strategy. Technology will improve and streamline processes for staff, patients and the public whilst improving effectiveness and efficiency of services and care. The ICT Local Service Plan will be aligned to organisational objectives, in particular, the improvement of patient care and safety through the use of ICT. ICT remains a key component to the delivery of objectives, whilst resultant information will support the numerous aspects of the Organisational Development Strategy and will play a key role in the delivery of the WAG recommendations in Setting the Direction for primary and community services to improve the joint working interface between the community, primary and social care settings. The development and utilisation of electronic workforce systems will be a key component to support organisational and local objectives, in addition to strengthening corporate governance to assure the Board of safe and efficient workforce arrangements in terms of staff deployment and management SERVICE IMPROVEMENT THE WAY FORWARD To ensure this Organisational Development Strategy is embedded within Aneurin Bevan Health Board, each management area will be engaged in delivering local action plans. The aim being to enable local needs to be met but ensuring a cohesive strategy to harness the critical mass required to facilitate the change in structure, process, people and culture. This will ensure the development of an organisational culture focussed on improvement and quality which is at the heart of day-to-day delivery of clinical care and services. To succeed in the development of an improvement culture, a programme will be developed focussing on generating the will to pursue the change, the ideas to transform services and the ability to execute the change. Leadership development and team working will be vital to support the organisation s development and transformation to an improvement culture. This will also need to be underpinned by staff with the skills and capabilities to utilise and embed service and performance improvement techniques in all aspects of patient care and service delivery. These will include the use of Plan, Do, Study and Act (PDSA) cycles to implement and spread system change and run charts to communicate and understand variation. The development of these skills at all levels of the Organisation will be vital so that improvement is something which happens on a daily basis and is not seen as something for the future. The momentum of small every day changes and improvement will be key to changing the ownership and responsibility of quality to all. This will Organisational Development Strategy July Page 9 of 26

10 ANEURIN BEVAN LOCAL HEALTH BOARD empower the workforce at all levels to bring about longer term cultural change. Organisational Development Strategy July Page 10 of 26

11 Appendix 1 Organisational Objectives /2011 OBJECTIVES/THEMES/AIMS TARGET SOURCE EXECUTIVE LEAD LINK TO SHS Corporate Objectives TIMESCALE Fourteen High Value Opportunities KEY RISKS AND ISSUES Integrating our system Develop new settings of care Continue to develop and rationalise the Primary Care Estate. Work with partners to implement new models of community based services and to provide alternatives to acute hospital attendance or admission. Implement the actions identified in the Rural Health Implementation Plan, to be finalised in early. Continue developing and commissioning Ysbyty Aneurin Bevan including the reconfiguration of services of Community services and future of Tredegar and Blaina hospitals. Develop commissioning plans for Ysbyty Ystrad Fawr Develop an Interim Service and Capital Plan for Acute Services pending decision on SCCC Develop options for a phased development of the SCCC. ABHB DPCMH ABHB DPCMH AOF 4 3,4,6,7, 11,13,1 4,25,27 ABHB ABHB DPCMH/ ABHB ABHB Challenges of identifying and agreeing key priorities across all organisations - need to develop service consistency while reflecting local diversity. Health Board required to progress against deliverables identified in Rural Health Local Action Plan on Quarterly basis. Key themes are access to services, closer service integration and community cohesion and engagement. YAB expected to be commissioned in Autumn - further engagement with key partners required. Service plan needs to be finalised to allow capital plans to be agreed. YAB and YYF will be important key developments and slow stream rehabilitation. Clinical engagement in identifying service and patient risk and acceptable alternatives. Public acceptability a major issue. Risk around capital availability for interim service changes. Organisational Development Strategy July Page 11 of 26

12 Appendix 1 OBJECTIVES/THEMES/AIMS Improve long-term care pathways Implement the actions in the Chronic Conditions Management (CCM) Local Plans and CCM Action Plans for /2011. Critically review the provision of continuing health care to reduce costs whilst improving service quality and equity. TARGET SOURCE Develop improved unscheduled care pathways Develop plans to accelerate roll out of Care Pathways Implement frailty programme and new community-based models, using the Clinical Futures framework Achieve an effective and coordinated programme of care and treatment through CPA including development of Care Plan, assessment of needs, and Assertive Outreach assessment. Implement the organisational delivery plans for in support of the delivery of the Cardiac Disease Strategic Framework and achieve 26 week waiting time target. EXECUTIVE LEAD LINK TO SHS AOF 3 DPCMH 7,13 ABHB DPCMH ABHB MD 7,10 ABHB DPCMH 7,13 AOF 15 DPCMH 7,10,13, 23 Corporate Objectives TIMESCALE Fourteen High Value Opportunities 2, 4 7 1, 2, 3, 4, 7 2, AOF 21 7, , 4 KEY RISKS AND ISSUES Need to demonstrate establishment of CCM Locality Care Co-ordination, established CCM teams, monitored and evaluated service developments including moving appropriate people from secondary to primary/community settings and implemented 09/10 actions from local plans. Currently overspending by 1.9M per month. Considerable work being undertaken but uncertainty on financial outlook remains. Need effective clinical engagement, service planning and OD. Issue of speeding up planning and implementation and applying whole systems approaches. National progress expected on Stroke, Cardiac and Mental Health. Focus also on structural arrangements, process indicators and outcome measures. Maintain momentum and achieve funding. Effective implementation and delivery essential to achieve benefits. Major difficulties with information systems and reporting compliance against the CPA standards. This is a problem throughout Wales. Reporting expected to start in the near future. Good performance generally through09/10 but increasing demand and issues of diagnostic capacity can result in delays. Organisational Development Strategy July Page 12 of 26

13 OBJECTIVES/THEMES/AIMS Implement the organisational delivery plans for in support of the delivery of the Stroke Programme. Implement the organisational delivery plans for in support of the delivery of the Renal Strategic Framework. Implement the organisational delivery plans for in support of the delivery of the Cancer Strategic Framework Implement the organisational delivery plans for /2011 in support of the delivery of the Critical Care Strategic Framework. Improve Patient Flow through Emergency care Achieve targets for - Average Length of Stay - Emergency Care Sustain 09/10 position for General Surgery and develop plans to achieve 10/11 target of 5.9 days Achieve 09/10 target of 4.3 days for Urology by Sept 09 and develop plans to achieve 10/11 target of 3.3 Develop and implement plans to achieve target of 9.4 for T&O by Sept 10 Sustain 09/10 position of 0.8 for Gynaecology TARGET SOURCE EXECUTIVE LEAD LINK TO SHS AOF 22 DN 7,13 Corporate Objectives TIMESCALE Fourteen High Value Opportunities 2, 4 AOF 23 7, , 4 AOF 20 7, , 4 AOF 25 DPCMH 7, , 4 ABHB 7 AOF 8 and E&Pty 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, , 2, 4 1, 2, 4 1, 2, 4 1, 2, 4 1, 2, 4 1, 2, 4 Appendix 1 KEY RISKS AND ISSUES Good progress on pathway development in 09/10 and in establishing TIA clinics. Focus now on early recovery and rehabilitation and that work recently started. Resource challenges in delivering whole package in all sites. Renal Assessment Tool to be developed in 10/11and used to assess organisational performance against the Renal Strategic Framework Progress achieved during 10/11 with expansion of Critical Care facilities but funding issues still outstanding. Delayed transfers remain an issue due to service pressures in emergency medicine. Current ALOS is good but with room for improvement in Trauma. Patient Flow work in for Emergency Medicine and project reviewing Trauma services in place. Clinical engagement to improve current models key to success. Current performance meets 09/10 target with small improvement required to achieve 10/11 target. Improving Trauma pathway pre and post surgery essential Current performance very good but some data issues need clarifying. Organisational Development Strategy July Page 13 of 26

14 Appendix 1 OBJECTIVES/THEMES/AIMS Develop and implement plans to achieve 9.3 days target for combined medicine Achieve long stay bed day reductions Ensure that 95% of new patients spend no longer than 4 hours in a major A&E department until admission, transfer or discharge TARGET SOURCE EXECUTIVE LEAD LINK TO SHS 7,9,13,1 4,19,25, 27 AOF 12 7 Corporate Objectives TIMESCALE Fourteen High Value Opportunities 1, 2, 4 1, 2, 4 1, 2, 4 KEY RISKS AND ISSUES Patient flow project in place with support from Sustainability Team Good progress in 09/10 but still short of target. Joint working with LAs key to progress. Ensure that 99% of patients spend no longer than 8 hours in a major A&E department until admission, transfer or discharge. AOF , 2, 4 Ensure the handover of all patients from an emergency ambulance to major accident and emergency departments within 15 minutes. Support the achievement of a monthly minimum performance of 60% of first responses to Category A calls arriving within 8 minutes Achieve the Year 3 reduction of the DToC programme for mental health services. (See Ministerial letter EH/ML/019/08). AOF , 2, 4 AOF , 2 AOF 17 DPCMH 7,10,13 2, 4, 7 Low levels of DToC achieved during 10/11. Emphasis now shifting to days delayed as favoured performance measure. Increase health and social care partnership & integration Develop sustainable working relationships with Powys LHB regarding health care services ABHB , 4 Increasing service impact on Emergency Medicine in ABHB as a result of position in Powys, ABHB becoming a more significant service provider for Powys and the resultant governance challenges. Organisational Development Strategy July Page 14 of 26

15 OBJECTIVES/THEMES/AIMS Improve collaboration in regional networks for services Focusing on safety and quality TARGET SOURCE EXECUTIVE LEAD LINK TO SHS Corporate Objectives TIMESCALE Fourteen High Value Opportunities ABHB MD 1.4 2, 4 Appendix 1 KEY RISKS AND ISSUES Put quality at the heart of everything the Health Board does Continue to improve compliance with Standards for Health Services for Wales ABHB MD Process in place. Implement 10 High Impact Changes for Primary Care Implement the key actions identified within Our Healthy Future - 10 priorities and develop Public Health Local Plan. Continued development of 1,000 lives campaign across the Health Board Continue to improve the Patient Experience and Environment Continue to reduce Hospital Acquired Infection Rates Demonstrate a minimum of 20% reduction over the next 12 months in the number of cases of C.Diff ABHB DPCMH 2.6 2, 4 AOF 1 DPH 3, ABHB MD ABHB ND ABHB ND 2.7 1, 2 AOF 19 ND Need to identify key priorities with engagement of GPs. Increasing demand for both Emergency and Elective presents major risk on quality, money and targets. Top 10 priorities as identified in OHF, as basis. Programmes of delivery must meet requirements of Standards for Health Services for Wales. Evidence needs to be developed to rate progress of the Public Local Plan for 10/ lives will be succeeded by 5 year programme to reduce avoidable harm in Welsh Healthcare. Local targets will need to be established for harm and hospital mortality. Health Boards will need executive Leads, effective clinical coding, process data entry, and sign up to mini-collaboratives. Patient experience included on Health Board dashboard but measures need to be developed with reliable and frequent measurement. Local reduction targets must be in place by March. Must be embedded evidence based practice in place across Health Boards based on improvement strategies e.g Lives campaign. Action Plans must be in place to improve performance. Cleanliness standards and implementing Cohort approach Organisational Development Strategy July Page 15 of 26

16 OBJECTIVES/THEMES/AIMS Achieve over 95% compliance with mandatory HCAI surveillance schemes. Achieve a CAMHS service which meets the 8 standards. Achieve the 2 Crisis Resolution Home Treatment (CRHT) targets Ensure that 100% of GP practices are reviewed and are all meeting contractual requirements for opening times and telephone access Manage the Community Pharmacy contract to achieve 100% self assessment questionnaire completion, multi disciplinary audits, robust internal audit and patient satisfaction surveys. TARGET SOURCE EXECUTIVE LEAD LINK TO SHS Corporate Objectives TIMESCALE Fourteen High Value Opportunities AOF 19 ND AOF 18 AOF 16 DPCMH 7,10,13, 23,25,2 7 7,10,13, , 2 AOF 6 DPCMH AOF 7 DPCMH 7,9,14,1 6 Improving quality and financial, stability by reducing harm, waste and variation Achieve and maintain an uptake rates of 95% for childhood vaccinations Achieve and maintain an uptake rate of 90% for the routine HPV vaccination Achieve and maintain an uptake rate of 75% for seasonal flu vaccinations AOF 2 AOF 2 AOF 2 DPH DPH DPH 3,4b,13, 16 3,4b,13, 16 3,4b,13, New target for 10/ Appendix 1 KEY RISKS AND ISSUES Reviews undertaken in 2009 indicate considerable work and targeted investment may be required to achieve progress. Plans have been developed and review of position currently being undertaken. Good progress in Newport but challenges elsewhere. Work being initiated with Local Authorities to expedite progress. Assessment based on 100% of practices. Increasing evidence that telephony access strongly linked with demand capacity approaches can result in potential demand management opportunities. Current performance variable - need to provide stable and consistent delivery across Health Board. 2 " 2 " Ensure that at least 95% of contracted dental activity is delivered for each LHB area* AOF 5 DPCMH 7a, 25abc 6 2 Need to ensure consolidation of contracting arrangements across new organisation. Strategic direction based on oral health delivery necessary. Organisational Development Strategy July Page 16 of 26

17 OBJECTIVES/THEMES/AIMS Ensure that patients referred by their GP with urgent suspected cancer start definitive treatment within 62 days of receipt of referral. Ensure that patients not referred as urgent suspected cancer but subsequently diagnosed with cancer start treatment within 31 days of diagnosis Ensure that all patients have access to core sexual health services within 2 working days. TARGET SOURCE EXECUTIVE LEAD LINK TO SHS Corporate Objectives AOF 20 7, AOF 20 7, TIMESCALE Fourteen High Value Opportunities Appendix 1 KEY RISKS AND ISSUES Need to sustain resource in managing patients along pathway in short term but work on how to make target achievement more sustainable. Need to continue working closely with the Cancer Centre and Regional Networks. Need to sustain resource in managing patients along pathway in short term but work on how to make target achievement more sustainable. Need to continue working closely with the Cancer Centre and Regional Networks. AOF 24 7, Excellent progress achieved. Eradicate Waiting Lists ABHB Ensure that at least 98% of patients waiting on an open pathway will have waited less than 26 weeks from Quarter 1 onwards. Ensure that 100% of patients not treated within 26 weeks, for clinical reasons and/or patient choice, are treated within a maximum of 32 weeks (on an open pathway). Achieve a maximum waiting time of 8 weeks for specified diagnostic tests and 14 weeks for specified therapy services AOF 10 /DPI AOF 10 /DPI AOF 10 /DPI Increasing demand a major financial and target achievement risk. Demand and capacity modelling tools are not robust resulting in increased risk. Strongly linked to improving efficiency and productivity and more effective demand management. " " " Ensure that all patients referred to cardiology receive treatment within 26 weeks of receipt of the original referral AOF 21 /DPI " Organisational Development Strategy July Page 17 of 26

18 Appendix 1 OBJECTIVES/THEMES/AIMS Continue to modernise services to improve performance against core efficiency targets Achieve targets for - Average Length of Stay - Elective Care Sustain 09/10 position for General Surgery and develop plans to achieve 10/11 target for 3.4 days Achieve 09/10 target of 2.7 days for Urology by Sept 10 and progress to 10/11 target of 2.2 days Sustain 09/10 position for Orthopaedics and develop plans to achieve 10/11 target of 3.8 days Achieve 09/10 target of 1.2 days for ENT by Sept 09 and develop plans to achieve 10/11 target of 1.1 days Achieve 09/10 target of 2.8 days by Sept 09 and develop plans to achieve 10/11 target of 2.6 days Achieve targets for - Critical Care DTOC Achieve targets for - Theatre Utilisation 10% for Early Finishes (more than 30 mins) and Late starts (more than 15 mins) Achieve target rates for the short stay basket of procedures TARGET SOURCE EXECUTIVE LEAD ABHB AOF 8 and E&P AOF 8 and E&P AOF 8 and E&P AOF 8 and E&P AOF 8 and E&P AOF 8 and E&P AOF 8 AOF 8 AOF 8 LINK TO SHS 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,9,13,1 4,19,25, 27 7,13,14, 19,25,2 7 7,13,14, 19,25,2 7 7,13,14, 19,25,2 7 Corporate Objectives TIMESCALE Fourteen High Value Opportunities " " " " " KEY RISKS AND ISSUES Efficiency and productivity improvements assumed on a prospective basis in Access plan with consequent reduction in LDP funding to achieve targets. Requires clinical leadership and engagement to make major improvements. Current ALOS is variable for Elective Services. Need to sustain good performance but effect improvements particularly ENT. Strongly linked to day of surgery admission targets. Key challenge is to establish DOSA facilities and processes. Critical Care Delivery Group in place but achievement is dependent on success of patient flow work to prevent unnecessary delays. Reasonable performance for early starts but poor for early finishes. Improvements required in surgical assessment to reduce cancellations and improvements in scheduling. Progress on total Day Surgery rate but room for improvement in some key procedures. Work required on assessment processes, scheduling, 'ward day cases' and assessing capacity issues at NHH. Also 'basket' has changed for 10/11. Organisational Development Strategy July Page 18 of 26

19 Appendix 1 OBJECTIVES/THEMES/AIMS Achieve specialty target rates for elective cases as a day case Achieve targets for - Cancelled Operations TARGET SOURCE AOF8 AOF 8 EXECUTIVE LEAD LINK TO SHS 7,13,14, 19,25,2 7 7,13,14, 19,25,2 7 Corporate Objectives TIMESCALE Fourteen High Value Opportunities KEY RISKS AND ISSUES Good performance but progress needed on individual procedures as above. Improvement in Assessment processes and patient communication required. Major impact on WLI and service efficiency. Achieve targets for - Outpatients DNA Rates AOF 8 7,13,14, 19,25, Improvements being achieved but further progress required. Patient focused booking needs to be extended and improved timeliness on telephony essential. Achieve targets for - Outpatient Follow Up Ratios AOF Current performance very good on comparative basis. Further scope for improvements through pathway development and virtual clinic approach. Clinical leadership and engagement key to success. Stop wasteful clinical interventions Stop wasteful clinical interventions ABHB MD INNF agreed by HB - needs effective implementation. Drive Highest Value Prevention Campaigns ABHB DPH Manage Medicines More Effectively ABHB MD Achieve targets for - Prescribing National Indicators. Using our staff AOF 8 MD 7,13,14, 18,25,2 7 Modernise the workforce to ensure maximum efficiency and effectiveness Continue to improve Staff Communication & Engagement Increase the effectiveness of partnership working with staff organisations ABHB DWOD ABHB DWOD Link with OHF work, AOF 2 and established work on breastfeeding and tobacco control.. Work stream in place as part of Sustainability programme led by Medical Director. Organisational Development Strategy July Page 19 of 26

20 OBJECTIVES/THEMES/AIMS Maximise Health at Work improvements and achieve platinum in the Corporate Health Standards to demonstrate achievement. Redesign the workforce to ensure incremental changes are achieved to meet a 3% reduction in A4C Bands 5 and above and increasing Bands 1-4. Stabilise and reduce management costs by 2.4 million in /2011. Achieve the core efficiency and productivity targets for - Workforce - Sickness and Absence rates TARGET SOURCE EXECUTIVE LEAD LINK TO SHS Corporate Objectives TIMESCALE Fourteen High Value Opportunities ABHB DWOD ABHB DWOD ABHB DWOD AOF 8 DWOD Appendix 1 KEY RISKS AND ISSUES Need to establish stable cost base and progress implementation of management structures subject to available resources and meeting savings targets. Risks associated with not being able to implement structures because of insufficient monies. Consistent application of new Wales Sickness Policy key and providing Managers with confidence and support to apply. Ensure that attendance at work is maximised and 4.99% is achieved. Ensure the effective deployment of all staff Develop a comprehensive workforce plan, which meets service and financial targets. Design and develop new roles to support service reconfiguration Enable a 10% increase over the next three years in the proportion of staff providing services in the community Improve leadership and management capacity and capability within the Health Board ABHB DWOD 3.3 ABHB DWOD ABHB DWOD ABHB DWOD ABHB DWOD Increase is only sustainable through transfer of resources from secondary care and development of effective alternatives to hospital care. " Organisational Development Strategy July Page 20 of 26

21 OBJECTIVES/THEMES/AIMS Improve personal review, appraisal, skills and knowledge of the workforce in line with KSF Developing sustainable solutions TARGET SOURCE EXECUTIVE LEAD LINK TO SHS Corporate Objectives ABHB DWOD 3.3 TIMESCALE Fourteen High Value Opportunities Appendix 1 KEY RISKS AND ISSUES Plans in place to roll out eksf training to improve appraisal rates. Development of new service models delivering governance and quality Progress the interim capital investment programme Deliver the business case for quality Operate within available resources and deliver/maintain financial balance. Establish Service Line Management and patient-level costing Improve Procurement and Supply Chain Develop and implement revised models for Emergency General Surgery to achieve sustainable services Redesign Gynaecology services at NHH to deliver 5 day working Redesign Acute Paediatric Services to achieve sustainable and safe services Review Minor injury services and agree future service model Continue and complete review of services for North Torfaen ABHB 48 ABHB CE/MD? AOF 9 CE/DOF , 14 New Capital rules have resulted in reduced flexibility for the HB between years and in defining capital spend. Must be achieved through higher quality and achieving the Efficiency and Productivity measures. WAG clear that there will be no additional funding for health organisations failing to meet financial targets. ABHB DOF FD and MD have been discussing roll out in HB. ABHB DOF ABHB ABHB ABHB ABHB DN Oracle remains a major challenge in ensuring compliance and effective use. The recent Why Don't We campaign highlighted poor image of Oracle. Further work to consider options and to effectively engage with all stakeholders Development of feasibility, options and engagement still required. Impact to other key services and engagement with key stakeholders Alternative options need to be considered and ways of facilitating effective engagement ABHB DPCMH Engagement processes need to be sustained Organisational Development Strategy July Page 21 of 26

22 Appendix 2 ORGANISATIONAL DEVELOPMENT STRATEGY ACTION PLAN ORGANISATIONAL ALIGNMENT Objective 1. Establish Strategic Objectives which are: Specific Measurable Attainable Relevant Time-Bound 2. Identify a method of deployment and levels of deployment throughout the Organisation by each Director. Lead Andrew Goodall / Allan Davies Alan Davies / Executive Team Review Date July September 3. Each Division, Locality and Corporate function will develop and deliver a local Organisational Development action plan based on the overarching strategy and action plan to ensure consistency and critical mass of effort to affect change. Executive Team April 2011 Objective ORGANISATIONAL DELIVERY 1. Identify and develop performance management infrastructure for individuals, teams, departments, Divisions and Localities. 2. Design organisational structures and roles fit for purpose based on organisational need. 3. Identify a range of tools and techniques which identify organisational inefficiencies and improve quality of patient care including the use of driver diagrams, PDSA cycles, run charts and A3 reports. Lead Anne Phillimore / Allan Davies Anne Phillimore / Executive Directors Anne Phillimore / Grant Robinson Review Date September September October Organisational Development Strategy July Page 22 of 26

23 Objective ORGANISATIONAL INFRASTRUCTURE 1. Establish communication process to meet organisational need and ensure people/staff focus and understand organisational vision and values. 2. Ensure that internal frameworks for meeting all financial and operational controls are in place and are evaluated against key success criteria. 3. Develop a programme of financial management skills for all clinicians and managers, which reflects the financial strategy. Lead Richard Bevan Alan Brace / Richard Bevan Alan Brace Anne Phillimore Review Date September September October Objective ORGANISATIONAL LEADERSHIP 1. Utilise the set principles for management and leadership behaviour as identified within the Leadership Qualities Framework (identify organisational gaps via use of 360 LQF tool). Support development using a range of tools and interventions. 2. Develop and deliver leadership and management programmes for all 3 rd and 4 th in line managers that enable individuals to have skill set to meet the principles described in the LQF. 3. Develop and implement a Leadership and Management Strategy that supports the delivery of the organisational objectives and includes succession planning and specific leadership and management development programmes for clinicians and others where necessary. 4. Ensure leadership and management development programmes are developed which recognise and enhance the key roles of clinicians within the organisation. Lead Anne Phillimore Anne Phillimore Anne Phillimore Grant Robinson Denise Llewellyn Jan Smith Anne Phillimore Grant Robinson Denise Llewellyn Jan Smith Review Date January 2011 September February 2011 October Organisational Development Strategy July Page 23 of 26

24 ORGANISATIONAL ENGAGEMENT Objective Lead Review Date 1. Identify blocks to innovation within the organisation, utilising a range of tools and interventions such as Organisational RAIDS. Anne Phillimore March Establish and maintain processes that empowers staff and encourages innovations. Anne Phillimore December 3. Develop a process from Executive to all levels of the Organisation that utilises team effectiveness and delivers cross-pollination of organisation. Anne Phillimore April Establish an organisational infrastructure, which enables business to be delivered and effectively communicated to all staff. Anne Phillimore / Richard Bevan December 5. Develop a culture of workplace health that focuses on improving employee well-being and achieving the platinum Corporate Health Standard. 6. Maximise employee attendance at work and achievement of 4.99% sickness target. Anne Phillimore March 2011 Anne Phillimore March Undertake baseline survey and targeted action plan in relation to the current organisational culture and transition to an improvement culture. Anne Phillimore / Judith Paget March 2011 Organisational Development Strategy July Page 24 of 26

25 ORGANISATIONAL SKILLS AND KNOWLEDGE Objective Lead Review Date 1. Develop targeted internal educational programmes that reflect the needs of KSF outlines and service delivery with focus on service improvement, customer care and leadership development. 2. Develop a model of employee engagement based on partnership, involvement and participation with staff and staff organisations. Anne Phillimore Anne Phillimore December October 3. Ensure workforce deployment meets service capacity demands via electronic rostering and rostering efficiencies. 4. Develop new and extended roles based on the workforce plan, which support the delivery of the Service Strategy and AOF targets. Anne Phillimore April 2011 Anne Phillimore March Develop an improvement plan that enables full compliance with the Knowledge and Skills Framework and Personal Development Review. 6. Develop a comprehensive plan of service improvement and development skills based on the Service Improvement audit. Anne Phillimore Judith Paget December September ORGANISATIONAL EXTERNAL PARTNERSHIPS Objective 1. Develop and implement a partnership model that includes key stakeholders and external parties. 2. Develop networks that support independent contractors and their contribution to core delivery Lead Joanne Absalom / Judith Paget / Richard Bevan Anne Phillimore / Joanne Absalom / Grant Robinson Review Date December 2011 December Organisational Development Strategy July Page 25 of 26

26 Objective ORGANISATIONAL VALUES AND ENVIRONMENT Lead Review Date 1. Develop a set of organisational principles and objectives relating to Organisation culture and behaviours. 2. Develop transition plans, which support the transfer of staff and roles to deliver community based care. 3. Develop an integrated workforce across health and social care to support key projects such as Frailty. 4. Develop and implement the Information Technology Strategy to improve services to patients and staff. 5. Develop and implement a Strategy for electronic staff management systems, which supports effective management of staff and resources. Andrew Goodall Joanne Absalom / Judith Paget Anne Phillimore / Joanne Absalom / Judith Paget Grant Robinson Anne Phillimore Alan Brace December 2011 April 2011 April 2011 December 2011 December 2011 Organisational Development Strategy July Page 26 of 26