Risk Register. Date 22/11/2013 Risk Status. Risk Area. Open. Restructure

Transcription

1 Risk Register Date Risk Status Risk Area Open Restructure

2 Page 2 of 19

3 891 Failure to achieve Cause, Effect and Risk Source: operational service Causes: delivery from - Realignment of services to provide restructure front line resources in order to provide quality and safety - Emergency Care restructure occurring in tandem - reduced ability to ensure all support functions are continued due to reduction in middle managers within operations - Recruitment delay - unable to recruit Paramedics in line with trajectory - Changes will be occurring at time of peak pressure (winter) - 20m saving required in tandem with additional 7m CIP saving - significant financial pressure across Trust - Restructure being managed by teams involved in the restructure - Financial cut to provide increased capacity in operations - driver does not focus upon quality changes in the areas being cut - Intended timescales for change significantly reduced compared to the ideal Significant restructure occurring at a time of significant organisational risk - clinically and operationally - Impact of the current culture and poor relationship with staff limits the effectiveness of the restructure - Lack of Emergency Care lead to engage with other Directors during the restructure 5 5 Formal 45 day consultation process completed. Comments and feedback from s, meetings and workshops have helped to determine final structures 15 Defined risk assessment process in place for all service changes ELT discussions and away day focussing upon structure, risks and gap analysis Extra-ordinary Risk Management Group reviewed transition and implementation risks, including initial gap analysis Organisational Development Strategy in situ to ensure Managers are equipped to make new structure succeed Red review meetings to receive arm s length review of operational structure Clinical Capacity review focussed upon delivering a safe and effective clinical operational service. Restructure supports funding for the structure Star Chamber Work streams Systematic review of best fit across all directorates undertaken Restructure 4Risk to ensure alignment with new structure and appropriate access Restructure Datix to align with new structure and ensure appropriate access Business case for 8-10m transitional funding To be implemented by: 30/11/2013 Page 3 of 19

4 -Interim Board and Executives leading the restructure -Lack of transitional arrangements -Lack of phasing of change 8-10m transitional funding required -Lack of robust and up to date Business Impact Analyses and Business Continuity Plans - No alternative plan is 20m cannot be found -Increased support requirements likely to be required due to operational restructure (e.g. IT), however support services are the focus of the 20m restructure - Organisational segmentation - potential animosity across Trust due to pressure placed on support teams in order to secure increased funding for operations -Inefficient use of resources in operations seen as the cause and now the benefactor, causing resentment - Gaps in fundamental processes that reduce overall Trust effectiveness and quality of care - Cuts in certain support services (training, IT, audit etc.) have the potential to counteract aims around increased recruitment and an increased clinical workforce - Risks to Care Quality Commission outcomes relating to staff, risk, and governance Page 4 of 19

5 - Significantly reduced staff morale - at management level but also throughout staff if management support for them is reduced - Lack of assurance around the process of the restructure and efficient and effective use of the 20m (process seen as poor) - Uncertainties around long term viability and the ability to make further sustainable quality & efficient changes for further CIP programmes -Delays in provision of support (IT, governance, finance, HR etc.) due to cuts within the restructure - Significant IT and reporting system alterations required due to restructure (Datix, 4Risk, CAD, ACQI's etc.) whilst reducing resources - Loss of organisational and corporate memory - Loss of circa 120 roles - current benchmarking says already a lean service +ve: To improve the front line delivery of resources to patients, improve back-up delays and improve transportable resource. +ve: Increased objectivity in performance Risk Source: - Realignment of services and priorities. Page 5 of 19

6 1 - Transition/Implementation 972 Failure to deliver all Cause, Effect and Risk Source: required functions Causes: through transition to - Lack of visible plan for transition new structures period and move into new structure - No plan in place to ensure delivery of BAU functions during transition - No clear Business Continuity Plans in place - Timescales for VR and disappearance of roles in situ - Lack of transitional funding to ensure on-going delivery -Risk to patient safety - Reduction in performance through transition -Risk to delivery of all essential functions across the Trust during transition period - Negative impact upon staff - Adverse reputational damage Source: Director BAF reviews & ELT 5 4 Extra Ordinary RMG discussed transition and implementation risks 15 and mitigations required Gap Analysis through consultation feedback Project support in situ via PMO Risk identification through ELT and 1:1 discussions with Risk Manager Phase and check approach through transition To be implemented by: 31/03/2014 Development of clear, phased transition plan across all Directorates, taking into account interdependencies throughout Restructure Board paper to include risk assessment and gap analysis of new structure. EdC compiling risk section To be implemented by: 27/11/2013 Page 6 of 19

7 1 - Transition/Implementation 978 Failure to deliver Cause, Effect and Risk Source: transformation and Causes: culture changes in the - For restructure to be successful, required timescale culture and management capabilities need to change - Timeframe for changes do not match implementation timeframe - Inability to deliver leadership coaching in interim due to focus upon restructure - No appropriate performance management process in situ to support - Slotting in to roles could result in incorrect people in post - Management requirements within the new structure will fail - Ongoing and worsening culture and morale issues - Sound management pivotal to success of structure - Disengaged workforce -Patient safety issues -CQC registration 5 4 Amended structure includes specific roles to focus on culture and 15 leadership OD strategy in situ Training team able to bring in ad hoc additional support KPI and performance monitoring regime To be implemented by: 31/03/2014 Management training for First line managers To be implemented by: 31/03/2014 Page 7 of 19

8 1 - Transition/Implementation 966 Failure to deliver a functional structure Cause, Effect and Risk Source: Causes: -Emergency Care restructure Risk Owner occurring in tandem with support services -Risk that gaps are not recognised -Lack of discussion around roles and remits within the new structures -A structure that does not deliver full requirements - Potential for the need to restructure again, especially once the new Board is in situ -Work streams not delivered -gaps not identified until the function is not delivered Source: Director BAF reviews 5 4 Formal 45 day consultation process whereby feedback has been 12 incorporated into final structures ELT & TLT discussions Extraordinary RMG held on 22nd October Final structure includes mitigations for the gaps recognised in the initial draft Capital bid for HR call centre functions IM&T external review To be implemented by: 31/01/2014 Determine investigation team requirements Review Job Descriptions and establish gaps within new structure/capacity To be implemented by: 11/12/2013 Page 8 of 19

9 1 - Transition/Implementation 968 Failure to plan an Cause, Effect and Risk Source: optimum Causes: implementation date - Unknown actual start date -likely start date for transition to be within the winter period of peak demand - Inability to plan around start date to ensure BAU -Further reduction of performance and service delivery due to implementation during winter period -patient safety risks -Increased pressure on staff - Reputational damage Implementation delayed due to review of structures Project support via PMO Winter resource plan in situ Communicate transition timeline Determine project and implementation timeline following recognition of all risks and issues Page 9 of 19

10 1 - Transition/Implementation 970 Lack of positive Cause, Effect and Risk Source: engagement with the Causes: process -Staff morale low - Disillusioned with process and limits productive engagement - Timeframes for consultation make engaging with all staff difficult - Resistance to change as will negatively impact upon current staff's T&C's (band 7/6) - Impact upon success of structure -low morale staff slotted in to posts - Ongoing culture and morale issues - CQC outcomes 12 & Restructure in situ for all staff to utilise 9 Consultation process in all directorates including meetings and briefings Restructure information on intranet JD workshops Page 10 of 19

11 1 - Transition/Implementation 976 Negative Publicity Cause, Effect and Risk Source: during restructure Causes: -Number and cost of Voluntary Redundancy will be public - Media already focussed upon EEAST - View of reducing staff when service failing - Cost of many interims during financial pressure 3 4 Commissioner review of structure feedback received 9 Regular communication with stakeholders making clear the restructure is to provide more frontline resources -poor media (ongoing and long term) -Poor public perception of service - Public misunderstanding of the rationale behind the restructure - Increase in complaints and PALS enquiries Source: ELT meetings Page 11 of 19

12 1 - Transition/Implementation 971 Lack of objective & Cause, Effect and Risk Source: appropriate Causes: management of - Restructure process being restructure managed in-house by teams involved in restructure - Lack of overall project lead/support -Interim Board managing the permanent change process with very little corporate memory. - Lack of funding of the change process - No external specialist overview of the process - Potential disjointed approach -no clear timeframes - Process will be impacted by morale of those in process 4 4 Formal 45 day consultation with feedback shaping amendments to the structures PMO support 8 IM&T external review To be implemented by: 31/01/2014 Source: Director BAF reviews Page 12 of 19

13 1 - Transition/Implementation 965 Lack of visible risk Cause, Effect and Risk Source: assessment of new Causes: structures -lack of visible adherence to risk management procedure -Pressure/need to deliver restructure resulting in difficulties in following due process -Compressed timescales -Failure to follow approved policies -Risk of failure of success -Decisions not based upon full information 4 5 Board Workshop with risk paper October ELT & TLT risk discussions in relation to the restructure Extra-ordinary RMG focussed upon the restructure (22nd October 2013) Red team review Risk review of final structure Risk Source: Director BAF reviews 2 - New Structure/Delivery Page 13 of 19

14 2 - New Structure/Delivery 969 Failure to deliver the Cause, Effect and Risk Source: savings required to Cause: support front line -Restructure of support services will operations not deliver 20m required - Shortfall not funded by commissioners 5 4 Contract and funding negotiations for future delivery 20 ORH Clinical Capacity Review evidences need for additional resources Establish prioritised placement of additional resources to ensure an appropriate order of clinical delivery -On-going patient safety risks - Failure to meet performance targets and quality indicators - Ongoing Reputational and media damage -Failure to meet CQC outcome 4 and the Health and Social Care Act 979 Failure to deliver future Cause, Effect and Risk Source: CIPs Causes: -Restructure results in lean model - Limited room for future savings for 14/15 onwards - Historical poor ability to develop true quality improvement CIPs 21/10/ Inability to deliver future CIPs - Financial penalties Source: ELT meeting Page 14 of 19

15 2 - New Structure/Delivery 967 Failure to utilise 20m Cause, Effect and Risk Source: adequately into frontline Causes: services -National shortfall of Paramedics will negatively impact upon ability to deliver ORH requirements - No alternate plan in situ -Ongoing failure to deliver a timely and quality response to patients - Patient safety issues -Failure to deliver on main contract - Continued contractual financial penalties - Ongoing reputational issues -further impact on staff morale if restructure does not bring about positive change Source: Director BAF review 5 4 Ongoing recruitment plans Determine alternate plan for short-mid term in relation to shortfall of clinicians and resources Person Responsible Consider international pathways for recruitment of clinicians and conversion courses for nurses To be implemented by: 30/11/2013 Page 15 of 19

16 2 - New Structure/Delivery 975 Loss of Corporate Cause, Effect and Risk Source: Memory and Causes: Management Expertise - Staff likely to be eligible for voluntary redundancy have abundance of corporate memory and management skills - Loss of this within the transition phase 23/10/ Uncertainty of VR process to avoid loss of essential people - Those making final decisions have insufficient corporate memory to understand the consequences 3 4 VR process in situ where Directors must approve an individual's VR prior 12 to the panel considering it - Loss of experience in managing change could negatively impact outcome of restructure - Moving forwards into delivery phase, a younger and less experienced set of managers - Investment in management development required Source: ELT and TLT meetings Page 16 of 19

17 2 - New Structure/Delivery 974 Failure to achieve Cause, Effect and Risk Source: compliance with Causes: national requirements -New structure does not include key roles/work streams used to ensure compliance with national legislation/requirements - Reduction in workforce prevents delivery - Numerous aspects of legislation at risk: DPA/FOI CQC Health and Social Care Act Information governance processes Governance processes Source: ELT & TLT meetings 5 4 Formal 45 day consultation with feedback incorporated into amended 10 structures Corporate affairs - more focus upon ensuring compliance ELT and TLT discussions to ensure no gaps in structure Essential roles under legislation are within the new structure Extra Ordinary Risk Management Group to review gaps and risks Red Review of draft structure undertaken Clearly defined remits across Directorates in relation to setting standards, monitoring standards and implementing standards Page 17 of 19

18 2 - New Structure/Delivery 977 Failure to manage Cause, Effect and Risk Source: major incidents Causes: -Loss of resilience due to a loss of operational management posts - Reduction in those able to deliver major incident command and control - Inadequate BC plans, out of date due to restructure - Patient safety issues in times of major incident -Increased pressure on the small number of operational managers remaining post restructure 5 3 Additional first line managers in amended structure to ensure 10 management support at incidents Train increased numbers of staff in major incident management, including non-operational managers To be implemented by: 31/03/2014 Source: ELT meetings Page 18 of 19

19 2 - New Structure/Delivery 973 Failure to deliver Cause, Effect and Risk Source: operational Causes: requirements - Reduction in support services places increased pressure on a reduced operational management structure - Reduction in ability to complete all essential tasks - Risk to patient safety and staff welfare - Potential reduction in performance and quality indicators if band 6 staff need more than 20% protected time to deliver these functions - Potential for processes to 'fall through the gap' Source: ELT 4 4 Additional management within service delivery - Clinical Leads, Station 8 Managers Board workshop in October - risk paper and risk register discussions Formal 45 day consultation and feedback has been incorporated into amended structures ELT and TLT planning of restructure Extra Ordinary RMG reviewed transition risks and gaps in structures Red Review - external review of operational structure Page 19 of 19