Board of Directors Meeting

Transcription

1 Board of Directors Meeting Date: 27 January 2010 Agenda item: 7.3, Part 1 Title: Prepared by: Presented by: Action required: Suzanne Tracey, Director of Finance and Business Development Suzanne Tracey, Director of Finance and Business Development The Board of Directors is requested to note the current position in the rollout of SLM across the Trust. 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) Board Date: 27 January of 11

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. 2. BACKGROUND 2.1 A progress report was provided to the board in September 2009 which explained the progress being made on SLM within the Trust and described the current position. 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 day to day work of the project has continued to be on developing the tools required and the strategic level focus has continued to be on establishing the way in which Service Line Reporting will operate in the first instance, ahead of SLM being possible. 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. A Service Line Reporting Policy and Procedure has been approved which describes the RD&E approach to SLR and how it will work in practice. A rollout plan has been agreed and this commences with a series of rollout workshops that have been arranged from January 2010 onwards. The workshops are designed to bring service line management teams together and prepare them for SLR implementation. Work on developing the management tools required has progressed significantly: Patient Level Information and Costing System (PLICS) further developed and although continuing to prove difficult, further reports have been produced and more testing undertaken. Performance Scorecard solution has been developed and is being populated with a wide range of data on topics including activity levels, quality and safety. Work to review the impact of SLR/SLM on roles and responsibilities is complete and job descriptions have been revised. Relevant competencies flowing from this have been identified and training needs established with potential training provision currently being assessed. The communication plan is being implemented to build awareness across the Trust and involves issuing information via a number of channels including the Trust intranet site and via the staff newsletter. Updates to various staff groups continue in order to keep those in key posts up to date with progress. 3.2 The Project is broadly on track with the revised project plan with the next steps being delivery of SLR workshops from January 2010 to train staff in preparation for the roll out of SLR. 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. Board Date: 27 January of 11

3 4. PROPOSALS 4.1 The current focus of the SLM project is to : Deliver SLR workshops to train key staff ahead of implementation Ensure the performance scorecard and PLICS tools are ready for implementation in 2010/11 Roll out use of tools and working practices across the organisation from May onwards 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. Board Date: 27 January of 11

4 Report January 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 September Since then further progress has been made and implementation of SLR is now drawing near. 2 SLM / SLR background 2.1 Although the project began looking at Service Line Management, as previously reported the focus has shifted towards implementing Service Line Reporting. 2.2 Service Line Reporting will involve the production of financial and other performance information to help Service Line Management Teams (groups of managers and clinicians) in their decision making. SLR will allow an understanding of profitability and performance at Service Line Level, it is the fundamental information which is a prerequisite to SLM. 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 Work to revise job descriptions for key roles has been completed. Relevant competencies flowing from this have been identified and training needs established with potential training provision currently being assessed. Performance Scorecard Working Group Consolidating information for the scorecard is requiring considerable effort but is progressing well. There are some difficulties in presenting meaningful information at the service line level due to the nature of the performance indicators and the new perspective that SLR requires. It should be acknowledged that it will not initially be possible to show all the desired information. An example of the format of the Performance Scorecards is shown at Appendix A. Finance Working Group The finance working group continues to meet weekly to address issues around the accuracy of the financial information and the levels of analysis available. Initially it is expected that information will contain some flaws and the full drill down to patient level may not be available. However, the Project Board view is to press ahead with roll out and share information that we can then work together to improve over time. There are some difficulties in presenting complete information and examples include how to calculate budget/plan targets and performance indicators. An example of the SLR Finance Report format is shown at Appendix B. Board Date: 27 January of 11

5 3.3 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 the SLR financial information and it will enable the reporting of Service Line profitability. The system is still not yet developed to our full satisfaction but test reports have been produced and learning from these has been fed back in to further development of the system. The system should be ready for live use from April 2010 but will require ongoing refinement and development. 3.4 In order to describe our approach to SLR and to address the practical issues, a draft SLR policy and procedure document was produced and has now been refined and approved. It explains how SLR will actually work and is therefore an important point of reference. 3.5 To address communication in a structured way a communications plan was produced and is now being implemented to ensure SLR is understood across the organisation. This has involved delivering presentations to key staff groups and writing articles for the Staff Newsletter and the internal IAN website. 4 Rollout Plan 4.1 A plan has been set for the rollout of SLR which sets key milestones for the coming months and describes the order in which the various service lines will be involved. The plan is shown at Appendix C. 4.2 As part of the rollout plan, a series of workshops are currently being delivered to train and prepare key staff including Lead Clinicians, Senior Matrons and relevant managers. The workshops will be an opportunity for service line teams to come together to understand SLR and its impact. The programme being covered in the workshops is shown at Appendix D to illustrate the SLR guidance staff are receiving. 5 Summary 5.1 The Trust continues to work towards implementing SLM with SLR as the priority. Some good work has been completed and more is underway but still there remains much to do. 5.2 There are several potential barriers to progress which are recognised, monitored and addressed as necessary. 5.3 The project is broadly on track and milestones have been updated to reflect recent progress and thinking. Board Date: 27 January of 11

6 Appendix A Example of the Performance Scorecard format Specialty X Service Line Score card for the Period April - August 2009 Access Activity Cancelled Operations Cancer Complaints Data Quality Indicator Type ED Finance Human Resources Infection Control Maternity Patient Experence Patient Flow Service Line Theatres 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Green Amber Red N/A Board Date: 27 January of 11

7 Appendix B Example of the SLR Finance Reports Board Date: 27 January of 11

8 Appendix C SLR Rollout Plan Broad Approach The SLM Project plan sets out the work required to develop and roll out SLR. The effort is prioritised around first developing the tools needed whilst at the same time defining our procedures for how it will work in practice. The Project plan has until now only loosely sketched out the roll out phase so here we describe the rollout more clearly Milestones to reach and deliver rollout Tools PLICS ready to produce SLR finance reports Jan 10 Scorecard production system ready for use Jan 10 Policy and Procedures Training Rollout Drafted and ready to pilot Jan 10 External training to build relevant competencies Feb May 10 Prepare SLR starter pack Jan 10 Internal SLR specific workshops for Service Line Teams Feb Jun 10 Pilot in some specialties Jan Mar 10 Further rollout to remaining specialties Apr Jun 10 Live SLR implementation Apr 10 First live performance scorecard production May 10 First live SLR finance reports Jul 10 Risks and dependencies The key risk is that the PLICS system will not be sufficiently well developed to provide accurate SLR finance reports. This is managed as a separate project but there has been significant difficulty developing the system and continual slippage on the project milestones and further difficulties could reasonably be expected. Consideration should be given to delaying the rollout because of the highly likely nature of this risk. Reliance on the development of an in house performance scorecard solution is a further risk. This is a lower level risk as good progress has been made towards developing a solution but some risk remains that this will not be functioning correctly in time. Rollout is dependant on developing starter packs and in house training materials which will require significant effort to produce. Support from management accounts and other colleagues will be required during rollout. This will place additional demands on already stretched resources. Board Date: 27 January of 11

9 Proposed rollout sequence Rollout will be organised in phases to deliver the starter pack and in house workshops. The first live finance reports for quarter 1 will be produced in July so quality support to initial service line team meetings around July and August will be important. Phase 1 - pilots Jan 2010 Ophthalmology Plastic Surgery Obstetrics Gynaecology Phase 2 - complete Specialist Surgery, C&W plus cancer services & Surgery 1 Feb Mar 2010 Oral and maxillofacial Orthodontics ENT Paediatrics (split?) Clinical genetics Oncology Radiotherapy Haematology Surgery 1 Breast Colorectal General Thoracic and Renal Urology Phase 3 Apr 2010 Orthopaedics Rheumatology Trauma Orthopaedics Critical Care Anaesthetics Intensive Care Unit Phase 4 May 2010 Medicine EMU and General Elderly Care Cardiology Gastro Dermatology Neurophys ED Respiratory Diabetes Renal Neurology Board Date: 27 January of 11

10 Appendix D Workshop outline Service Line Reporting (SLR) Workshops January 2010 onwards What is Service Line Reporting? SLR is a way of reporting the performance of our services in financial and operational terms. Service Lines are what we have traditionally called specialties - the units from which the trust s services are delivered, each with their own focus on particular medical conditions or procedures and their own specialist clinicians. Each Service Line also has clearly identified resources, including staffing and finances. SLR seeks to give a clear picture of how each service is working, at both an operational and financial level. SLR is recommended good practice from our independent regulator (Monitor) and we are seeking to learn from experience elsewhere. Objectives of the workshop To prepare staff for the implementation of SLR by providing an understanding of what it is, explaining the impact it will have and building awareness and skills to deal with it. The workshop will aim to : Provide the background story surrounding SLR Explain the language and definitions involved Explain the purpose of SLR and potential benefits Explain how it should work in practice and explore the information which will be available and demonstrate the systems Prepare staff to effectively analyse and interpret the information Consider potential management action that SLR may prompt Help staff plan for the next steps Who should attend? Various staff who are likely to be involved in the SLR agenda including: Lead Clinicians Senior Matrons Clinical Services Managers Directorate Managers Supported by - Directorate Management Accountants Information Analysts HR Managers Board Date: 27 January of 11

11 Structure of the workshop Note: Workshops may be run in mornings or afternoons so indicative timings given for both. Morning Session Afternoon Session Arrival and coffee Welcome and introduction SLR language and definitions Background What we are trying to achieve and why SLR impact The timeline where we are and where we want to be The SLR model The main strands of the SLR way of working Trust policy and procedures Service Line structure The information and what do we do with it Performance information Traditional information Performance scorecard concept Our scorecards The IT solution Using the scorecard Coffee Break Financial information Traditional financial information Our SLR reports How reports are produced How costs are allocated and apportioned PLICS system Using the reports Next Steps Implementation timeline Monthly timetable What to do next Support and guidance The future Summary and close Board Date: 27 January of 11