Aligning our approach to wellled building on existing frameworks

Transcription

1 Aligning our approach to wellled building on existing frameworks Alex Baylis Head of Acute Sector Policy, Head of Acute Sector Policy, CQC Miranda Carter Executive Director Provider Appraisal, Monitor Tom Rafferty Head of Policy & Partnerships, NHS Trust Development Authority May 2014

2 Purpose of assessing well-led I have made a great many recommendations, no single one of which is on its own the solution to the many concerns identified. The essential aims of what I have suggested are to: Foster a common culture shared by all in the service of putting the patient first Develop a set of fundamental standards. Robert Francis QC 2

3 Purpose of assessing well-led I have made a great many recommendations, no single one of which is on its own the solution to the many concerns identified. The essential aims of what I have suggested are to: Foster a common culture shared by all in the service of putting the patient first Develop a set of fundamental standards. Robert Francis QC For the first time, the NHS will have an effective failure regime that addresses quality as well as financial distress and failure Clinical unsustainability will be grounds for failure procedures, including placing organisations in special measures, just as financial unsustainability is at present. DH: Hard Truths 3

4 Definition Five key lines of enquiry Vision, values and strategy and achievability Governance Leadership and culture Focus on patients experience and staff engagement Learning, improvement, innovation, future sustainability 4

5 Rating well-led CQC approach Inspection reality tests mostly qualitative information, mostly collected by CQC over time 6-12 weeks pre-inspection local intelligence, trust self-rating and Intelligent Monitoring indicators all updated and compiled in data pack Throughout the year, local inspector builds up intelligence e.g. observing Board meetings, complaints case tracking, discussion with Monitor/TDA

6 Relationship management A more formalised and defined process than in the past Structured to enable: o o Information collection throughout the year Synthesis of information to contribute to inspection prioritisation alongside Intelligent Monitoring Potential learning from aviation although experience in that sector developed over decades o o o o Major incidents Minor incidents, patterns, what they tell us about broader safety Resilience and discrepancies in proceesses Developments in context and environment

7 Pre-inspection Currently in testing or development: Case tracking of population groups (LD, dementia, MH, diabetes, BME) Complaints and whistleblowing Incidents and safety alerts Information flows Other possible areas identified e.g.: Board, executive or clinical governance committee minutes analysis Observation of meetings 7

8 Building on existing frameworks Historically Monitor has looked at Well Led under two areas: Board Governance Quality Governance Board Governance Quality Governance Well Led Effective planning Risk and performance management Skills and capabilities Organisational capacity Financial governance + Board level leadership on trust wide quality performance Covered by 10 key questions under the domains of: Strategy; Capability and culture; Processes and structures; and Measurement. = Board s leadership on: Strategy and planning Accountability Shaping culture Risk and performance oversight quality, operational and financial performance Covered by 10 key questions under the domains of: Strategy and planning; Capability and culture; Processes and structures; and Measurement 8

9 Combining our approach to board and quality governance leads to a Well Led Framework Key: Board s role = Governance Domains = Key questions = 1. Does the board have a credible strategy to provide high quality, sustainable services to patients and is there a robust plan to deliver? 10. Is the Board assured of the robustness of information? 2. Is the Board sufficiently aware of potential risks to the quality, sustainability and delivery of current and future services? Strategy & Planning Measurement 9. Is appropriate information on organisational and operational performance being analysed and challenged? Board s leadership role: Strategy and planning Accountability Shape Culture Risk and performance oversight quality, operational and financial performance. 3. Does the Board have the skills and capability to lead the organisation? Capability & Culture Process & Structures 8. Does the Board actively engage patients, staff, Governors and other key stakeholders on quality, operational and financial performance? 4. Does the Board shape an open, transparent and quality-focused culture? 5. Does the Board support continuous learning and development across the organisation? 6. Are there clear roles and accountabilities in relation to board governance (including quality governance)? 7. Are there clearly defined, well understood processes for escalating and resolving issues and managing performance? 9

10 Key inputs for Well Led Framework Quality Governance Framework good practice Guide for Applicants Board Governance Assurance Framework The NHS Healthy Board 2013: Principles for Good Governance Guidance for the annual Planning Review 2014/15: Strategic planning 10

11 Well Led Framework overview Question five focuses on continuous improvement and aligned to CQC s KLOE Well Led 5 Strategy and planning Capability and culture Process and structures Measurement Q1 Does the Board have a credible strategy to provide high quality, sustainable services to patients and is there a robust plan to deliver? Q2 Is the board sufficiently aware of potential risks to the quality and delivery of current and future services? Q3 Does the board have the skills and capability to lead the organisation? Q4 Does the board shape an open, transparent and qualityfocused culture? Q5 Does the Board help and support the organisation to continuously learn and improve? Q6 Are there clear roles and accountabilities in relation to board governance including quality governance? Q7 Are there clearly defined, well understood processes for escalating and resolving issues and managing performance? Q8 Does the board actively engage patients, staff, Governors and other key stakeholders on quality, operational and financial performance? Q9 Is appropriate information on organisational and operational performance being analysed and challenged? Q10 Is the board assured of the robustness of information? 11

12 Example framework question: extract from question one Q1 Does the Board have a credible strategy to provide high quality, sustainable services to patients and is there a robust plan to deliver? Outcome There is a structured, effective strategic planning process in place. The planning process takes account of regular engagement with external and internal stakeholders. The board understand the implications for the trust of all relevant local health economy factors, and incorporates these in the strategic plan. Quality is embedded in the trust s overall strategy through discrete, welldefined goals. Plans are designed to cascade initiatives through the organisation. Framework questions have expanded to cover corporate as well as quality governance, so has the good practice e.g. on question 1 more on strategic planning in addition to quality driving the strategy. 12

13 Aligning our Approaches 13

14 Assessing Well-led CQC well led framework: key lines of enquiry Line of enquiry W1: Is there a clear vision and a credible strategy to deliver high quality care to patients and are the risks to achieving this understood? Line of enquiry W2: Do the governance arrangements ensure that responsibilities are clear, quality and performance are regularly considered and problems are detected, understood and addressed? NHS TDA/Monitor well led framework: key questions Q1 Does the Board have a credible strategy to provide high quality, sustainable services to patients and is there a robust plan to deliver? Q2 Is the board sufficiently aware of potential risks to the quality, sustainability and delivery of current and future services? Q6 Are there clear roles and accountabilities in relation to board governance (including quality governance)? Q7 Are there clearly defined, well understood processes for escalating and resolving issues and managing performance? Q9 Is appropriate information on organisational and operational performance being analysed and challenged? Q10 Is the board assured of the robustness of information? Line of enquiry W3: How do the leadership and culture within the organisation reflect its vision and values, encourage openness and transparency and promote delivery of high quality care across teams and pathways? Line of enquiry W4: How does the organisation ensure that patients views and experiences are the key driver for how services are provided, and that staff are involved and engaged? Line of enquiry W5: How does the organisation strive to continuously learn and improve, support safe innovation, and ensure the future sustainability of high quality care? Q3 Does the board have the skills and capability to lead the organisation? Q4 Does the board shape an open, transparent and quality-focused culture? Q8 Does the board actively engage patients, staff, Governors and other key stakeholders on quality, operational and financial performance? Q5 Does the Board help support continuous learning and development across the organisation? 14