1. “Driving improved organ donation within your hospital”
Making Change Happen
Dr Paul Murphy
Adam King
Dimple Cosgrove
26 May 2010
Good morning and welcome, again, to you all to our Masterclass on Making Change Happen
I am Paul Murphy and I will be working alongside Caroline Smith from Deloitte in leading you through this masterclass today.
You will recall that the ODTF report used several phrases repeatedly – making donation usual, not unusual was one of them, and making donation core business was another one of them.
Today is about planning for donation in your hospital, making the changes that will required for it to become usual, routine in your practice. Today is about using the business planning cycle to develop donation in your hospital, and about developing the business relationships between yourselves and your organisations, yourselves and NHSBT, so that donation is part of your business as well as our own.
“Driving improved organ donation within your hospital” 1

2. Session objectives By the end of this session, participants will:
Understand the importance of having a clearly defined vision for Organ Donation and start to articulate their own vision for Organ Donation within their hospital
Appreciate the benefits of annual planning and reporting to leading Organ Donation within their hospitals
Understand the skills, knowledge and process required to develop Annual Organ Donation Plans and Annual Reports
Be provided with practical hints and tips on developing local Annual Organ Donation Plans and Annual Reports
Understand the roles and responsibilities of the Clinical Leads, Donation Committee Chairs and Specialist Nurses for Organ Donation in the Business Planning Cycle
Have an opportunity to put theory into practice and build a local plan for organ donation
Presentation
Facilitator notes:
Introduce yourself to the participants
Run through session objectives providing an opportunity for participants to ask questions and clarify purpose of the session 2

3. The progression of your learning journey
Online Tool: Self-Assessment Tool, Document Sharing, Podcasts, Discussion Forum, PDP Atlas, Programme Progress Tracker
National Kick-Off Event
(inc Law & Donation after Cardiac Death Master Class)
Change Management & Leadership Fundamentals
Master Class 1 (Diagnosis of Brain Stem Death and Regional Peer Consulting Group Launch)
Master Class 2 (Donor Management & Physiology and Emergency Medicine)
Making Change Happen (Development of action plan to implement changes in Trust)
Master Class 3 (Consent / Authorisation)
Donor Simulation & Paediatrics (Additional Subject Areas)
Regional Peer Consulting Groups (Coaching & networking event)
National Review Event (Review of Programme and Ethics and Media Skills Master Class)
Regional Peer Consulting Group
(Introduction and coaching in action learning sets)
Podcasts: Eye & Tissue Donation, Epidemiology of Donation & Transplantation, Audit & Statistics and PDA: interpretation & Action
Online Tool Self Assessment Tool, Document Sharing, Podcasts, Discussion Forum, Programme Atlas, Programme Progress Tracker
All
Clinical Leads
Non Clinical Champions
Presentation
Key messages:
This is your second Change Management workshop
Although the content of this session is quite different from the previous, it is a natural progression
In the first session we talked about what you can do to affect and implement change in your hospitals. In today’s session we define how you go about planning those changes based on effective assessment of available data 3

4. Agenda 1 Change Management and Leading Fundamentals Refresh
09:30-09:55 2
Developing your vision for Organ Donation
09:
Break
11:15-11:30 3
The Annual Organ Donation Planning Cycle
11:30-11:50 4
Developing an Annual Organ Donation Plan
11:50-12:05 5
Developing an Annual Report
12:05-12:20
Lunch
12:20-13:00 6
Managing and Tracking Against Plan
13: 7
Building a Local Plan (Part A)
13:20-14:30
14:30-14:45 8
Building a Local Plan (Part B)
14: 9
Summary and Close
15:
Presentation
Facilitator notes:
Provide a brief run-through of agenda 4

5. Fundamentals of Leading Change - Refresh
During the Fundamentals of Leading Change session we:
Identified what can help to make change successful and what are the common reasons for failure
Identified the local barriers to promoting change within your hospitals
Introduced the change frameworks which you can use to guide change Management for Organ Donation
Discussed the importance of understanding who your stakeholders are to any change effort and tools for identifying and analysing your stakeholders
Defined the three way leadership between Donation Committee Chair, Clinical Leads and Specialist Nurse for Organ Donation and your respective roles as Change Leaders
Discussed techniques for tackling difficult conversations
Started to plan actions to identify and implement the changes you can make within your own hospital
Presentation and Discussion
Facilitator notes:
Please refer to the ‘Fundamentals of Leading Change’ presentation for more information on the content of this session.
Run through the key learnings identified in the slide
Before each session, a number of individuals attending the event will be asked to contribute / share their stories following FLC i.e.
What have they achieved?
What have they learnt?
What did they find useful?
What have they found challenging?
Facilitators to flipchart key messaging coming from presenters
To have a maximum of 2 people presenting for 5 mins each with any questions to follow
Maximum length of time for this part of the session 15mins 5

6. Understanding the bigger picture
Local strategic direction for Organ Donation
Annual Organ Donation Plan
Improve and implement using clinical and change management skills
Assessment
Annual Report for Organ Donation
PDP Strategic Big Wins
Presentation
Facilitator notes:
Use this slide to help participants understand how the different elements of the session, and also the Masterclasses and Change Management workshops fit together
Key messages:
Over the last few months we have been working to support your with the change and leadership skills you need to work towards achieving the 6 big wins of the PDP
These big wins should be influencing and feeding into your local Visions for Organ Donation
The local visions will provide the direction and context for the Annual Organ Donation Plan (which we will cover today)
The objectives set out in the Annual Organ Donation Plan will be realised through delivery of both Clinical and Change Management skills
Actions and results need to be assessed and monitored to ensure progress against plan, to identify remedial actions and to reassess objectives where necessary
The assessment will also feed into the Annual Report for Organ Donation – a record of past achievements and progress to date
The insights from the Annual Report for Organ Donation will ensure you are on track to realise the vision for Organ Donation and confirm that the progress is being made towards it 6

7. Developing a vision for Organ Donation7

8. What success looks like for the PDP
The PDP for Organ Donation will contribute to the Organ Donation Taskforce objective to increase Organ donation rates by a minimum of 50% within 5 years – Making organ donation “Usual”
To achieve this vision the Programme will focus on 6 big win areas:
Presentation
Facilitator Notes:
Briefly remind participants of the Programme vision and the 6 big wins as the context for developing their own vision 8

9. What does success look like under each of the 6 big wins?
We would like you now to split into six groups, one group per strategic big win
For your strategic big win we would like you to describe the future state of what a gold standard hospital would be doing under this objective i.e.
What would people in the hospital be doing around organ donation from a clinical perspective?
What would the Organ Donation Committee be doing?
What behaviours would you see?
What outcomes might have been achieved / what success stories are there?
Put your ideas on post-it notes and stick these on a flip chart
Group discussions for 30 minutes and then 30 minutes feedback
Presentation
Facilitator Notes:
Introduce interactive activity which is to last for 15mins
Group to split into 6 groups and each to gather round a flipchart
Each group is to be given a different strategic big win and describe the perfect state for a hospital under each i.e. what does gold standard minimum criteria look in a hospital for example; what do CLODs do in this hospital?; what are key processes and behaviours?
Groups are to write their thoughts on post-its and stick them in the circle provided on their flip chart
Groups are to do this for 10mins and then there is to be 5 – 10mins group feedback
Over lunch, facilitators to cut these populated circles out and stick at the front of the room 9

10. Why do you need a strategic direction for improving Organ Donation?
What can happen without an effective strategic direction?
Lack of general direction and lack of a clearly defined ‘future state’
Failure to appreciate the longer-term interests and too much emphasis on short-term success
Actions are un-coordinated and without shared purpose or meaning
Ineffective decision-making and poor prioritisation
What is needed is a compelling view of what the future of Organ Donation looks like in your hospital
Presentation and Discussion
Facilitator Notes:
Present content as is on slide – do not labour the concept, just introduce it and impress the importance
If you want to engage the audience, ask if they have ever been involved in a project that did not have an appropriate and clear vision – what was their experience?
Facilitators to capture output on flipchart
Additional notes if required – The purpose of a vision:
Clarifies the general direction of change and defines the “future state” of the organisation
Motivates people to act in a certain direction, even if not in their short-term interests
Co-ordinates people in a fast and efficient way – people have a foundation from which to base their decisions 10

11. Ensuring alignment of your Organ Donation Strategic Direction
Your strategic direction for Organ Donation must be developed in the context of the wider vision for Organ Donation and the local visions of your individual hospitals
NHSBT will identify the common organ donation themes and support Donating Hospitals to shape their local strategic direction for organ donation in alignment with the Taskforce vision
Organ Donation
Taskforce Objective
To increase organ donation rates by 50% within 5 years
Local Hospital Organ Donation Strategic Direction
Overall Hospital Vision
Annual Plan
Local Organ Donation strategies will be based on local needs, the overall hospital vision and the ODTF objectives
Presentation
Key messages:
It is important that a vision is not developed in isolation from the environment in which it operates.
The Organ Donation strategic direction that you develop for your hospitals should be aligned to the overall objectives of the Organ Donation Taskforce.
Your direction should also be aligned to the aims and objectives of your own hospital so that your organ donation strategic direction is contributing to, and supporting the achievement of your hospitals strategic goals.
Your local Annual Organ Donation Plans will help you to define the activities you need to deliver to meet your strategic direction
The information that NHS BT collates from the individual hospitals will help identify themes across the hospitals and support the achievements of the local and wider visions 11

12. Ensuring your strategic direction for Organ Donation is effective
Build a believable image of how Organ Donation will be in the future in your hospital
Is it realistic?
Ensure that this image is inspiring, realistic and achievable so that people are motivated to act as the vision intends them to
Is it achievable?
Align the vision to the interests of key stakeholders, the wider organisation and those of the national agenda for Organ Donation
Is it meaningful to a wide audience?
Focus the vision on clear priorities and ensure that it is easily understood
Does it eliminate confusion and support decision making?
Create a vision that is easily communicated to the rest of the hospital
Is it concise and does it appeal to people’s emotions?
Avoid visions which are too prescriptive or constrain individual initiative
Is it flexible?
Presentation
The specific content of a vision for Organ Donation will vary between hospitals but there are common traits which make a vision effective:
Additional information on to support slide content – An effective vision:
Picture of the future:
Describe in a way that can be visualised what an activity / group looks like in the future.
Describe this in terms that are meaningful to those concerned.
Inspiring, realistic and achievable vision:
Help people understand why the change is necessary.
Be ambitious and innovative enough to force people out of their routines.
The vision’s goals should be measurable in concrete terms.
The vision should be consistent with any realities faced by the organisation which cannot be changed.
Aligned to stakeholder interests:
Be consistent with the strategy of the overall organisation
Appeal to the long-term interests of key stakeholders
Clear and easily understood priorities:
Eliminates confusion on what is important – allows for clearer prioritisation between activities.
Can clearly be used as a guide to decision making – shows a direction all can follow.
Identify key enablers to help bring about the vision.
State clear targets and expected results.
Easily communicated:
Be concise – a vision should be able to be explained in 5 minutes
It should be appealing and play to people’s emotions
Flexibility:
When being implemented, it should not constrain individual initiative
It should not be constrained by small changes in circumstances or it will lose credibility 12

13. Examples of Organ Donation Visions
Transplant Australia exists to enrich and celebrate life. Our vision is for Australia to lead the world in organ and tissue donation and transplantation - saving lives, improving quality of life and providing much needed care and support.
The vision of Donate Life America is to ensure that every person in the U.S. understands the need for organ and tissue donation and accepts donation as a fundamental human responsibility.
We wish to see organ donation become a usual rather than unusual event as part of end-of-life care across the NHS
Each individual should be given the choice and opportunity to offer their organs for the purposes of transplantation after their death. This choice should not be denied by the assumptions of NHS staff or a lack of facilities and infrastructure
Presentation and Discussion
Facilitator Notes:
Give participants a few minutes to read through the visions and initiate discussion around them using suggested questions below
Group discussion
What vision do you like the best and why?
What do you think is good about these visions?
Is there anything that you would change?
Are there any here that you think are particularly bad? 13

14. How do you develop a strategic direction?
The process involves the combination of both creative and logical approaches
Development of the vision may involve several iterations as you test your ‘hypotheses’ and validate with your colleagues and stakeholders
The type of data which you can use to input into the development of your strategic direction include:
Review of the Organ Donation Taskforce Report and the Programme’s 6 Strategic Big Wins
Assessment of the national legal and policy frameworks for organ donation
Assessment of your hospital’s overall vision
Analysis of current Organ Donation practices within your hospital
Benchmarking against Organ Donation best practice within other hospitals
PDA data
Draft strategic direction and collect data to test it
Refine the direction and validate with others
Communicate and embed the strategic direction
Presentation
Facilitator notes:
Do not present this slide – just reference core content i.e. shows the development process of a strategic direction, highlighting some of the challenges
State that people can read this in their own time
Challenges to the process:
It is easy to be too tied to the past or engrossed in the present to picture the future. To create a vision, what the future involves needs to be focused on. This may require stepping away from historical traditions and current problems that are being faced.
The final product is a simple document, but the data required to create this is often incomplete – think carefully about the information you use to test and validate your vision
A vision needs to be something that people are committed to and as such, may require time to think, argue, feel and reflect over. Feeding into this process will be questions on values and priorities which will require more than just one meeting with key stakeholders.
If the vision is changed, it is important to communicate what has been changed and why that the vision does not lose its credibility.
Initiate group discussion using suggested questions below
Group discussion
Who would you involve in the development of your vision?
Are there any other sources of data you feel would be useful?
If you have experience of developing a vision for your hospital or organisation/ business, can you share any best practice or pitfalls to avoid in the development process 14

15. Communicating your vision for Organ Donation?
Communicating your strategic direction to your colleagues and the wider hospital and receiving their buy-in is essential to the vision’s success
Ways of communicating your vision include:
Written and verbal communication e.g. the Annual Organ Donation Report, the Annual Organ Donation Plan, training materials and other communications
Encouraging discussion of the Organ Donation strategic direction within your hospitals and amongst colleagues
Reinforcing key messages by linking it to the day-to-day activities of the hospital
You know your vision has been embedded when:
Stakeholders are able to articulate the strategic direction and it’s impact in their own words
The strategic direction is discussed outside of situations in which it is required
Elements of the strategic direction become part of the organisational culture and ‘the way things are done around here’
Presentation and Discussion
Facilitator Notes:
Do not spend a long time on this slide – just stress the importance of communicating the strategic direction to ensure people move in the same direction
Reference back to Kotter’s 8 steps where Step 4 states that people should communicate for buy-in
Key messages:
The communication of the vision to your organisation and to those involved in the organ donation process will be critical to the vision’s success.
Additional notes - Hints and tips for communication
Provide the context for change.
Use different communications methods to spread the message.
Encourage both formal and informal discussions of the vision.
Align the leadership actions to the vision’s message.
Identify the key messages that need to be communicated
Use simple language, leveraging analogies or metaphors where appropriate
To accept the change brought about by the vision, stakeholders must be able to understand its objectives and visualise how the change will impact them 15

16. The Annual Organ Donation Planning Cycle16

17. What is the Annual Organ Donation Planning Cycle?
The annual organ donation planning cycle provides a structure of analysis, planning and reporting around which you can make the right changes to improve organ donation
Purpose of planning cycle:
Ensure content of plan reflects realistic ‘path’ from current state to objectives
Ensure delivery of plan is on-track and responds to changes in circumstances
Ensure oversight by Executive Board
Presentation
Facilitator Notes:
Overview of what the Annual Organ Donation plan is and why is it here?
What does it mean for CLODS, DCCs and SNODS/SODs? 17

18. What does the Organ Donation Planning Cycle look like?
Benchmarking data
April
Annual Report
(Financial Year begins)
Annual Organ
March
May
Donation Plan
February
June
Present to Executive
Board
Key
ODC Meeting
Organ Donation Planning Cycle
January
July
CLOD, SNOD & DCC*
Annual Report
August
December
Annual Organ Donation Plan
Mid Year Review
November
September -
Presentation and Discussion
Facilitator notes:
Make it clear that this is the expected ‘business as usual’ cycle.
Explain the suggested process for the next 18 months, “Year 1”
The rationale for an 18month year is based on where we are at currently in the journey. Need to provide time for people to settle and get used to the requirements
Talk through the cycle and suggested timelines. The cycle is animated:
Click 1: Shows when the organ donation committee meetings take place (something everyone feels comfortable with)
Click 2: Reflects informal meetings between CLODs, Specialist Nurses for Organ Donation & DCCs
Click 3: Highlights when the Annual Organ Donation Plan is due
Click 4: Highlights when reporting data is available to support people prepare
Key Messaging: (to be developed)
Year 1 set up (to be updated)
The first year will involve setting up these processes and becoming comfortable with their responsibilities around the planning cycle.
We recommend that following the Making Change Happen session, participants use the first mid-year review point as an opportunity to:
Develop an ‘Annual’ report for the previous 6 months.
Develop a Organ Donation Plan for the next 6 months
Use the National Review Event in 2011 to check progress of each hospital
Jan – April Activities:
Start preparation for Annual Report
Start to discuss key priorities for following year
April – July Activities:
Assessment of PDA and comparative data
Develop Annual Organ Donation Report
Present Annual Report and Annual Organ Donation Plan to Executive Board for endorsement
Implement priority Organ Donation activities
July – October Activities:
Revise Annual Organ Donation plan based on feedback from Executive Board
Engage additional stakeholders as required
Continue to act on key priorities as identified in the Annual Organ Donation Plan
October – December Activities:
Assessment of data and comparative data
Conduct a mid-year review of activity and progress
Define and implement priority actions that come out of the mid-year review
Communicate findings and key insights of review to key stakeholders
Benchmarking Data
October
Mid Year Review
PDA
Benchmarking data 18

19. How can you plan effectively in line with the Organ Donation plan?
Planning is not a one off activity – it requires regular assessment of progress and interventions. Remember 3 simple steps: Assess; Plan; and Implement
Assess:
Conduct analysis of internal and external environment to identify issues and potential opportunities
Plan:
Consider objectives to overcome issues / make the most of opportunities and establish activities and when these would happen to achieve objectives
Implement:
Deliver & track against plan, as well as reporting against progress
Presentation and Discussion
Key messages
Planning is not an isolated activity – the outcomes depend heavily on the availability and analysis of key data.
Facilitator notes:
Briefly run through the 3 step cycle and state this session focuses on Assessment and Planning. We will also reference the Annual report which will help people to report on the progress made following implementation 19

20. Key Assessment Activities Potential Donor Audit (PDA)
Plan
Implement
Key Assessment Activities
Potential Donor Audit (PDA)
Fishbone Analysis
SWOT Analysis
Assess
To what extent is this person/ group affected by the Change?
High
Low
Influence
Impact
Presentation
Facilitator Notes:
Highlight key assessment activities
State that we went through fishbone and stakeholder analysis in FLC and that we will be focusing on PDA and SWOT today
Ask if people know and are comfortable with each of these assessment tools
When talking about the Unit Profile, state that this is a document completed by Specialist Nurses for Organ Donation. Your hospital may or may not have one of these – contact your Specialist Nurse for Organ Donation to see if you do have one of these or not. Basically provides an overview of organ donation environment in your hospital
Talk about SWOT here i.e. ask who has heard of it and then quickly walk through how you would use this:
A tool used to understand the Strengths, Weaknesses, Opportunities, and Threats involved in your hospital
It involves identifying the internal and external factors that are either supportive or unfavourable to achieving success
SWOT is useful as part of a planning process and to support effective decision-making
Benchmarking
Unit Profile
Stakeholder Analysis 20

21. Potential Donor Audit - Introduction
Assess
Plan
Implement
Potential Donor Audit - Introduction
What is it?
The Potential Donor Audit (PDA) is an audit of all deaths occurring in Intensive Care Units for patients under the age of 75. A recent initiative is extending the audit to Emergency Medicine departments, however, this is still in progress.
Aims of the PDA?
Determine the potential for solid organ donation
Understand why solid organs were not retrieved where potential recognised
Identify all patients for whom death was diagnosed following brain stem tests
Raise the profile of solid organ donation
Heighten awareness of donation issues with clinical staff
Presentation
Facilitator notes – NHSBT representative:
Walk through the slide to introduce PDA and highlights its key aims & objectives
Detailed Notes - How PDA data can be used:
Understand the activities leading to death and how these progress statistically within your own organisation
Compare it to the data from other hospitals and recognise where your hospital is both performing and under-performing in the organ donation process
Highlight where the potential for donation has not been realised to ensure that these individual instances are reviewed in more detail
Track the trends identified through the PDA to support planning activities and highlight where improvements are being made
Help prepare for upcoming challenges and opportunities
Support detailed conversations between the CLOD, Donation Committee Chair and SNOD / SOD to agree actions that need to be taken by the donation committee to improve the number of donors across all areas of the hospital 21

22. Developing an Annual Organ Donation Plan and Report22

23. What is an Annual Organ Donation Plan?
Assess
Plan
Implement
What is an Annual Organ Donation Plan?
What is it?
An Annual Organ Donation Plan is a formal statement of a set of ‘Organ Donation goals’ for the hospital, the reasons why they are believed attainable, and the planned interventions (or activities) for reaching those goals
What are the benefits?
Clarity of vision
Objectives and actions
Describe the metrics
Define the seriousness of the venture
Presentation and Discussion
Facilitator notes:
Provide information on what is an Annual Organ Donation Plan and what is its purpose
Ask participants if any of them have had experience of writing business plans
Benefits of an effective Annual Organ Donation Plan
Helps the Organ Donation team to clarify their vision and decide whether to move ahead with certain actions
Gain support for the work of the Organ Donation team including Executive Board level support
Define the objectives and actions required to achieve these objectives
Help understand the risks involved and potential problems in order to identify remedial actions
Demonstrate a seriousness in the intentions of the Organ Donation team
Set targets to measure the success of the team
Keep the team focused on achieving objectives
Identify the key themes within and across Donating Hospitals 23

24. What is the Annual Report for Organ Donation?
What is it?
An Annual Report is a comprehensive report on an Organ Donation team’s activities throughout the previous year. It is intended to provide their stakeholders including NHSBT with information regarding the team’s activities and performance against their goals.
What is the purpose?
The Annual Report is intended to provide their stakeholders including NHSBT with information regarding the team’s activities and performance against their goals in an easy to digest format
Development of the report helps the Organ Donation team to reflect on their performance from the previous year and aid their future strategy development
The Annual Report is a celebration and communication of past and recent successes
Communicating the Annual Report within and outside of the local hospital will help to share lessons and develop learning
Presentation
Facilitator notes:
Provide information on what is an Annual Report for Organ Donation what is it’s purpose
Mention that the Specialist Nurses for Organ Donation have already been producing Annual Reports and this knowledge and experience should be drawn upon
Benefits of an Annual Report for Organ Donation:
A look back on the year’s performance – what were the key achievements?
Easy to digest format with content in one place
Provide how resources are being used and what has been achieved in comparison with other hospitals
Promote better understanding about future performance
Promote good management practice – linking strategy with results
Develop vision and direction for the Organ Donation team for the following year 24

25. What does an Annual Organ Donation Plan look like?
Assess
Plan
Implement
What does an Annual Organ Donation Plan look like?
Annual Organ Donation Plans are a decision making and communication tool and should be determined by the specific goals and stakeholders of the Organ Donation team. Typical high level structure includes:
Content
Description
1. Introduction
What are their main priorities for the year, what is the purpose of the Annual Organ Donation Plan?
2. Background
Who is in the team, what are the primary roles of the Organ Donation Team. What’s happening in the hospital that would impact Organ Donation activities?
3. Policy Framework
What national and legal polices have changed over the last year, how will this affect the key targets for the following year?
4. Strategic Direction
What are the high level strategic plans for the Organ Donation Team and their hospital?
6. Action Plans
Detail actions against the objectives and indicate timelines for completion as well as owners, risks and issues
7. Risks/ Issues
What are the likely key risks and challenges inhibiting delivery against the action plan and what mitigation strategies can be put into place to minimise the impact?
8. Performance Indicators and Monitoring Arrangements
How will the Organ Donation team measure success against each of the key targets for the following year?
Presentation
Facilitator notes:
Briefly run through high level content as provided in the slide
Key messages:
This is a typical high level structure. The Annual Reports will include more details and sub headings under each category depending on the individual cases. 25

26. What does an Annual Report look like?
Annual reports consist of but are not limited to the following contents: \
Content
Description
Introduction
Introduction to the report including messages from the Donation Committee Chair and Clinical Lead
Overview and Background
Feedback from the Donation Committee and the Strategy and Vision for Organ Donation
Summary of the Year
Summary of performance for the year based on objectives set in the Annual Organ Donation Plan
Performance Variances and Action Plans
Detailed review of variances against the action plans and set objectives
PDA Benchmarking
Benchmarking of Donation rates across hospitals and regions
Local Initiatives
Topics to include may include local activities to increase Organ Donation rated, promote awareness or responses to change in law or policy
Future Development
Vision and desired actions for the following year – Where does the Organ Donation Team want to be in a year’s time?
Possible risks/pressures
Highlight risks and issues identified through the year, what are the challenges, how are the Organ Donation Team going to overcome these?
Presentation
Key messages:
This is a typical high level structure for an Annual Report – the detailed content will vary depending on the Organ Donation Team
Briefly run through high level content in the slide 26

27. SMART Objectives S M A R T
Assess
Plan
Implement
SMART Objectives
The Annual Organ Donation Plan should be focussed upon SMART objectives S M A R T
Specific
Measureable
Accurate
Realistic
Timely
Is there a description of a precise or specific behaviour / outcome which is linked to a rate, number, percentage or frequency?
Is there a reliable system in place to measure progress towards the achievement of the objective?
With a reasonable amount of effort and application can the objective be achieved?
Can the person with whom the objective is set make an impact on the situation?
Do they have the necessary knowledge, authority and skill and is it relevant to the organizational goals and aims?
Is there a finish and/or a start date clearly stated or defined?
Presentation
Facilitator notes:
Walk participants through the use of SMART to help write objectives for their plan 27

28. Example SMART Objectives
Assess
Plan
Implement
Example SMART Objectives
The Annual Organ Donation Plan should be focussed upon SMART objectives
Objectives for the next year
Actions required to deliver objective
Measurable outcome/KPIs
Person responsible for leading action
To have 100% referral of all potential non-heart beating donors and brain stem dead donors – with 80% conversion rate by 2010
Resident Specialist Nurse for Organ Donation to feedback PDA
Utilise Clinical Lead and Donation Committee
PDA reflects 100% referral
Specialist Nurse for Organ Donation lead
Clinical Lead for Donation
To achieve an 80% conversion rate by 2010
PDA reflects 80% conversion
The minimum notification criteria is used in 100% of all cases to ensure timely referral
Communicate/ reaffirm minimum notification criteria to all relevant staff
PDA reflects use of notification criteria in 100% of cases
Clinical Lead
To scope the implementation of a new Organ Donation programme within the Emergency Medicine department within 6 months
Understand the process within emergency medicine
Agree roles and responsibilities for scoping exercise
A comprehensive report that progresses an Organ Donation programme within Emergency Medicine to be made
Presentation and Discussion
Facilitator Notes:
Facilitator to walk participants through some examples of SMART objectives for Organ Donation as provided in the slide
Initiate discussion using suggested questions below:
Group Discussion:
Why are these objectives SMART?
Can you provide examples of any other objectives that would fit the mnemonic ? 28

29. Managing and Tracking Against Plan29

30. Balanced scorecard and Key Performance Indicators (KPIs)
Purpose:
The balanced scorecard is a strategic planning and management system that is used to:
Align business activities to the vision and strategy of the organisation
Improve internal and external communications
Monitor organisation performance against strategic goals
Key performance indicators are quantifiable measurements, agreed to beforehand, that reflect the critical success factors of an organisation.
KPIs help an organisation:
Define and measure progress toward strategic and operational goals
Benefits:
Increase focus on strategy and results
Improve organisational performance by measuring what matters
Align organisation strategy with the work people do on a day-to-day basis
Focus on the drivers of future performance
Improve communication of the organisation’s vision and strategy
Prioritise projects / initiatives
Without metrics, management can be a nebulous if not impossible exercise. How can we tell if we have met our goals if we don't know what our goals are? How do we know if our business strategies are effective if they have not been well defined?
The balanced scorecard as documented by Robert S. Kaplan and David P. Norton in the Harvard Business Review article The Balanced Scorecard - Measures that Drive Performance1 describes a methodology used for measuring success and setting goals from financial and operational viewpoints. With those measures, leaders can manage their strategic vision and adjust it for change.
Balanced Scorecard approach generally has four perspectives:
Financial
Internal business processes
Learning & Growth (human focus, or learning and development)
Customer
Each of the four perspectives is inter-dependent - improvement in just one area is not necessarily a recipe for success in the other areas.
An important part of the balanced scorecard concept is the emphasis on establishing a balance between four types of measurements. These types of measurements include:     1) Short term and Long term,      2) External (for shareholders and customers) and Internal (for critical business         processes, innovation, and learning and growth),      3) Leading indicators (outcomes desired and performance drivers) and          Lagging indicators (outcomes),     4) Objective measures (e.g., financial) and Subjective measures (e.g., many         non-financial).
Adapted from Robert S. Kaplan and David P. Norton, “Using the Balanced Scorecard as a Strategic Management System,” Harvard Business Review (January-February 1996): 76. 30

31. Organ Donation KPIs
Resources, learning and growth
(What we need to enhance to succeed)
Outcomes
(What we want to achieve)
Internal Processes
(What we
need to do well to reach our goals)
Customers / Partners
(What we need to do for and with others)
SNODs achieve and maintain competencies
Right proportion time spent in NHS organisations
Implement policies and best practice
Embedded SNODs
Increase submission data on time
Increase donor family consent
Complaints and Clinical Governance incidents
Increased approaches by trained person
CLODs are in place
Increase referral rates
Increase DBD conversion rates
Increase BSD testing
Chairs of Donation Committees are in place
Improve adherence to MNC
Increase DCD conversion rates
Increase DBD organ donors
Increase transplantable organs DCD
Effective partnership working
Increase transplantable organs DBD
Increase DCD organ donors
Increase proportion solid organ donors donating eye tissue
ODT have set to particular 'targets' for this year - increasing the proportion of patients who are confirmed to be brainstem dead when this appears to be a likely diagnosis, and increasing referral rates of potential donors to 100%. 
Whilst this might be intended to be a 'target' for Specialist Nurse for Organ Donation teams, it clearly refers to what clinical staff are doing. 31

32. Roles and Responsibilities
Responsible
Accountable
Consulted
Informed
Annual Organ Donation Plan
Specialist Nurse for Organ Donation, CLOD & Committee Chair
Donation Committee
Executive Board
EM / ICU Departments
Senior Nurses, other Clinicians & Healthcare Professionals
NHSBT
Medical Director & Director of Nursing
Chief Executive
Governance Committee
Annual Report for Organ Donation
Hospital Policy
Specialist Nurse for Organ Donation & CLOD
Portering/ Lab Staff
Other hospital staff
Unit Profile
Specialist Nurse for Organ Donation
Clinical Lead
Other clinicians
Unit clinicians
PDA
Donation committee
Presentation and Discussion
Key messages:
We have now gone through some extensive assessment and planning tools, however, before we can move on to implement the plan, we need to find the right person for the activities!
RACI is helpful where they are a number of people involved in the completion of a task or in the making of a decision, and it is not clear what everyone’s responsibilities are.
As a Organ Donation leader, it is important to clearly identify your expectations and to avoid any potential confusion over roles and responsibilities.
Facilitator Notes:
Talk through the concept of RACI
Talk through each of the deliverables/ activities covered and who will be responsible, accountable, consulted and informed
Test with the participants that these are the most appropriate stakeholders
Additional notes on RACI:
R is Responsible: This person is generally the doer or coordinator who ensures the work gets done. They have responsibility for getting the task done or the decision made. They may do the work or gather information and they make recommendations to the person accountable.
A is Accountable: Who is the person that will be held accountable for any outcomes of a decision, or results of a job? Who will ensure that the job is completed satisfactorily? Who will take responsibility if things go wrong?
C is Consulted: Generally a task or decision will require the input from many. The Responsible person seeks information from these people, and will make his or her recommendations from the findings. While people who are consulted may have opinions (and these may be taken into consideration by the person Responsible) they are not decision-makers nor are they accountable for any outcome of a decision.
I is Informed: These are people who do not contribute information to get the job done or to make a decision, but they are affected by the outcome and there need to be informed. 32

33. Suggested schedule for Donation Committee Meetings
Core Donation Committee Meetings
Monthly Update Meetings
Frequency
Quarterly (minimum)
Monthly
Attendees*
Clinical Lead
Donation Committee Chair
Specialist Nurse for Organ Donation
Medical Director
Clinical Lead or Senior Nurse for:
ICU
Emergency Medicine
Neuro ICU (if appropriate)
PICU (if appropriate)
Consultant surgeon
Consultant Palliative Care or lead nurse
End of Life Care Pathway Lead
Operating theatre representative – Senior nurse
Practice Development Nurse
Service Improvement
Key Inputs
PDA and comparative data
Data collected from other sources (interviews, conversations, general observations etc)
Annual Organ Donation Plan
Individual updates
Minutes from previous Donation Committee Meetings
Suggested Agenda Items to include
Quarter 1
Review PDA and comparative data
High level assessment of progress and achievements
Draft key headlines for Annual Report and Annual Organ Donation Plan
Agree contributions and timelines for content development
Discuss key updates
Discuss progress against action plan
Review PDA data provided by Specialist Nurse for Organ Donation
Discuss next steps and priorities
Discuss risks and issues
Discuss individual cases, outcomes and implications for future Organ Donation activity
Quarter 2
Discuss feedback on Annual Report and Annual Organ Donation Plan from Executive Board
Revise Annual Organ Donation Plan if necessary
Review progress and identify remedial actions
Quarter 3
Conduct mini-assessment of progress and achievements
Identify remedial actions
Confirm requirement for a mid-year review and key areas of focus
Quarter 4
Discuss insights from mid-year review
Agree preparatory activities for Annual Report (meetings, data collection etc.)
Consider key priorities for following year
Presentation
Talk to the information on the slide after delivering the key information below
Draw upon a few key ideas in the committee structure to bring key messaging to life
End with asking the group if they feel this way of organising their committee would work
Key messages:
A key forum you can use to establish RACI and share ideas / plans is the Organ Donation committee
This forum is great for getting people involved and bought in to what you are doing
It is not enough to just share what you are going to do, you need to have a forum where you can share how you are getting on and get people to work with you to reshape, support with activities that may be off track
As a committee, you really need to talk to one another about what you are doing to ensure that any dependencies, risks / issues are being managed
Here we have suggested a structure for your committee meetings to help you plan, share plans and report against plans, bringing people who are instrumental to organ donation on the journey with you
Regular status updates are critical so think about what kind of meetings you may like to have these before these to prepare (reference back to the Annual Planning Cycle)
Also think about how you would communicate progress with the wider hospital organisation – communications are key and should be considered as part of planning activity
*Other potential representatives include: Ethics Committee; Chaplaincy (multi-faith); Patient groups/ Foundation Trust Council (where applicable); Local donor family; communications department ; A representative from dialysis or transplant services 33

34. Action Planning 34

35. Building a Local Action Plan
We would now like you to work with your strategic big win team from this morning and consider the key actions you would need to carry out to achieve the vision set for your big win
To do this you will need to consider:
SMART objectives against your vision
Supporting actions
Prioritisation of actions i.e. immediate, short, medium and long-term
We would like you to use the SMART template below to support your thinking and jot all your actions on post-it notes
We will then ask you to come and plot your activity along the T-map as we did during the case study activity
Presentation
Facilitator Notes:
Introduce next phase of the case study
We want the 6 groups to come back together and develop SMART objectives for the hospital in their case study to help them achieve the big win
Groups are to guide discussion using template provided
Ask groups to try and come up with several activities for each objective
Completion dates can be phrased as Q1, Q2, Q3, Q4 for the years 2010, 2011, 2012 and 2013
Groups to have 20mins discussion and then 10mins group feedback
Objectives for the next year
Actions required to deliver objective
Measureable outcomes / KPIs
Person responsible for leading action
Completion date
Resources required 35

36. Transformation Map Presentation Key messages:
Increased referral according to minimum notification criteria
Increased diagnosis of brainstem death
Increased consent / authorisation rates
Increased rates of donation in Emergency Medicine
Quick Wins
Vision
Medium Term
Long Term
Short Term
Increased organ donation rates by 50% in 5 years
Increased donation after cardiac death
Increased quality and quantity of organs from improved donor management
Presentation
Key messages:
Once all activities are on the transformation map under the relevant timeframe to ask Paul/Lesley to come up to the front of the room and present back what people are saying
Paul/Lesley to give the feedback about the type of things people are coming up with
It may be interesting to ask the group the questions:
Are you doing any of these activities in your hospital?
Do these activities seem sensible?
Are they prioritised correctly?
Would you find a map like this helpful?
Based on the information in here are there any activities you might look to start or stop? 36

37. Summary
Make sure you have a realistic and strategic vision that will support you to hit and achieve targets for organ donation in your hospital
Use the organ donation planning cycle to help you support your planning, reporting and meeting together as a team and organ donation committee
Take time to complete annual organ donation planning and reporting documentation to support you lead Organ Donation within your hospital
Understand how you can best share workload for making changes in your hospital between the Clinical Lead, Donation Committee Chair and Specialist Nurse for Organ Donation
Focus on those activities which are really going to make a difference in your hospital around the six big wins for organ donation
Remember that this programme is an evolution not revolution - change will take time!
Exercise
Instructions to facilitators:
Hand out the Annual Organ Donation Plan and Annual Report templates to each of the Organ Donation team. Explain that these headings are to act as guidelines to help them develop initial drafts of both their plan and annual report and agree next steps.
Facilitators to explain that this exercise is to get a feeling for what content will be required, considering what is their vision for their Organ Donation team, and what key messages do they want to convey in each documents
Remind them of the activities they have just carried out throughout the session i.e. assessment & planning, to guide and shape their thinking
Ask groups to work together for (25 minutes) on completing their templates
Then ask each pair to join with another pair to present back their templates
Ask each pair to questions to probe and challenge the other pair and provide additional suggestions (25 minutes)
For remaining 10 minutes as a plenary ask participants to share their top actions and next steps 37

38. What’s Next? 38

39. PDP for Organ Donation: Regional Event Calendar
Bristol
London 1
London 2*
Edinburgh
Birmingham
Manchester
Leeds
Kick-off Event
01/02/10 – 02/02/10 (London – Britannia International Hotel)
Change & Leadership Fundamentals
24/02/10
10/03/10
15/03/10
19/03/10
14/04/10
15/04/10
21/04/10
Diagnosis of Death & RPCG Kick- off
31/03/10
28/04/10
11/05/10
29/04/10
09/06/10
Donor Mgt & Emergency Medicine
22/04/10
15/06/10
08/09/10
06/10/10
12/05/10
Paediatrics
19/05/10 (London)
Making Change Happen
13/05/10
26/05/10
23/06/10
10/06/10
27/05/10
30/06/10
16/06/10
Consent / Authorisation
09/09/10
13/10/10
03/11/10
21/09/10
14/10/10
RPCG Follow-up
21/10/10
16/09/10
07/09/10
18/10/10
18/11/10
16/11/10
24/11/10
National Review Event
18/01/11 (London)