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“Driving improved organ donation within your hospital”

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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 Donation

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 Cycle

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 Report

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 Plan

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)

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