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Celebration Event 21 st October 2014. Leading Across Boundaries Programme Welcome.

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Presentation on theme: "Celebration Event 21 st October 2014. Leading Across Boundaries Programme Welcome."— Presentation transcript:

1 Celebration Event 21 st October 2014

2 Leading Across Boundaries Programme Welcome

3 –10.15 Welcome and Introduction –10:45Project Presentations x 2 –11:15Break –11.45Creating sustainable leadership –12.45 Lunch – Market Stalls and Networking –13.45Project Presentations –14:15Awards –14:45Key Note Speaker – Gavin Boyle, Chairman of –East Midlands Leadership Academy –16.00 Close Agenda for today

4 Leading Across Boundaries The Academy has recently joined Twitter we would like you to “Tweet” to Raise and respond to questions Provide feedback on speakers comments Comment on key topics Collaborate & network Please use the following hash tag #emlaAcrossBoundaries Follow @nhsEMLA to keep up to date with what’s going on in our region

5 LEADING ACROSS BOUNDARIES CELEBRATION EVENT – 21 st October 2014 Welcome Paul O’Neill – Director of East Midlands Leadership Academy


7 #emlaAcrossBoundaries LEADERSHIP WORD 1, WORD 2, WORD 3

8 #emlaAcrossBoundaries SYSTEM – Definition (about 100 characters)

9 Good Organisational Leadership: Single Vision Aligned Strategy and Business Plan Focus on Quality and Finance Strong Governance Standardised policies and procedures Agreed measures of success Owned and Understood Values and beliefs Consistent and Positive Culture Distributed Leadership Strong team identities and effective working Having all of these traits working well together is not very common in large healthcare organisations. Consider working with multiple organisations – how many of these are true?

10 Key findings Delivering system-level integration will require a combination of a collaborative approach to leadership and directive, effective organisational leaders. Both of these different leadership approaches can and ideally should be modelled within the system, but this is challenging at an individual level. Health and social care organisations are complex adaptive systems. Successful approaches to developing system leaders recognise this and the need for a new leadership approach, although paradigms of ‘command and control’ leadership are prevalent. Studies show that the world’s most successful health care systems make widespread and systematic use of improvement methods. These encourage learning by doing, using small tests of change to observe, reflect and explore what works best for a particular context. David Fillingham Belinda Weir October 2014

11 Learning in a complex adaptive system Learning needs emerge and change Inter-organisational and inter-professional teams are critical to successful change What works is context specific… so local organisation and health economies will need to adapt not just adopt A successful change will require attention to technical aspects (‘the anatomy’) and cultural aspects (‘the physiology’). (Zimmerman et al 1998)

12 Learning from other sectors: markets, hierarchies, networks Key featuresMarketHierarchyNetwork Normative basisContractsEmployment relationshipComplementary strengths Means of communication PricesRoutines and rulesRelationships Conflict resolutionHaggling/litigationAdministrative edictReciprocity seeking win/win Commitment among the parties LowMedium to highHigh Tone or climateSuspicionFormal bureaucraticOpen-ended mutual benefit ActionsIndependentDependantInterdependent Source: adapted from Powell (1990)

13 LEARNING FROM THE PRIVATE SECTOR Learn to operate without the might of the hierarchy behind them and use their individual skills rather than their formal position to achieve results Be able to compete in a way that enhances rather than undercuts the competition – to do this these leaders must become successful collaborators Conduct their business to the highest ethical standards; trust is crucial to successful alliance-building Develop a process focus – concentrating not only on what is to be achieved but how

14 Knowledge and skills framework What skills and knowledge do you need to do this? Technical know-howService design Governance arrangements Innovative contracting and financial mechanisms Improvement know-howSystems thinking Improvement science Large-scale change Personal effectivenessInterpersonal skills and behaviours Coaching ability A visionary and participative style

15 Discuss in Pairs: What have you learned that you didn’t know before you did this programme? In what ways (if any!) have you changed the way you work with others?

16 Discuss in Groups: How successful has your project been? (score 1-10) How much has the learning from this programme contributed to its success? (score 1-10) Add these two scores together. Make sure everyone on your table knows what your total score is!

17 Let’s get Curious!

18 The ability to work across boundaries and to put the needs of the system ahead of, or at least alongside, those of their own institution will be one of the hallmarks of the leaders who will thrive in the new world.

19 Chesterfield Royal Hospital NHS Foundation Trust & Derbyshire Community Health Services NHS Trust Frail Elderly Care Pathway Part 1 & 2

20 Integrated Care and the Discharge to Assess and Manage Process

21 Integrated care ‘The current fragmented services fail to meet the needs of the population and greater integration can improve the patient experience and the outcomes and efficiency of care’ (Kings Fund, March 2013) The aim for Northern Derbyshire as outlined in our System Plan is to keep people: Safe and Healthy – free from crisis and exacerbation At home – out of social and health care beds Independent – managing with minimum support

22 Right care, Right place, Right time Patient centred wrap around care More efficient with NO duplication

23 “In a fully integrated system, patients’ needs not organisational boundaries would decide how care is provided” Nuffield Trust, 2014

24 Our LAB team Ruth Cooper – GP and Integrated Care Lead, Hardwick CCG Kath Shakespeare – Consultant Geriatrician, Chesterfield Royal Hospital (CRH) Lisa Falconer – Matron, Acute Frailty Unit, CRH Kim Ashall – General Manager, Derbyshire Community Health Services Carolyn Nice – Group Manager, Adult Care, Derbyshire County Council Kirsty Ball – Senior Commissioning Manager, North Derbyshire CCG

25 Why are we trying to keep people out of hospital? 10%10%

26 Frailty Unit Pilot at Chesterfield Royal Hospital Unit for the acute care & re-ablement of frail older patients MDT working with a patient centred approach & comprehensive geriatric assessment Enables timely discharge with coordinated and integrated plan for treatment & follow up

27 Why D2AM? Thinking about risk differently…

28 Traditional Discharge Model Medically ready for discharge Therapy assessments Care needs ascertained Care package Discharge

29 ICT PILOT Two pilot sites working with two identified GP practices of a substantial size Community based teams of Therapists, Nursing Staff, Social Care and GP support Teams supported by the Care Co-ordinators within the two GP practices

30 The teams


32 What went well The teams Enthusi asm Permiss ion Knowle dge ProcessImpact Commu nication

33 Even better if… … we had senior nurse input … there was one IT system and better network coverage … we could access equipment more quickly … we had more patients through the pilot... we had more comprehensive services out of hours … the community teams had more experience managing risk … the pilot was the day job

34 Next Steps Full evaluation Rollout from the Frailty Unit Roll out across Chesterfield Royal Discharge process at out of area acute sites

35 Questions for the team

36 Northampton General Hospital Theatre Improvement

37 Leading Across Boundaries Programme Winning Ways

38 Northampton General Hospital NHS Trust Mr Paul Jervis (ENT Consultant) Dr Ramaswamy Karunakaran (Consultant Anaesthetist) Mrs Sue McLeod (General Manager) Mrs Lorna Gould (IQE Advisor) Mrs Linda Bazeley (Theatre Improvement Project Lead) Our Great Team

39 Lots of different club Chairman No one counting the goals Couldn’t see the league table Lack of investment We didn’t hear the whistle We didn’t know where the goal was Our football team, Northampton Town F.C; ‘The Cobblers’ statistics. A tale of woe…. Exec team and external companies Poor data quality Theatre Dashboard not being used Data analysis / time/ equipment /I.T./ training Start and finish times No shared vision

40 More woe…. No Red Cards No set pieces No pre-match chat No post match celebrations No plan for the season Behaviours unchallenged No standardisation Few planning meetings Debriefs No capacity and demand planning

41 Our club strategy…. Player / Manager Coaching Project team Years secondment for Theatre Matron EMLA Learning new skills

42 Second half…. Agree length of match Kick off and finish on time Improve team play Understand the off-side rule! Avoid relegation Session times, 85% utilisation target Improve start and finish times Same teams working together Greater understanding of business Sustainability

43 Thank you for listening. Any questions?

44 Leading Across Boundaries Programme Break

45 Leading Across Boundaries Programme Reducing Internal Waits Royal Derby Hospital

46 Reducing Internal Waits Why did we ‘chose’ the project? Who we are? What did we expect from ‘Leading Across Boundaries’? What did we need to know? How did we plan to do it? What did we find? How did we tackle the problem? How will we solve the problem?

47 Why did we do this project? Acute Trusts have constant pressure from ED 4-hour target 4-hour target is a whole-system measure Inefficient IP processes = Inadequate acute bed capacity = Poor flow = Failed 4-hour target Ageing population/Complex co-morbidities We need to create capacity within the system

48 Why did we do this project? The Emergency Care Intensive Support Team (ECIST) reviewed all RDH in- patients with a LOS over 7 days in August 2013. 20% of adult inpatients were only in hospital because they were awaiting a test, specialist opinion or similar

49 ‘We can reduce length of stay for a significant proportion of our adult in- patients by expediting tests, assessments, specialist opinions or similar.’ Hypothesis

50 December 2013: The A team NameRole Jonathan Allsop Associate Medical Director Chris Whale Assistant Clinical Director Jenny Sidle Operations - Head Of Nursing Penny Owens General Manager/Lead Radiographer - Imaging Business Unit Liz Ryalls Transformation Programme Manager

51 What did we expect from LAB?

52 What did we need to know?  What do patients wait for?  Why do patients wait?

53 How did we plan to do it?

54 It’s not just about the project…..

55 How did we plan to do it?


57 What did we discover?

58 How did we measure impact?


60 “No fault found”

61 Recurring solutions

62 How will we measure?



65 IT systems don’t work?

66 IT systems will work

67 “Ready to Go!”

68 Thanks to Joanna Klein and Rachel Jerram Lots of work to do (Phase 2). Comms, branding, development Inspired by commitment. Leadership is a journey. Traffic jam in the rain Open road in the sun

69 Leadership…a resource for the team not a privilege for the incumbent…should be defined and evaluated in terms of the performance of the team Robert Hogan

70 Creating sustainable leadership As a team consider; How you worked together as a team? What felt easy? What took time to develop? Your highs and lows over the last 10months What experiences and learning will support you in future Leading Across Boundaries working? How will you build on success?

71 Letters from the Launch Event Take some time to reflect: What you have learnt about yourself from the programme? How are you leading differently? What is your leadership goal for the future?

72 Leading Across Boundaries Programme Lunch

73 Integrated Mental Health Tri-Agency Triage Car

74 Background  East Midlands Ambulance Service cover 6425 square miles across Lincolnshire, Nottinghamshire, Leicestershire and Rutland, Derbyshire and Northamptonshire.  We serve a population of approximately 4.86 Million people delivering both Emergency and urgent care transport, as well as PTS within the North of Lincolnshire.  On a daily basis EMAS receive 2155 emergency calls via 999.  Ambulance staff nationally receive limited mental health training during their standard paramedic education.  The most probably outcomes for Mental health patients in crisis when seen by EMAS are section 136 and ED attendance.

75 What is a Tri-Agency Mental Health Triage Car?  A car with the specific function of meeting the needs of those in mental health crisis.  Supported by three agencies, Ambulance, Mental health and Police  Unmarked Car provided by and maintained by EMAS  Trained staff man the car from ambulance and mental health services to ensure a complete Pyscho-Social assessment is completed combining the expertise of the two health professionals  Provides on scene support for Patients, Ambulance staff and Police  Provides telephone triage for Ambulance and Police

76 Current Operating Procedure  All call outs are processed through the Lincolnshire Emergency operations centre for EMAS.  The car is staffed from 16:00 to 00:00 seven days a week and is accessible by EMAS frontline staff and police  Police calls and 999 calls are processed through AMPDS(Card 25)  EMAS frontline staff call control for support the car then attends to provide back up.  The car provides assessment and intervention as required and a care plan is agreed on by the paramedic and mental health nurse.  If a police officer is present at the call then the care plan is tri-agency with agreement from the police officer as well.  Care plans will be created with, and provided to the patient if appropriate.

77 Impact Pre-car Outcomes Current Outcomes

78 Who Benefits From This Outcome?  Improved outcomes for patients who are detained in the community.  Reduction in ambulance crews and police on scene time  Reduction in the use of conveyance by police and ambulance crews.  Reduction in the number of inappropriate detentions made under the s136 of Mental Health Act.  Reduction in the call out of Forensic Medical Examiner (FME) and Approved Mental Health Professional (AMHP) within custody.  Increased accessibility to mental health service staff beyond normal working hours.  Experimental learning due to multi agency teamwork, leading to greater understanding of roles of other professionals within the mental health service.  Improved use of resources and multiagency working leading to financial benefit for the National Health Service and the Criminal Justice System. EVERYONE !

79 Where Do We Go From Here?  Review the hours the Lincoln Car runs  Review the need for a second car  Consider expanding the role of the car to include adolescents  Integrate the car across EMAS to improve patient services across the trust  Develop a paramedic rotation to combine time on the MH car and standard responding.  Up-skill the Paramedics to include suturing/gluing  Expand the paramedics Mental Health knowledge and skills  Use the links developed with Mental Health services to create pathways for Paramedics when the car is unavailable

80 Rampton Hosptial, Nottinghamshire Healthcare NHS Trust Women’s High Secure Physical Healthcare

81 The Jasmine Healthcare Suite for Women in a High Secure Psychiatric Setting  Dr Sue Elcock (Consultant Forensic Psychiatrist)  Mr Richard Phipps (General Manager)  Ms Natalie Jennings (Modern Matron, Forensic Division)  Ms Martina Griffiths (Ward Manager – Topaz Ward)  Ms K Johnstone (Team Leader – Topaz Ward)


83  To develop a therapeutically appropriate and safe environment for patients to receive physical healthcare whilst maintaining privacy and dignity e.g. palliative care  To provide an enhanced level of staff knowledge and confidence in identifying and managing physical health issues in patients in a psychiatric setting  To be able to maintain ongoing psychiatric care whilst receiving appropriate physical healthcare in their own environment to aid relational security and reduce risks potentially associated with inpatient admissions to other hospitals  To provide equivalent care to female patients as male patients AIMS

84 IMPACT  “Whilst being nursed in the jasmine suite I felt all my needs were met and I felt I could move around without being restricted. I had lots of amenities at hand and the staff were brilliant. I had more quality of life on the jasmine suite than I’ve ever had being nursed out of grounds. My transition from Bassetlaw to the Jasmine Suite went very smoothly and there was nothing more I could of needed. Once in the Jasmine Suite I was able to move around more freely and was able to reach all of the amenities without much assistance. The fresh air and exercise are easily accessible and wheelchair access is well within limits. I think fresh air is an important part of recovery. The actual suite is well ventilated, cosy and warm, its homely and pleasant, staff were friendly and its very spacious. I feel the Jasmine Suite is well equipped and all the amenities are well at hand for the patient. The Jasmine suite played a very big role in my transition back to the ward and I hope all other people that stay there will be comfortable too.”

85  “I was very privileged to be part of the opening of the Jasmine Suite but I was personally proud of the fact that after the death of a friend I had written to Dr H suggesting that we needed an infirmary suite that catered for palliative care as well as convalesce where recovery can be physical as well as mental. It was named by a patient who won a prize for naming it in a competition and has been used already for a patient to recover after a hospital stay.”


87 Awards

88 Leading Across Boundaries Programme Coffee

89 Gavin Boyle, Chief Executive Officer, Chesterfield Royal Hospital NHS Foundation Trust & Chairman East Midlands Leadership Academy &

90 Leading Across Boundaries Programme Close

91 Some simple maths 17+85+6+58+ 85 = LAB

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