1. AHP Master class: Benchmarking, Management and Leadership Tools and Techniques for Thriving and Surviving JJ Consulting Healthcare Management Ltd. Robert Jones Fiona Jenkins 5 th October 2012 JJ Consulting Healthcare Management Ltd

2. Benchmarking, why now? The global situation The fast changing NHS The added value AHP services can bring What makes efficient and effective services Quality and cost

3. 10.00am Introduction to the day The fast changing NHS and the added value that AHP services can bring What makes an effective and efficient service? 11.15am BREAK Does quality drive out cost? How does your service compare with others? Data, information, interpretation and uses Benchmarking, and its application to AHP services Analysing staffing levels, skill mix and workloads 1.00pm LUNCH 1.30pm Analysing continued: Inpatients, outpatients, community Service re-design options after benchmarking Management quality matrix how can it help you? Business cases for surviving and thriving 4.30pm How do you make the most of your management structure?

4. Plan for the day Housekeeping Confidentiality Information we have provided The importance of networking Benchmarking today Outcomes from the Master class Your action plans

5. Is there any thing else you want from today?

6. The Global Picture

7. Change is Happening Future job market/turnover Population changes Technologies Dr Google Globalisation of healthcare- digitisation

8. “ Never waste the opportunities offered by a good crisis.” Machiavelli

9. The Financial Context Extraordinary Public Sector Debt Public Sector Funding Restricted (Zero Growth) Higher Inflation and Downward Pay Pressure Tariff reduced by 1.5% - 2% per annum Population Increase (elderly, LTC) Medical and Drug Advances (Technology) Shift from Secondary to Primary Care Expensive Infrastructure Financial Deficits in Organisations

10. The Fast Changing NHS: It’s not an easy time

11. The Next 5 Years …at least Extraordinary public sector debt Organisations with recurring deficits Continuing tariff reduction At least 2% inflation Efficiency requirement Less money to do more activity or work differently Activity volumes too high to be affordable Poor community and primary care infrastructure Variation in efficiency e.g. length of stay Too many follow-ups and too many DNAs Impact of private sector growth

12. The Health and Social Care Act 2012: Themes Commissioning - GPs taking more control charge Increasing democratic accountability “Public Voice” Liberating NHS service provision Strengthening Public Health services Reform of arms-length bodies

13. Infinite Demand

14. SOME SHORT AND LONG TERM STRATEGIES Improved effectiveness and efficiency Organisation development structure Patient level costing Improved productivity Vertical and Horizontal integration Quality, patient safety initiatives Reduced activity- introduction of thresholds Disease management - self care Programme management efficiency programmes Less money = less beds and staff Cheaper management costs Tendering Any qualified provider Mergers/ take over

15. The Added Value that AHPs can bring Doing this is not an option!

16. The Roles of Managers and Leaders Roles, duties and responsibilities The evidence-base - research - the literature The politics of therapy management and leadership today

17. What is the special contribution of AHP managers and leaders?

18. Comprehensive clinical knowledge- all specialties, all sectors Comprehensive understanding of illness, disease, trauma, their treatment and long term management Wide understanding of public health and preventative agenda Problem solving skills transferrable between clinical and managerial practice Clinically credible management/leadership Leadership of rehab and integrated care Facilitation of safe timely discharge Skilled in capacity management Cost effective and clinically effective solutions Innovative solutions to clinical and managerial problems Culture of effective MDT working Ability to re-design clinical systems for patient benefit and organisation requirements

19. AHP managers unique? Clinical Heads of clinical services Credibility with other clinical leaders Extensive knowledge of the services they manage ( clinical and managerial) In-built patient centred approach- built by years of clinical practice Understanding and interpretation of the evidence-base Understanding the diversity of clinical provision and the inequities Knowledge of staff capabilities Knowledge of workloads, clinical prioritisation, skill mix Ability to manage the short tem needs and longer term strategic changes Contribution to business planning built of sound clinical knowledge and managerial expertise

20. AHP Managers - really unique Code of ethics and professional status = Integrity Experience of the whole healthcare system = Unique perspective of the whole system AHPs =Patient Centredness Therefore uniquely equipped to contribute to the wider organisational agenda

21. Added Value for Success AHP Managers and Leaders Co-ordination of staff activity Guide work towards goals of the organisation- and effect real change Provide safe value for money services Co-ordinate services across traditional boundaries and interfaces Ensure optimum efficient use of workforce Ability to re-prioritise based of implementation of evidence base to ensure change of practice is embedded

22. AHP Managers Can Deliver Workforce, skilled flexible and efficient Highly skilled clinicians, and well trained support staff Staff who promote self care and reduced dependency Leaders who can prioritise for efficiency gains Team workers with a “can-do” culture

23. Can You Do It? Be up to date, personally and professionally Have a contemporary PADR Review your CPD portfolio and CV Review your leadership competencies Network and share Keep abreast of the wider NHS developments....is your network wide enough?

24. Does Quality Drive out Cost? Placing quality at the heart of business strategy will result in improved healthcare outcomes Focus on cost cutting will not deliver the solution Poor healthcare outcomes can be measured through spiralling cost, overspends, wasted resources and poor investment Poor quality increases costs through harm waste and variation Collaboration between clinical decision- makers, managers/leaders and finance teams is essential, to drive down costs and improve quality

25. What makes an effective and efficient service?

26. What can be learned from others?

27. And Consider Do you know what your users think of your service? What is the strategy of your organisation? Do your service plans fit with the strategy? Are you providing the right services? Is it time for some change? Skill mix profile – is it optimal, is it affordable? Staff profile, activity and service costs How long per appointment, how many contacts? Are you ready to re-design? Is your service ready for change?

28. How does your service compare with others? How do you know?

29. Data, Information, Interpretation and Uses What is data? What is information? What have you got? How do you collect it? How do you use it ? What do you need ?

30. Benefits Information for: Management clinical finance workforce

31. Staff Activity What do staff do with their time? How much of each activity Who does it Where it happens Managers need an accurate picture of what staff are doing with their time Have you got a benchmark by staff band? What activity do you expect from a band 6?

32. Where does your service sit compared to this?

33. …….and this?

34. Band 5 activity 54.16% 15.30% 4.05% 1.18% 19.43% 1.77% 0.40% 2.35% 1.37% FACE CONTACT IND FACE TO FACE GRP TEL CONTACTS WARD ROUNDS CASE CONFERENCE STUDY LEAVE LIAISON ADMIN MANAGEMENT HOME VISITS TRAVEL CLINICS MTGS IN SERVICE TRNG TEACHING PHYSIOS TEACHING STUDENTS TEACHING HEALTH PROF TEACHING PUBLIC CLIN. SUPERVISION OTHER

35. OT

36. Comparison by Band

37. Run Chart for service improvement

38. Finance

40. Balanced Score Card

41. Are you a budget manager? What's the split between staffing costs and non-staff costs? Were you involved in budget setting? How do you make your CRP? What %? Do you understand the finance data well enough?

42. Any Questions?

43. Does Your Service Have Alignment? Between : Strategy Vision Desired Outcomes Performance if so, how do you compare your performance with others?

44. Have you thought of Benchmarking? An Invaluable means of enhancing understanding your service's performance compared with others Requires collection and interpretation of data Can be wide-ranging or very focussed Can speak louder than your single voice ….or identify where efficiencies can be made

46. Edited by Robert Jones and Fiona Jenkins Foreword by Karen Middleton The Jigsaw of Reform: Pushing the Parameters Money, Money, Money: Fundamentals of Finance Commissioning for Health Improvement: Policy and Practice Striking the Agreement: Business Case and SLAs Thriving In the Cash Strapped Organisation Information is Power - Measure it, Manage it Information Management for Healthcare Professionals Allied Health Records in the Electronic Age Data ‘Sanity’: Reducing Variation Outcome Measurement in Clinical Practice Improving Access to Services Benchmarking AHP Services Management Quality and Operational Excellence Evaluating Management Quality in the AHPs Evaluating Clinical Performance in Healthcare Services Project Management for AHPs with Real Jobs Marketing for AHPs Effective Report Writing Demonstrating Worth: Marketing and Impact Measurement

47. 4.8 treatments per episode of care is the benchmark Average Face to face Contacts Trauma and Orthopaedics

48. Average face-to-face contacts musculoskeletal out-patients Benchmark contacts 3.31 Benchmark first to follow up ratio of 1:2.31

49. Waiting Time from Referral to Treatment – Occupational Health The benchmark wait is 1-2 weeks

50. Paeds waiting time

51. Introducing our Benchmarking Toolkit- Where did it come from?

52. How to use it Your organisation Your professional group In-patient services Out-patient services Community services

53. Analysing Staffing Levels, Skill Mix and Workloads Look at the data you brought with you- compare this with others.. and set the benchmark for areas you have overlap in If no one has benchmarked the same data as you.. just join in and go through the process on analysing with others the benchmark where there are areas of overlap. Go through each worksheet in turn Create a benchmark from the data you all have Nominate one person from your table to be the holder of your table bench mark data

54. Its Lunch time!

55. Analysing Continued… Inpatients, outpatients, community Compare you table benchmark data with the national benchmark data which we have just given you Create a benchmark for your table from the REAL data you have Come and write up your benchmark information on the flip chart Where there was no one with similar information to benchmark….come and write this up on the flip chart sheets

56. 1. What does the benchmark show you? 2. What actions are you going to take?

57. The Allied Health Professions – Essential guides series is unique in providing advice on management, leadership and development for those in the Allied Health Professions (AHP). This highly practical volume offers a wide range of assessment tools and techniques in such critical areas as management quality, organisational and management structure, benchmarking, outcome measurement, and Integrated Care Pathway design as well as capacity and demand management, activity analysis, report writing and presentation skills. “The NHS is facing the greatest period of challenge in its history. The key to success is leadership. Allied Health Professionals will be a central part of this leadership response. In this work, Robert and Fiona continue their series supporting Allied Health Professionals in that leadership journey. It is an important contribution to this critical effort.” - From the Foreword by Jim Easton

58. Management Quality Matrix how can it help you? 1. Strategy 2. Patient and service user experience 3. Clinical excellence 4. Finance 5. Information and metrics 6. Activity 7. Staff resource effectiveness 8. Staff management and development 9. Service improvement and re-design 10. Leadership and management development 11. Risk management 12. Corporate governance 13. Communications and marketing 14. Key performance indicators

59. Management Quality in the AHPs Key concepts of Management Quality Impact on AHPs Where does it come from? - the evidence-base and conceptual framework Why is it important? - patients and their families/carers - clinical practice - the staff - the organisation - the Profession

60. The Three Phases of Excellence 1. Lean 2. Supply Chain 3. Strategic

61. Six Dimensions of Quality Communication Participation Employee development Measurement Delegation Integration

62. Management Quality Matrix Evaluating a wide range of performance parameters Draws on management quality, industrial and healthcare excellence work Concepts: Performance Management ‘Lean’ Six Sigma Balanced Scorecard ‘Dashboards’ TQM Benefits Realisation

63. Think about your service Is everyone in the team 'pulling' in the same direction? Does the direction benefit the patient? Are we measuring so that we know whether we are improving? Do staff have the training, motivation and respect to provide value and bring about improvement? Are tensions around fear of change recognised and managed? Are problems/mistakes treated as opportunities to improve?

64. Business cases for Surviving and Thriving Rob sort the hand out if you can Purpose of the Business case Put forward a proposal for change or development Structured format to develop the case Benefits realisation Costs Timescale Strategic fit

65. Option Appraisal Guidance Set out possible options in turn Describe each option outline Identify costs Analyse pros and cons Evaluate each option via weighting or scoring Compare options, rank them and recommend preferred option with reasons why

66. How Do you Make the most of your Management Structure? Make them work for you….............................. what ever they are, however they change Don’t fight them Influence them Speak the right language Make yourself indispensable Make the right connections/contacts/allies Keep your focus on the patient …..and the organisation’s strategic direction

67. To Summarise

68. Is There Anything We Haven't Covered?

69. The Challenge of Implementation Action plan…what are you going to do by: Next Friday? A month from today?

70. Evaluation How was it? Are you going to use the benchmarking data? What more could you do after today? Is there more you need to do be business like?

71. Be a great leader…your team needs you!

72. Some Resources for you

73. Final Questions?