1. Transforming health care Transferable learning from Kaiser Permanente Mary Burrows

2. Translating the Kaiser experience Three key themes Clinical leadership Patients as primary care providers Integrated care through patient pathways

3. Clinical leadership Kaiser Clinical Leadership in Practice (KCLIP) Academic and project based programme with personal learning, CEO sponsorship with guarantee Kaisers model of Customized, Coordinated Medical Care S T R U C T U R E P E R F O R M A N C E Permanente/ Patient Relationship Quality Medicine Self Management Self Governance Group Responsibility Resource Management

4. Clinical Pathway Improvement Project. NHS Structure Strategic Development Leadership Corporate & Clinical Governance Organisational Behaviour Working with Teams Programme Induction Aims Ground rules Team identity established Process Mapping & Improvement Skills Personal objectives Identify & Agree Project Clinical Pathway Improvement Project Pt 1 Programme Review & presentation of Action Plan to Sponsors & Guests Module 1Module 2Module 3Module 4Module 5Module 6 Clinical Pathway Improvement Project Pt 2 Clinical Pathway Improvement Project Pt 3 Clinical Pathway Improvement Project Pt 4 Clinical Pathway Improvement Project Pt 5 Clinical Pathway Improvement Project Pt 6 Northampton Clinical Leadership Project Overview

5. Outcome of KCLIP Detailed pathway and implementation plan for obesity and osteoporosis & falls prevention Use of PbR and nGMS enhanced services to deliver clinical change Obligation and commitment to drive forward changes

6. Integrating care : Kaiser No distinction between primary & secondary care Clinicians work and learn together Healthy competition between clinicians Problem solving & quality improvement is clinician led They understand their market

7. Integrating care: Northampton 2 Lead LTC physicians with project manager to co-ordinate and support work Stratified approach to chronic disease applied using Kaiser model with public health data Set in motion projects that apply the bang for buck theory as the driver for change Development of managed clinical networks for LTC Implemented case management as part of basket of strategies

8. Integrating care and services Improving preparation for elective surgery to reduce ALOS Case managers in A&E Patient pathway team with health and social care to case manage medical patients in and out of hospital Case managers in community within managed clinical networks and linking with acute services

9. Integrating care and services Development of integrated care centres as the physical manifestation of integrating care and breaking down boundaries - LIFT and PFI batch secured with first centre in 2007 Agreed models of care with acute sector (inc mental health) and social care that bring services together over time - foundation community

10. Patients as primary care providers Drivers for change – customer led & information rich society, Patient Choice Moving from paternalism to equal partner status – the clinician as guide (Choice) Emerging evidence that involvement in own care improves outcome Intellectual contracts: compliance to concordat/ rights and responsibilities

11. Patients as primary care providers Using diabetes, patient education and self- management pack introduced (Desmond) LTC team tasked with developing models for empowering patients (e.g. patient run group clinics) through use of expert patient groups Making use of the media to bring about change Practices using techniques to encourage self management

12. Future work Phased implementation of managed clinical networks commencing April 05 Grounding of a foundation community through health and social care community leaders Evaluation of networks and other methodologies employed to indicate if outcomes are as expected Further involvement of patient and user groups with social care