A leadership journey - .NET Framework
Transcript of A leadership journey - .NET Framework
London 18th March 2016
UCL Partners
NorthumbriaCreating a clinically led Trust
A leadership journey
David Evans
Chief Executive
Clinical engagement
Training to lead
System redesign to support clinical leadership
Skills for managing organisational change
Developing a new workforce
Northumbria’s clinical leadership model
What does this mean for training?
What could this mean for a career choice?
What is going on out there?
Desire to engage
Appropriate skill set – not simply clinical
Time
Systems to allow engagement
Clarity of process = open & honest
In depth Academic analysis
In depth Academic analysis
or
A slightly quirky view from a Trust that
believes it has made this happen…….
Northumbria’s numbers….
500,300 pop 2,500 sq ml 85%15%
85 ml A1 65:35 Em : El
9,300 staff 500 Docs >1,100 beds
10 I/P sites £ 440 mill 83 , 84
We are a bit odd…..
Stability with flexibility 2 CEs in 20yrs
Willingness to try…
Community Hospital decant
Adult Social Services, Northumberland CC
Rural pressures = drive for innovation
“centralise when clinically better , devolve where
clinically safe”
In the beginning , 1996
Traditional Clinical DirectoratesLeadership on rotationNo trainingNo timeNo systemNo dataMajor distrustMajor non-engagement
= Service Reviews…….& lots of data 3 clicks!
1997:
Clinical Leadership Development Programme
7 days over 9 months
2 + 1 + 1 + 2 + 1
multidisciplinary
collaborative
absolute requirement for management role
a few said “ no thanks “C 17
Trust values
Myers Briggs
CEO / DoF /MD
Change management
NHS £€£€
Business case
Law / corporate manslaughter
Scene setting PO
Peer group support
Work based project
Clinical Policy Group 1998
“ Keeper of clinical governance “
Every clinical manager = 82
+ 6 GPs
Monthly
3 cycles
NSECH
SUIs & governance
Forward thinking
Clinical Policy Group 1998
“ Keeper of clinical governance “
Every clinical manager = 82
+ 6 GPs
Monthly
3 cycles
NSECH
SUIs & governance
Forward thinking
FRANCIS = Soul & conscience
Clinical Leads Forum 2001
Informal grouping
Clinical leads from both sides
-The NHS works well here , it is in no-ones interest to destabilise that
-Any change should be based on patient pathways and for the direct benefit of patients
-No surprises please…..
Formalised 2006
- Speed of change was amazing
2004 :O & G / ITU 7/7 Centralise maternity
Extended working day 08:00 – 20:00
On-call = work Surgery / Ortho 7/7
Sole commitment is to emergency stream & emergency theatres
Rolling Consultant rounds & Rapid assessment clinics
Every patient seen every day
Medicine
Foundation Programme Pilot
Single door point of entry
Consultant led Acute Care Stream = reborn ACPs
ACP 08:00 – 22:00
Split FOH / BOH
Develop H@N Teams – NNP s
All clinically driven on Safety & Quality
7 Day Working
Re- badged ‘ Acute Care Physicians’
Started with 6…
New ways of working
‘ Blurring the boundaries’
Business Units oversee everything
‘ No surprises please ‘
No deals
No £££££
No extra staff.
42 week year
Everything annualised & in your job plan
7 Day Working
Re- badged ‘ Acute Care Physicians’
Started with 6…
New ways of working
‘ Blurring the boundaries’
Business Units oversee everything
‘ No surprises please ‘
No deals
No £££££
No extra staff.
42 week year
Everything annualised & in your job plan
2004 Consultant recruitment
Competencies of a Northumbria ConsultantDeveloped by everyone
2 days
Formal meeting BUD & GM
Psychometrics - Horgan & Neo pi
Clinical scenarios – x 2
1hr 10min structured interview@values
Weighted scoring
70% bar
Tailored welcome
Changed teamsChanged sitesMentorshipY1 PDP in placeKnow & understand strengths & weaknessesNew Consultants’ Programme30%
2006 Foundation Trust
Business Units & service line reporting
BUDs x 4 50:50
Health as a business
Financial consequences of clinicians’ actions
Cost efficiency
No deals , no surprises , no corridor conversations
Control with responsibility & accountability = freedom…
Good things happened
Captured the natural competitiveness
Business Unit..
BUD Exec Director OSM s
Matrons Clinical & site leads Nurses
Finance Data Governance
H R Pharmacist Therapists
I T Patient experience
+/- non-execs
+/- MD
+/- CE
Speciality Boards
Development & evolution:
It seems to have worked for us …..
Each one is different now….
Reports are shorter & crisper
Everyone contributes
There's a little bit of competition
Everything goes on the intranet
Accountants think differently…..
Charts vs Graphs
“ I think a rolling average would really help here “
We have invested a lot
in clinical management …
No longer the Dark Side…
Visible clinical leadership & management
Flat structures , open doors & easy access
Exec / non exec walk around
Board to Ward programme
Board development (PS 2010) Leadership ( HSJ 2013 & 2015)
Clinical lead presentations each month
“ This is the way we do business”
“No corridor conversations or backdoor deals”
Job planning:
A meaningful exercise for both parties…..
Flexibility and annual negotiation
42/52 annualised
Evening & weekend working
Teaching & training - tariff within SPA time
New starters 9:1 , most become 9:2 , some 8:3
General understanding this is not fixed or a right
Extended days , O&G , ACP, ITU …in preparation for ECC
Change of location.
CEA = quality rather than quantity
Safety & quality
LIPS x 4
Safety panels
Quality council
Safety & Quality committee
Safety walk around
Patient Safety Fridays
Feedback
Safety & quality
Mortality reviews
Ward based SPCs
Trust harm rate IHI trigger tool
Dr Foster etc…. Unexpected / high & low risk codes
Trust mortality review
Horgan
< 1% > 3 , 4 x 4
VLADs
Grow a new workforce
Advanced Neonatal Nurse Practitioners , Level II
Night Nurse PractitionersNurse PractitionersAdvanced Critical Care PractitionersSurgeons assistantsSpecialist NursesClinical PharmacistsPhlebotomists
Co-located OOH service
GP Clinical Directors 2013
New ways of working
Protocol driven = the Northumbria way
Handover + SBAR
Shared ownership eg post-op care
Fast track hip & knee
Day case > 95%
POW = POD = PO ½ D
Facilitated discharge & ‘ ticket home’
Ambulatory care
Every change or development ‘ECC proofed’
Why not be radical?….
A whole system change…..
Create a Specialist Emergency Care Centre
Split Elective / Emergency work
24/7 resident Consultant in Emergency Care
Extended working day 7/7 , 9 clinical teams
Change DGH s for elective / community care KIDD.
Develop Ambulatory Care & Frail Elderly
Direct access to palliative care
Builds on our existing decant model
Puts a building around our new ways of working
• ECC location map to do….*
Front line….Emergency Care Consultants 24 / 7 Acute Care Physicians
Surgery x 2Orthopaedics x 2Cardiology + Respiratory + Stroke + Elderly careIntensivistsO & GPaediatrics ( 8 ‘til late )
+ Nurse practitioners / ACCPs
+ Clinical Pharmacists210 beds + 6 theatres + 18 ITU + 2 x CT + MRI + 4 PFAmbulatory care + surgical assessment + mat + paedsEndoscopy + cath lab
NSECH
UK’s first dedicated emergency care centreServe 530,000Merges 3 acute streams into 1Consultant led , 24/7 , 365
9 specialist teamsLinked with Primary Care and Social ServicesHyper-acute stroke
Patient centred = Keogh MAJOR A & E
£££££ ?
£ 200 million over 10 years
£70 + FTFF £90 build
Rest from CIPs & productivity
Emergency Care Centre
2 new Community hospitals
Bed neutrality by 6 to 4 bed bays( A little bit about the politics)
£114.2 mill
2013