Midlands PHM Academy · Core Team events 12 Analyst Academy events 5 Analyst masterclasses 3...

Population Health Management

NHS England and NHS Improvement

Midlands PHM Academy5th March 2020



WelcomeKaren Bradley and Simon Bourne

The Strategy Unit



Why a Midlands PHM Academy?

Ruth LemiechHerefordshire and Worcestershire STP



Programme OverviewLucy Hawkins and Fraser Battye

The Strategy Unit

Our starting points

R&D not factory

Inspire, provoke, enjoy

Mix of

theory and

practice –

learn by

doing

A one-year programme

won’t ‘fix it’…build

enthusiasm, capability

and legacy

Early days on PHM: will be

mixed understanding

Demand / starting positions will

vary across STPs

Analysts are fundamental and (currently) badly used

Touch multiple parts of

local systems

Share everything (NHS

pays once)

Do with, not to or for

PHM requires multi-disciplinary teams…so:

Dedicated site to share products and promote legacy

The Midlands PHM Academy…

Core Teams Analysts

Leaders

Webinars

Open Events

Masterclasses

Core Teams

Homelessness

Children and Young

People in Crisis

Developing a

strategic approach

to PHM

High Intensity

Users

Diabetes

Social Isolation and

Frailty

Creating a

culture of

stewardship

Defining

population sub-

groups

Learning about

(and from)

populations

Using Logic

Models to

understand

impact

Measuring

what matters

Influencing

stakeholders

Analysts

Problem

structuring and

communicating

analytical results

An introduction

to actuarial

modelling

Risk prediction

and population

segmentation

The Science of

Improvement

Needs

assessment

and opportunity

analysis

Impact

assessment

and evaluation

Leaders

Webinars

Open Events

Masterclasses

System Leaders

Symposium

Analytics for

Leaders

Logic Models

webinar

Qualitative methods

webinar

Systems Leadership

webinar

Using evidence

webinar

Introduction to

PHE’s PHM tools

webinar

Introduction to R

masterclass

Automation using R

masterclass

Population

segmentation using

cluster analysis

masterclass

Risk prediction using

logistic regression

masterclass

Introduction to

machine learning

methods

masterclass

Perspectives on

PHM

Webinar series

The Midlands Population Health Management AcademyWhat did we achieve?

We ran:

7 Core Team events

12 Analyst Academy events

5 Analyst masterclasses

3 Analytics for Leaders

sessions

10 webinars

2 End of year events

11 STPs across the

Midlands took part

The PHM Academy website had over

2,000 users and

nearly 4,000 interactions

We had around:

125 Core Team attendees

300 Analyst academy

attendees (phase 1 and 2)

70 Masterclass attendees

85 Analytics for leaders

attendees

250 Webinar listeners

Check out our website for more information, all

event outputs and webinars here!For Core Team events:

Rated average of 7+ out of 10 for enjoyment

Most valuable elements: team work, networking with other STPs and subject knowledge shared by

the faculty

60% or more found that

sessions increased their knowledge of PHM

For Analyst Academy events:

70% ranked learning from

the sessions as 4+ out of 5

Most described the programme as

'informative' and

'challenging'

https://midlandsphmacademy.nhs.uk/

1: PHM can’t be a niche concern Demystify and engage

2: PHM’s limiting factors are ‘human’ and cultural Value relational skills

3: System working isn’t easy PHM can illustrate and develop it

4: PHM is fuelled by analysis Make (far) better use of analysts

5: PHM turns analysis into action Decision makers…see 4 (and DSUs)

6: Answers are not just in the data Keep sight of the citizen

7: PHM requires rare skills Public health has many of them!

8: PHM is an emergent practice NHSE/I regions can add significant value

Impromptu Networking

This Photo by Unknown Author is licensed under CC BY-NC-ND © Liberating Structures

http://xeloromero.com/tag/business

https://creativecommons.org/licenses/by-nc-nd/3.0/

Question 1: What are you hoping to learn today?

Question 2: What are your reactions to what you’ve heard so far?

Question 3: What do you think is next for PHM?



STP Core TeamsSession 1

In this session…

The Black Country and

West Birmingham STP

Combining Analysis and

MDT working to improve

young people’s Physical

Literacy

Nottingham and

Nottinghamshire ICS

Engaging the wider

system in the PHM

agenda

POPULATION HEALTH MANAGEMENT

10 tips!

Copyright © NHS Nottingham City Clinical Commissioning Group 2019. This document can be used or reproduced freely for non-commercial purposes.If all or part of the documents be reproduced, we request that the source and

Copyright owners be acknowledged.

1. PHM is complex, but you can choose not to boil the ocean.. Create a simple approach.. Choose little steps to achieve big transformations.

2. Begin the IG process as early as possible. There is a lot of data out there that is useful. Start the conversations within your system. (don’t forget wider determinants!)

3. Be clear on your outcomes. if you don’t have clear outcomes, you cannot target your interventions… simples!

4. Don’t get hung up on the segmentation process. it is a means to an end, and can be sliced anyway your system feels is relevant..

5. Pilot PHM on a test area, but ensure you have an integrated membership. Health only influences up to 11% of an individuals health and wellbeing, so wider stakeholders is imperative.

6. We cannot afford to buy fish from our own pond! Use and develop local resources… Research, Public Health, develop local resources wherever possible – You want a rod, not a fish!

7. Ensure the data you produce is meaningful. Commissioners and providers want to do the right thing, but at the moment financial pressure is on… Use PHM to help, not hinder.

8. Leave finance until last (sorry guys)… this way you will sustain clinical engagement, and will be focussing on where variation is, not where money is! (hold your nerve.. money will follow improvement)

9. Have a clear 12 month plan and ensure your PHM decisions support group are updated on a regular basis.

10. Be prepared to be ignored. It’s not personal.. Your system has a million priorities.. You are one of them, but lower down the food change. The nudge theory works… slowly slowly!



Break



STP Core TeamsSession 2

In this session…

Herefordshire and

Worcestershire

Understanding high

intensity users

Derbyshire

Developing a strategic

approach to PHM

Shropshire, Telford and

Wrekin

The good, the bad and

the…beautiful when

taking a PHM approach

Shropshire, Telford & Wrekin core & analyst group

• Gail Fortes-Mayer, Tracey Jones, Liz Walker, Beth Emberton & Craig Lovatt- CCGs

• Helen Potter, Damion Clayton & Anne-Marie McShane – T&W Council

• Rachel Robinson, Mark Trenfield, Craig McArthur & Gordon Kochane – Shropshire Council

• Angela Cook & Steve Price – ShropCom

• Raj Uppal – SaTH

• Adam Pringle – GP lead

• Penny Bason - STP

How have we have taken learning into action?• Collectively worked to narrow focus and agree how to work

together on a PHM approach

• Analysts joint working across organisations and the beginnings of an analyst network

• Developing the PHM approach to diabetes

• Creating PHM template for analysts

• Developing a data set for diabetes

• Setting ambitions for additional data and joint working

• Research into attitudes and perceptions of type 2 diabetes

• Developed an engagement plan and working with experts to deliver

• Working with the CSU on return on investment and actuarial analysis

• Skills mapping audit

• Developing plan for improving outcomes for people newly diagnosed with T2 diabetes

The not so good

• Leadership – internally, we didn’t get our roles right with the core group

• System leadership –securing the adoption and spread of PHM across the system is slow

• Understanding from the beginning – theory vs practical application

• Examples of practical applications earlier in the process would have aided understanding

• Speed required vs ability to gain understanding, to learn and deliver, in addition to business as usual

The good

• Collaborative working, across organisations

• Improved our understanding and relationships with analysts

• Developed an appreciation of each others lenses

• Feel like we now really understand population health management

The good, the bad and the…. beautiful

The beautiful - light bulb moments

• Culture of Stewardship –

• Creating a culture where decision quality is important, person centredcare, truly involving people in decision making

• Engagement

• Insight and understanding of local people’s needs, attitudes and perceptions, truly understanding what matters to people

• Workforce/ staff / culture

• Involvement, developing a new way of working, creating a phm culture



Lunch



Professor Sir Muir Gray

Resources

Need

Need + Demand

1. What is the challenge

…Resources: •Clinician and patient time • leadership bandwidth •carbon•money

All of these are finite

2019 2024 2029

What are the drivers of demand?-

Source: Office for Budget Responsibilityhttps://obr.uk/docs/dlm_uploads/Health-FSAP.pdf

INFLATION

What are the drivers of demand?


INFLATION

POPULATION AGEING

What are the drivers of demand?-

INFLATION

POPULATION AGEING

“inexorable rise in the volume and intensity of clinical practice”


2. Planning for 2025

3 Have a common doctrine

4. Training for three activities – Staff college

tactical operational strategic

5. Learning from and with others..aaction learning is continuous process of learning and reflection that happens with the support of a group or ‘set’ of colleagues, working on real issues, with the intention of getting things done. Source: (McGill I, Brockbank A. (2004) The Action Learning Handbook. UK. RoutledgeFalmer (p.11))

The aim is to create a community of practice for people involved in our learning programmes, because in the words of Etienne Wenger “Placing the focus on participation has broad implications for what it takes to understand and support learning. For individuals, it means that learning is an issue of engaging in and contributing to the practices of their communities. For communities, it means that learning is an issue of refining their practice and ensuring new generations of members.”Source: Wenger, E. (1998) Communities of Practice: Learning, Meaning, and Identity. Cambridge University Press. (p.7).

Culture

Process

Structure

Culture

Process

Structure

Where efforts are focussed Where the impact is

7. Create the culture of stewardship

8. Change how people think and feel



Al MulleyThe Dartmouth Institute

PHM for Longer Health With Wellbeing:

The Need for Specialist and Generalist Skills

Two new goals from Richmond House on 27 February

‘I want to set 2 goals for our healthcare system. One is a clinical goal, the

other a goal of ‘user experience’. Both are equally important. Each

reinforces the other.

1. The ultimate clinical goal is to increase healthy life expectancy in this

country. As a nation, we have set the goal of 5 more years of healthy

life expectancy by 2035. Not just adding years to life but life to years.

But not enough on its own. Everyone in the NHS goes to work to serve

patients…. Indeed, the NHS serves our country… by giving peace of mind

.

2. Increase public confidence in the NHS. Confidence that the NHS will

always be there for us. That the NHS will look after us and care for us

with dignity and respect. That it will treat me as a person with a history

and a future, not just a series of unconnected clinical episodes.’The Rt Hon Matthew Hancock

‘We need to combine generalist and specialist skills’

Professor Chris Whitty, CMO

Malcolm Gladwell’s Outliers: The Story of Success

Matthew Syed’s Bounce: The Science of Success

• ‘Think of the damage done to the

governance of Britain by the tradition of

moving Ministers….’

• ‘John Reid was moved no less than 7

times in 7 years. This is no less absurd

than rotating Tiger woods from golf to

baseball to football to hockey.’

Range: Why Generalists Triumph in a Specialised World

• Learning, Fast and Slow

• Desirable difficulties; the generation effect

• Distributed practice with repetition less

important than struggle

• Mixed practice (interleaving) to differentiate

types of problems and match them to strategy

• Expanding Your Range

• Don’t feel behind; start planning experiments

• Doctors / scientists are often not trained in the

logic of their tools

The Diagnostic Process: Conceptual Schemes for Classification

The Diagnostic Process:Fast and Slow, Matching Problems to Strategy

Range: Why Generalists Triumph in a Specialised World

• The Cult of the Head Start

• Kind learning environments or wicked domains

• Strength in the ability to integrate broadly

• In a wicked, world skill is in avoiding the familiar

What the Wicked World Demands

• Conceptual reasoning that can integrate ideas

in ways that work across contexts

• Breadth of training is needed for breadth of

knowledge transfer

Perspective on Specialist & Generalist Skills: The MGH

Making Health Care Decisions

You don’t have to choose… but if you did, which would it be?

± or

Capabilities, Measures & Tools for Integrated Care System Learning

Theory of Change Logic Models

coope

PREMs for Engagement &Measures & Tools for Teamwork

• Define an intended impact for

a chosen population and

develop a logic model

• Set learning priorities and

assess data and metrics

• Embed measurement logic for

real-time evaluation

• Identify interdependencies

across roles & offer tools for

mutual accountability.

WORKSHOP 1

Using Logic for Learning

• In outcomes & costs by

making visible processes

• In intervention rates by making

visible preferences

• In health & wellbeing by

making visible patients’ needs

and wants

• In resource allocation across

localities by understanding

assets & governance

WORKSHOP 2

Learning from Variation

• Focus on frontline teams’ need

to learn from patients

• Deliver the care they need &

want - no less but no more

• Allow no avoidable ignorance

about what is possible and

what would be valued

• Show manifest respect for what

matters most when trade-offs

are necessary

• Focus on patient-reported

measures including goals,

needs and preferences

• Measure decision quality and

the teamwork needed to make

high quality decisions

• Span boundaries for learning

across determinants of health

• Achieve real-time data &

feedback to learn & adapt

WORKSHOP 3

Delivering What is Valued

• Build teams by establishing

safety, sharing vulnerability

and defining purpose

• Build teams for learning

across distances, power

hierarchies, professional

expertise & organisations

• Measure & reward quality of

decisions and teamwork

• Leverage IT to support both

• Distinguish innovation from

improvement and organise

accordingly to support it

• Hold innovation leaders

accountable not for ongoing

performance but for learning

• Ensure innovation leaders

flexibility to define new roles

• Identify and learn from similar

efforts elsewhere

• Agree common purpose &

agenda for collective impact

• Align intrinsic motivation across

interdependent roles with

simple rules & measures

• Communicate continuously with

common measures of mutually

reinforcing activities

• Assure backbone support for

cascading collaboration

• Establish rules & norms that

define practices & interactions

between organisations to tackle

collective problems

• Anticipate and mitigate sources

of policy resistance

• Lead together on behalf of the

system, not own organisations

• Improve system effectiveness by

reallocating & reinvesting

WORKSHOP 5

Delivering with Teams

WORKSHOP 4

Measuring What Matters

WORKSHOP 6

Organizing for Innovation

WORKSHOP 7

Leading for Accountability

WORKSHOP 8

Governing for Stewardship

RightCare Commissioning for Value

Learning from Process Variation

Learning from Preference Variation

PREMs for Integration & Coordination

Value Compass for Population Health

Person Centred Delivery & Learning

Learning What is Valued

Organising Teams for Innovation

Understanding Innovation ROI

Innovators’ Accountability for Learning

Agreeing & Executing Value Proposition

Monitoring Impact across Contexts

Overcoming Policy Resistance

Aligning Incentives with Purpose

Frontlines of Delivery System LeadershipNu

mb

er

of

Stak

eh

old

ers

Inte

rde

pe

nd

en

ces

(Co

mp

lexi

ty)

Measures of Patient Engagement to Agree Goals, Needs & Wants

Tools & Measures for Care Integration &

Quality of Teamwork

Tools to Aggregate Outcomes, Preferences &

Costs for a Population

Measures to Learn while Guiding Implementation

of New Care Models

Measures of SDM, MI, Patient Preferences and

Decision Quality

Tools to Target Learning from Variation in Rates & Underlying Preferences Measures to Test Impact

and ROI Assumptions for Cross-Sector Investments

Tools to Partner across Health Organisations for

Needed Capabilities

Tools to Achieve Spread and Scale while Learning

across Localities

Measures to Assess Health Organisations’Readiness to Deliver

Measures to Assess Health & Care Collective Impact

across Populations

Tools to Govern for Sustainability across

Health & Care Sectors

Mutual Accountability for Whole-System Learning from the Frontlines to System Leadership

New frontline care teams hold themselves accountable for being the ‘learning front end’ of a sustainable ICS with

‘micro-commissioning’ informing joint ‘macro-commissioning’.

. Managers and system leaders hold themselves accountable for decisions informed by patients’ health and care needs and wants as they organise for innovation, fund

transformation, and reallocate capacities to achieve a fit-for-purpose integrated system.

60

Effective Teamwork and Directional Leadership

Balancing Technical and Relational Competencies Directional Leadership

Additional Slides for Discussion

Additional Slides for

Discussion

GP

network

GP

network

GP

network

GP

network

GP

network

Very high

risk

Medium risk

High risk

No / Low

risk

Practice / Network based MDT led proactive management

GP &

Geriatrician

Social careCommunity services (CTT,

Nursing) and mental health Vol / Third sector

GP

network

Dynamic identification of people at risk

Proactive multidisciplinary management of people with complex and escalating needs

Supporting healthy independencePreventative services, lifestyle support and community groups

2

Care coordinator

Person/ carer

Person/ carer

My care plan

3

4

Trusted assessment between

members of MDT

Integrated model of care – proactive management in community

1

6

5

Proactive management

Key components:

1.Dynamic identification of people at risk

2.Practice / Network based MDT led

proactive management

3.Development of people owned care

plan (or ‘my life/care plan’)

4.Care coordinator (or care lead) for

people who need more support in care

coordinating their care

5.MDT to trust each other (assessments

to start with)

6.Continued support for healthy

independence using community

groups and vol / third sector

Learning about Your Population Subgroup: Risk Stratification

Learning about and from Population Subgroups

Assuring Decision Quality: No Avoidable Ignorance

http://www.goinvo.com

‘I didn’t need this new hip. All

I needed was a bannister so

I could get down to see the

postman!’

‘You forgot to ask about the

dog. It died. That’s why she

doesn’t get out or take care

of herself as much.’

Learning about Your Population Subgroup: Engaging to Learn

http://www.goinvo.com

Measuring to Learn Population Needs and Personal Wants

Systems Thinking across All Stakeholders



PHM People Strategy: Creating teams, gaining insight and

influencing others

Margaret MulleyThe Dartmouth Institute

Go to www.menti.com and use the code 93 91 58

Mentimeter Poll

http://www.menti.com/

What are the key elements of a PHM People Strategy?•Who should be included to work with you on PHM projects across all the stages?•What are the most important characteristics you need to look for?

When should you engage the identified people?

How might you engage them?

Agenda

Approach derived from Discovery

Design: Design Thinking for Healthcare

Improvement . Katz, Driver and Mawer

Stanford Medical School

KEY TEAMS / PEOPLE

•Project Support Teams•Core

•Sponsors

•Partners

•Adopters

•Scalers

•Service Users

•Frontline service delivery staff

•Experts

Elements of a PHM People Strategy

WHAT, HOW and WHEN?

•Range of competencies

•Different activities at different phases of a project

•Different timing

‘You can design and create and build the most wonderful

place in the world. But it takes people to make the dream

a reality.’

Walt Disney

Setting the Stage: Scoping and Preparing

Core

High Trust

Small size

High Engagement

Diverse Membership

Clear Roles

Sponsors

Small Size

Be involved in key decision points

Check in at least every 2 months

Join periodic report-outs

Provide advice, consent & endorsement

Partners

Keep them informed of the specific reason for

their engagement

Share progress

Share credit

Adopters

Deeply engaged end-to-end

Share progress regularly

Share stories

Make your ideas visual & tangible

Scalers

Meet early

Share assumptions & learning

Include during pilots

Build your Team: Project and advisor teams to support rapid decision making across the life of a PHM project

Building your Team: Mindset for Core team members

Optimistic

Empathic

Inclusive

Experimental

Curious

Action-oriented

•People whose own agendas will benefit from your project

•People who have a track record of ‘getting things done’

•People with skill sets that complement your own

•People who are spoken highly of by leaders and frontline stakeholders

•People who are excited about the problems you want to work with

•People with whom you feel you can have a vibrant working relationship

•People who are fun to work with!

Building your Team: What a Team Leader should look for

‘Facts bring us to knowledge; stories bring us to

wisdom.’

Rachel Naomi Remen

The Discovery Stage

WHO?

Identifying sources of inspiration and preparing to meet people in real-life contexts

In-context interviews, observations & immersion•People with a unique point of view or experience that is directly relevant•Are naturally talkative and opinionated•Are interested in your agenda, not their own•Have witnessed a change in practice•Are particularly frustrated by the current situation•Have witnessed reluctance to change

Discovery: Planning your Exploration

Discovery: A Balance of Storytellers

User Needs

Insights

Point of View Statements

Discovery: Synthesizing Your Work

Curiosity

Empathy

Inclusiveness

SAY THINK

DO FEEL

‘We want to give ourselves the permission to explore lots

of different possibilities so that the right answer can

reveal itself.’

Patrice Martin

The Synthesis Review

and Idea Generation Stages

WHO? •Sponsors: Leaders and Decision makers •Service users who are directly impacted•Partners•Frontline staff•Experts

Synthesis Review: Engaging stakeholders to test Insights and ’How Might We’ (HMWs)

WHAT? to ask•Which insights feel most surprising, meaningful or consequential•Which HMWs feel most promising, exciting or impactful

WHO?•Sponsors: Leaders and Decision makers •Partners•Service users who are directly impacted•Frontline staff•Potential Adopters

Generation: Engaging stakeholders to test your Concepts

WHAT? you are seeking•Any flaws, cracks or gaps • To show your attitude towards services delivery team members and users•Build momentum and recruit early adopters

‘Do not seek praise. Seek criticism’

Paul Arden

Prototype and pilot

WHO? captures and evaluates the feedback?

•Core Team

What you want to learn

•Features to keep

•Features to increase/add

•Features to decrease/stop

•What are the most important elements?

•Questions that need further exploration

•New ideas to consider

Prototype

WHO? do you capture feedback from?

•Service Users

•Experts

•Frontline service providers

WHO?•Team members with expertise in measurement •Sponsor and adopters – you should have been keeping them informed – but you need to be sure they are very engaged here•Service delivery frontline staff•Service users

Piloting

Achievable

Viable

Feasible

Desirable

A Successful Pilot

An idea that

deserves to spread

Spread

From Possibility to Policy

‘The design is done when the problem goes away’

Jason Fried

‘The challenge is not starting, but continuing after the

initial enthusiasm is has gone’

John Ovretveit

1)What has stood out for you?

2)How will you apply this ‘back at base’?

3)What would you like to know more about?

Discussion questions

Image from: https://www.kpsol.com/benefits-using-

discussion-forums-knowledge-management-environment/

https://www.kpsol.com/benefits-using-discussion-forums-knowledge-management-environment/



Break



Reflections on the better use of intelligence in

health and careMohammed A Mohammed



The National Agenda for PHM

Bob Ricketts



What’s next for the Midlands Academy

Alison Tonge


Building on the 19/20 foundations

Alison Tonge

Regional Director of Commissioning

105 |105 |

Population Health Vision & Mission

Mission

To achieve our vision over the next 5 years we will improve

our populations health, reduce variation, integrate care and

systems to support people to live healthier lives

Vision

To develop world leading health and care by reducing

health inequalities and improving outcomes

106 |106 |

Developing PHM Capability and Capacity across the Midlands 20/21

Presentation title

To build upon the traction already made within the Midlands by further developing PHM approaches at Regional, System, Place and PCN level. Whilst learning from national PHM programme and incorporating that into our next phase.

We would like to develop a bespoke region wide programme that builds whole population and system approaches at every level of the health and care landscape

The 20 week PCN programme is absolutely key, however because of our more mature PHM foundations, through focussing of region, system, place we sustain traction at every level. This approach is outlined in the slides below.

107 |107 |

Developing the Midlands PHM Academy –Priorities for 2020/21

Region: Setting strategy, developing system enablers, integrating care and supporting collaborationThrough: Collaborative Commissioning Forum, Chairs development forum, Decision Support Unit (DSU) Board, Regional Integration Programme Boards, PHM Community of Practice, Clinical Stewardship, Programme oversight board for Inequalities and Prevention

System: Support a sustained focus on improving population health through intelligence led decision making to facilitating changeThrough: Integrated commissioning boards, local DSU development, enabler of place and strategic design, LG collaboration

Place: Developing population based integrated care, designing, developing and improving care, local enablers and leadersThrough: Primary Care integration boards, support from system DSU, service transformation and local professional networks, LG, DPH’s

Neighbourhood: locality driven service and service re-design reducing inequalities and preventing ill health.Through Population health management PCN Development programme outlined in Annex A, digital enabling and workforce development supported by local and regional DSU

C

l

i

n

i

c

a

l

S

t

e

w

a

r

d

s

h

i

p

Partnerships, Collaboration, Community and People

108 |108 |

• PHM Community of Practice

• Developing Strategic Commissioning

• Commissioning Integration

• Developing Clinical Stewardship

• Enabling Provider Alliances

• PHM in Primary Care Networks

• Enabling PHM through developing financial approaches

Academy Core Components

109 |109 |

• PHM Community of Practice - The midlands community of practice sponsored by a CCG AO supporting the development of best practice PHM in leaders, directors, clinicians and the whole workforce

• Strategic Commissioning - Ensures resource allocation to achieve the most, and focuses on prevention and early intervention. We will support systems to develop their strategic commissioning approaches

• Integration - A new culture of transparency, collaboration and partnership through Integrated Commissioning Boards and Primary Care Integration Boards

• Clinical Stewardship – To enable clinical to take greater responsibility for, and have greater authority over, the use of resources to improve health outcomes

• Developing Provider Alliances - Developing formal integrated accountability for delivery of care to segmented populations for pathways that are of greatest need in terms of demand, quality, sustainability

• Primary Care Networks - Change care delivery through PCNs and their public health, local authority, community, mental health and acute sector partners to start to achieve demonstrably better outcomes

• Developing Financial Approaches - Developing PHM approaches through DoFand financial systems an a enabler of PHM and system first methodology

Developments in 20/21

110 |110 |

Why do we need our Population Health Academy

WE KNOW - Our health and care needs are changing; we are living longer with more multiple long term conditions like asthma, diabetes and heart conditions.

WE KNOW - Much of this is down to behavioral risk factors and where we live rather than the health and care services treating us.

AND - Population health management helps us understand and predict future health and care needs so be can better target support, make better use of resources and reduce health inequalities



An introduction to the Midlands Decision Support

UnitsPeter Spilsbury

Unplanned Admissions

112

Analytical code (using R etc)

Evidence/literature reviews

Mutual technical support/QA (networked problem solving)Collaborative evaluations

Ideas

At scale regionalanalytical projects

113

Analytical code

(using R etc)

Evidence/literature

reviews

Networked

problem

Solving/QA

Collaborative

evaluations

Ideas

At scale regional

analytical projects

114

Fundamental components for a DSU

Analytical insights for the STP/ICS in making strategic choices (as opposed to

performance/business reporting, which should be kept separate yet

connected)

Evaluation of key local initiatives against agreed standards

Support for decision-making processes, using evidence-based methods

Support for evidence informed design of initiatives, including working with

clinical networks

Optional components for a DSU

Create and maintain citizens panels

Local ‘data’ repository/linkage

Training and development of e.g. local integrated teams in foundational

analytical, evaluation and critical appraisal skills

Clinical Leadership and wider engagement

Academic partnerships

Strategic workforce planning

•managed, active knowledge exchange across the Decision Support Network. This will include agreeing e.g. analytical standards that facilitate sharing ; establishing a library function etc

•provision of some specialist training/professional development for practitioners and system leaders

•specialist functions at scale, e.g. ‘improvement analytics unit’ for the Midlands to support complex evaluations

•R&D: developing evidence based analytical methods ( e.g. effective forecasting methods etc); guidance/tools for new decision support functions

•limited rolling programme of large scale analytical projects to address ’big questions’. Selected through extensive engagement and where doing the work once, at scale, will achieve best outcomes and value.

The core functions of the Regional Decision Support Centre will include:

115



Summary and Close

What’s next?

PHM Academy Webinar

17th March, 12:00-13:00Sign up here!

This webinar is for anyone who wants to

learn from what has been achieved in the

Midlands and is thinking about how to

establish a PHM approach in their area.

We will be sharing reflections from

Midlands Academy participants, providing

the opportunity to hear from the team

who led this work, and considering what

the next steps look like in the Midlands.

https://zoom.us/meeting/register/vJcuduigqTIjfqMg5iAT7JHqwfDQ0itu2A

Go to www.menti.com and use the code 93 91 58

We’d love to hear what you thought!

http://www.menti.com/



Safe journey home!

Midlands PHM Academy · Core Team events 12 Analyst Academy events 5 Analyst masterclasses 3...

Documents

Transcript of Midlands PHM Academy · Core Team events 12 Analyst Academy events 5 Analyst masterclasses 3...