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Transcript of Professional Development Programme for Organ Donation “Driving improved organ donation within your...
Professional Development Programme for Organ Donation
“Driving improved organ donation within your hospital”
Making Change Happen
1
Dr Paul MurphyAdam KingDimple Cosgrove
26 May 2010
Professional Development Programme for Organ Donation
By the end of this session, participants will:
• Understand the importance of having a clearly defined vision for Organ Donation and start to articulate their own vision for Organ Donation within their hospital
• Appreciate the benefits of annual planning and reporting to leading Organ Donation within their hospitals
• Understand the skills, knowledge and process required to develop Annual Organ Donation Plans and Annual Reports
• Be provided with practical hints and tips on developing local Annual Organ Donation Plans and Annual Reports
• Understand the roles and responsibilities of the Clinical Leads, Donation Committee Chairs and Specialist Nurses for Organ Donation in the Business Planning Cycle
• Have an opportunity to put theory into practice and build a local plan for organ donation
Session objectives
2
Professional Development Programme for Organ Donation
The progression of your learning journey
On
line T
oo
l: Self-A
ssessment T
ool, Docum
ent Sharing, P
odcasts, Discussion F
orum, P
DP
Atlas,
Program
me P
rogress Tracker
National Kick-Off Event(inc Law & Donation after Cardiac Death Master Class)
Change Management & Leadership Fundamentals
Master Class 1 (Diagnosis of Brain Stem Death and Regional Peer Consulting Group Launch)
Master Class 2(Donor Management & Physiology and Emergency Medicine)
Making Change Happen(Development of action plan to implement changes in Trust)
Master Class 3(Consent / Authorisation)
Donor Simulation & Paediatrics(Additional Subject Areas)
Regional Peer Consulting Groups(Coaching & networking event)
National Review Event(Review of Programme and Ethics and Media Skills Master Class)
National Kick-Off Event(inc Law & Donation after Cardiac Death Master Class)
Change Management & Leadership Fundamentals
Regional Peer Consulting Group(Introduction and coaching in action learning sets)
Making Change Happen(Development of action plan to implement changes in Trust)
Regional Peer Consulting Groups(Coaching & networking event)
National Review Event(Review of Programme and Ethics and Media Skills Master Class)
Podcasts: Eye & Tissue D
onation, Epidemiology of D
onation & Transplantation, Audit &
Statistics and PD
A: interpretation & Action
Online Tool Self Assessm
ent Tool, Docum
ent Sharing, Podcasts, Discussion Forum
, Program
me Atlas, Program
me Progress Tracker
All Clinical Leads Non Clinical Champions
3
Professional Development Programme for Organ Donation
Agenda
1 Change Management and Leading Fundamentals Refresh 09:30-09:55
2 Developing your vision for Organ Donation 09:55-11.15
Break 11:15-11:30
3 The Annual Organ Donation Planning Cycle 11:30-11:50
4 Developing an Annual Organ Donation Plan 11:50-12:05
5 Developing an Annual Report 12:05-12:20
Lunch 12:20-13:00
6 Managing and Tracking Against Plan 13:00-13.20
7 Building a Local Plan (Part A) 13:20-14:30
Break 14:30-14:45
8 Building a Local Plan (Part B) 14:45-15.30
9 Summary and Close 15:30-15.45
4
Professional Development Programme for Organ Donation
During the Fundamentals of Leading Change session we:
• Identified what can help to make change successful and what are the common reasons for failure
• Identified the local barriers to promoting change within your hospitals
• Introduced the change frameworks which you can use to guide change Management for Organ Donation
• Discussed the importance of understanding who your stakeholders are to any change effort and tools for identifying and analysing your stakeholders
• Defined the three way leadership between Donation Committee Chair, Clinical Leads and Specialist Nurse for Organ Donation and your respective roles as Change Leaders
• Discussed techniques for tackling difficult conversations
• Started to plan actions to identify and implement the changes you can make within your own hospital
Fundamentals of Leading Change - Refresh
5
Professional Development Programme for Organ Donation
Understanding the bigger picture
6
PDP Strategic Big Wins
Professional Development Programme for Organ Donation
What success looks like for the PDP
• The PDP for Organ Donation will contribute to the Organ Donation Taskforce objective
to increase Organ donation rates by a minimum of 50% within 5 years – Making organ
donation “Usual”
• To achieve this vision the Programme will focus on 6 big win areas:
8
Professional Development Programme for Organ Donation
What does success look like under each of the 6 big wins?
• We would like you now to split into six groups, one group per strategic big
win
• For your strategic big win we would like you to describe the future state of
what a gold standard hospital would be doing under this objective i.e.
What would people in the hospital be doing around organ donation from a clinical
perspective?
What would the Organ Donation Committee be doing?
What behaviours would you see?
What outcomes might have been achieved / what success stories are there?
• Put your ideas on post-it notes and stick these on a flip chart
• Group discussions for 30 minutes and then 30 minutes feedback
9
Professional Development Programme for Organ Donation
What can happen without an effective strategic direction?
• Lack of general direction and lack of a clearly defined ‘future state’
• Failure to appreciate the longer-term interests and too much emphasis on
short-term success
• Actions are un-coordinated and without shared purpose or meaning
• Ineffective decision-making and poor prioritisation
What is needed is a compelling view of what the future of Organ
Donation looks like in your hospital
Why do you need a strategic direction for improving Organ Donation?
10
Professional Development Programme for Organ Donation
Your strategic direction for Organ Donation must be developed in the context of the wider vision for Organ Donation and
the local visions of your individual hospitals
Ensuring alignment of your Organ Donation Strategic Direction
NHSBT will identify the common organ donation themes and support Donating Hospitals to shape their local strategic direction for organ donation in alignment with the Taskforce vision
Organ Donation Taskforce Objective
To increase organ donation rates by 50% within 5 years
Local Hospital Organ Donation
Strategic Direction
Local Hospital Organ Donation
Strategic Direction
Local Hospital Organ Donation
Strategic Direction
Local Hospital Organ Donation
Strategic Direction
Local Hospital Organ Donation
Strategic Direction
Overall Hospital Vision
Overall Hospital Vision
Overall Hospital Vision
Overall Hospital Vision
Overall Hospital Vision
Annual Plan Annual Plan Annual Plan Annual Plan Annual Plan
Local Organ Donation strategies will be based on local needs, the overall hospital vision and the ODTF objectives
11
Professional Development Programme for Organ Donation
Ensuring your strategic direction for Organ Donation is effective
Build a believable image of how Organ Donation will be in the future in your hospital
Is it realistic?
Ensure that this image is inspiring, realistic and achievable so that people are motivated to act as the vision intends them to
Is it achievable?
Align the vision to the interests of key stakeholders, the wider organisation and those of the national agenda for Organ Donation
Is it meaningful to a wide audience?
Focus the vision on clear priorities and ensure that it is easily understood
Does it eliminate confusion and support decision making?
Create a vision that is easily communicated to the rest of the hospital
Is it concise and does it appeal to people’s emotions?
Avoid visions which are too prescriptive or constrain individual initiative
Is it flexible?
12
Professional Development Programme for Organ Donation
Examples of Organ Donation Visions
Transplant Australia exists to enrich and celebrate life. Our vision is for Australia to lead the world in organ and tissue donation and transplantation - saving lives, improving quality of life and providing much needed care and support.
The vision of Donate Life America is to ensure that every person in the U.S. understands the need for organ and tissue donation and accepts donation as a fundamental human responsibility.
We wish to see organ donation become a usual rather than unusual event as part of end-of-life care across the NHSEach individual should be given the choice and opportunity to offer their organs for the purposes of transplantation after their death. This choice should not be denied by the assumptions of NHS staff or a lack of facilities and infrastructure
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Professional Development Programme for Organ Donation
• The process involves the combination of both creative and logical approaches
• Development of the vision may involve several iterations as you test your ‘hypotheses’ and validate with your colleagues and stakeholders
• The type of data which you can use to input into the development of your strategic direction include:
Review of the Organ Donation Taskforce Report and the Programme’s 6 Strategic Big Wins
Assessment of the national legal and policy frameworks for organ donation
Assessment of your hospital’s overall vision
Analysis of current Organ Donation practices within your hospital
Benchmarking against Organ Donation best practice within other hospitals
PDA data
How do you develop a strategic direction?
Draft strategic direction and collect data to test it
Refine the direction and validate with others
Communicate and embed the strategic direction
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Professional Development Programme for Organ Donation
Communicating your strategic direction to your colleagues and the wider hospital and receiving their buy-in is essential to the vision’s success
Ways of communicating your vision include:
• Written and verbal communication e.g. the Annual Organ Donation Report, the Annual Organ Donation Plan, training materials and other communications
• Encouraging discussion of the Organ Donation strategic direction within your hospitals and amongst colleagues
• Reinforcing key messages by linking it to the day-to-day activities of the hospital
You know your vision has been embedded when:
• Stakeholders are able to articulate the strategic direction and it’s impact in their own words
• The strategic direction is discussed outside of situations in which it is required
• Elements of the strategic direction become part of the organisational culture and ‘the way things are done around here’
Communicating your vision for Organ Donation?
15
Professional Development Programme for Organ Donation
What is the Annual Organ Donation Planning Cycle?
17
The annual organ donation planning cycle provides a structure of analysis, planning and reporting around which you can make the right changes to improve organ donation
Purpose of planning cycle:
• Ensure content of plan reflects realistic ‘path’ from current state to objectives
• Ensure delivery of plan is on-track and responds to changes in circumstances
• Ensure oversight by Executive Board
Professional Development Programme for Organ Donation
What does the Organ Donation Planning Cycle look like?
Benchmarking Data
Mid Year Review-
ODC Meeting
Annual Organ Donation Plan
July
October
January
May
June
December
November September
March
February
April(Financial Year begins)
AugustAnnual Report
Key
Organ Donation Planning Cycle
Annual Report
Annual Organ
Donation Plan
Benchmarking data
Benchmarking data
Mid Year Review
Present to Executive
Board
CLOD, SNOD & DCC*
PDA
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Professional Development Programme for Organ Donation
How can you plan effectively in line with the Organ Donation plan?
1. Assess: Conduct analysis of internal and external environment
to identify issues and potential opportunities
2. Plan: Consider objectives to overcome issues / make the
most of opportunities and establish activities and
when these would happen to achieve objectives
3. Implement: Deliver & track against plan, as well as reporting
against progress
Planning is not a one off activity – it requires regular assessment of progress and
interventions. Remember 3 simple steps: Assess; Plan; and Implement
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Professional Development Programme for Organ Donation
Key Assessment Activities
Assess
Fishbone Analysis
Potential Donor Audit (PDA)
SWOT Analysis
Unit Profile Stakeholder AnalysisBenchmarking
To
wha
t ex
tent
is t
his
pers
on/
grou
p af
fect
ed b
y th
e C
hang
e?
High
High
Low
LowInfluence
Imp
act
20
Professional Development Programme for Organ Donation
Potential Donor Audit - Introduction
What is it?
The Potential Donor Audit (PDA) is an audit of all deaths occurring in Intensive Care
Units for patients under the age of 75. A recent initiative is extending the audit to
Emergency Medicine departments, however, this is still in progress.
Aims of the PDA?
•Determine the potential for solid organ donation
•Understand why solid organs were not retrieved where potential recognised
•Identify all patients for whom death was diagnosed following brain stem tests
•Raise the profile of solid organ donation
•Heighten awareness of donation issues with clinical staff
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Professional Development Programme for Organ Donation
What is it?
• An Annual Organ Donation Plan is a formal statement of a set of ‘Organ
Donation goals’ for the hospital, the reasons why they are believed attainable,
and the planned interventions (or activities) for reaching those goals
What are the benefits?
• Clarity of vision
• Objectives and actions
• Describe the metrics
• Define the seriousness of the venture
What is an Annual Organ Donation Plan?
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Professional Development Programme for Organ Donation
What is it?
• An Annual Report is a comprehensive report on an Organ Donation team’s activities
throughout the previous year. It is intended to provide their stakeholders including NHSBT
with information regarding the team’s activities and performance against their goals.
What is the purpose?
• The Annual Report is intended to provide their stakeholders including NHSBT with
information regarding the team’s activities and performance against their goals in an easy
to digest format
• Development of the report helps the Organ Donation team to reflect on their performance
from the previous year and aid their future strategy development
• The Annual Report is a celebration and communication of past and recent successes
• Communicating the Annual Report within and outside of the local hospital will help to
share lessons and develop learning
What is the Annual Report for Organ Donation?
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Professional Development Programme for Organ Donation
Annual Organ Donation Plans are a decision making and communication tool and should be determined by the specific goals and stakeholders of the Organ Donation team. Typical high level structure includes:
What does an Annual Organ Donation Plan look like?
Content Description
1. IntroductionWhat are their main priorities for the year, what is the purpose of the Annual Organ Donation Plan?
2. BackgroundWho is in the team, what are the primary roles of the Organ Donation Team. What’s happening in the hospital that would impact Organ Donation activities?
3. Policy FrameworkWhat national and legal polices have changed over the last year, how will this affect the key targets for the following year?
4. Strategic DirectionWhat are the high level strategic plans for the Organ Donation Team and their hospital?
6. Action PlansDetail actions against the objectives and indicate timelines for completion as well as owners, risks and issues
7. Risks/ IssuesWhat are the likely key risks and challenges inhibiting delivery against the action plan and what mitigation strategies can be put into place to minimise the impact?
8. Performance Indicators and Monitoring Arrangements
How will the Organ Donation team measure success against each of the key targets for the following year?
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Professional Development Programme for Organ Donation
Annual reports consist of but are not limited to the following contents:
\
What does an Annual Report look like?
Content Description
Introduction Introduction to the report including messages from the Donation Committee Chair and Clinical Lead
Overview and Background Feedback from the Donation Committee and the Strategy and Vision for Organ Donation
Summary of the Year Summary of performance for the year based on objectives set in the Annual Organ Donation Plan
Performance Variances and Action Plans
Detailed review of variances against the action plans and set objectives
PDA Benchmarking Benchmarking of Donation rates across hospitals and regions
Local Initiatives Topics to include may include local activities to increase Organ Donation rated, promote awareness or responses to change in law or policy
Future Development Vision and desired actions for the following year – Where does the Organ Donation Team want to be in a year’s time?
Possible risks/pressures Highlight risks and issues identified through the year, what are the challenges, how are the Organ Donation Team going to overcome these?
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Professional Development Programme for Organ Donation
SMART Objectives
S M A R T
Specific Measureable Accurate Realistic Timely
Is there a description of a precise or specific behaviour / outcome which is linked to a rate, number, percentage or frequency?
Is there a reliable system in place to measure progress towards the achievement of the objective?
With a reasonable amount of effort and application can the objective be achieved?
Can the person with whom the objective is set make an impact on the situation?
Do they have the necessary knowledge, authority and skill and is it relevant to the organizational goals and aims?
Is there a finish and/or a start date clearly stated or defined?
The Annual Organ Donation Plan should be focussed upon SMART objectives
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Professional Development Programme for Organ Donation
Example SMART Objectives
Objectives for the next yearActions required to deliver
objective Measurable outcome/KPIsPerson responsible for leading action
To have 100% referral of all potential non-heart beating donors and brain stem dead donors – with 80% conversion rate by 2010
• Resident Specialist Nurse for Organ Donation to feedback PDA
• Utilise Clinical Lead and Donation Committee
• PDA reflects 100% referral • Specialist Nurse for Organ Donation lead
• Clinical Lead for Donation
To achieve an 80% conversion rate by 2010
• Resident Specialist Nurse for Organ Donation to feedback PDA
• Utilise Clinical Lead and Donation Committee
• PDA reflects 80% conversion • Specialist Nurse for Organ Donation lead
• Clinical Lead for Donation
The minimum notification criteria is used in 100% of all cases to ensure timely referral
• Communicate/ reaffirm minimum notification criteria to all relevant staff
• PDA reflects use of notification criteria in 100% of cases
• Clinical Lead
To scope the implementation of a new Organ Donation programme within the Emergency Medicine department within 6 months
• Understand the process within emergency medicine
• Agree roles and responsibilities for scoping exercise
• A comprehensive report that progresses an Organ Donation programme within Emergency Medicine to be made
• Specialist Nurse for Organ Donation lead•Clinical Lead for Donation
The Annual Organ Donation Plan should be focussed upon SMART objectives
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Professional Development Programme for Organ Donation
Balanced scorecard and Key Performance Indicators (KPIs)
Purpose:
• The balanced scorecard is a strategic planning and management system that is used to:
Align business activities to the vision and strategy of the organisation
Improve internal and external communications Monitor organisation performance against strategic
goals• Key performance indicators are quantifiable measurements,
agreed to beforehand, that reflect the critical success factors of an organisation.
• KPIs help an organisation: Define and measure progress toward strategic and
operational goals
Benefits:
• Increase focus on strategy and results • Improve organisational performance by measuring
what matters • Align organisation strategy with the work people do
on a day-to-day basis • Focus on the drivers of future performance • Improve communication of the organisation’s vision
and strategy • Prioritise projects / initiatives
Adapted from Robert S. Kaplan and David P. Norton, “Using the Balanced Scorecard as a Strategic Management System,” Harvard Business Review (January-February 1996): 76.
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Professional Development Programme for Organ Donation
Organ Donation KPIs
Resources, learning and
growth
(What we need to enhance to
succeed)
Outcomes
(What we want to achieve)
Internal Processes
(What weneed to do well
to reach our goals)
Customers / Partners
(What we need to do for and with others)
SNODs achieve and maintain competencies
Right proportion time spent in
NHS organisations
Implement policies and best practice
Embedded SNODs
Increase submission data on time
Increase donor family
consent
Complaints and Clinical Governance
incidents
Increased approaches by trained
person
CLODs are in place
Increase referral rates
Increase DBD conversion
ratesIncrease BSD
testing
Chairs of Donation
Committees are in place
Improve adherence to
MNC Increase DCD conversion
rates
Increase DBD organ donors
Increase transplantable organs DCD
Effective partnership
working
Increase transplantable organs DBD
Increase DCD organ donors
Increase proportion solid
organ donors donating eye
tissue
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Professional Development Programme for Organ Donation
Roles and Responsibilities
Responsible Accountable Consulted Informed
Annual Organ Donation Plan
Specialist Nurse for Organ Donation, CLOD & Committee Chair
Donation Committee
• Donation Committee• Executive Board• EM / ICU
Departments
• Senior Nurses, other Clinicians & Healthcare Professionals
• NHSBT• Medical Director & Director of Nursing• Chief Executive• Governance Committee
Annual Report for Organ Donation
Specialist Nurse for Organ Donation, CLOD & Committee Chair
Donation Committee
• Donation Committee• Executive Board
• Senior Nurses, other Clinicians & Healthcare Professionals
• NHSBT• Medical Director & Director of Nursing• Chief Executive• Governance Committee
Hospital Policy
Specialist Nurse for Organ Donation & CLOD
Donation Committee
• Donation Committee• Portering/ Lab Staff
• Senior Nurses, other Clinicians & Healthcare Professionals
• Other hospital staff• Medical Director & Director of Nursing• Chief Executive• Governance Committee
Unit ProfileSpecialist Nurse for Organ Donation
Specialist Nurse for Organ Donation
• Clinical Lead• Other clinicians
• Unit clinicians
PDA
Specialist Nurse for Organ Donation & CLOD
NHSBT
• Other clinicians • Donation committee• Other clinicians• Chief Executive• Medical Director & Director of Nursing
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Professional Development Programme for Organ Donation
Suggested schedule for Donation Committee MeetingsCore Donation Committee Meetings Monthly Update Meetings
Frequency Quarterly (minimum) Monthly
Attendees* Clinical LeadDonation Committee ChairSpecialist Nurse for Organ DonationMedical Director
Clinical Lead or Senior Nurse for:ICUEmergency MedicineNeuro ICU (if appropriate)PICU (if appropriate)
Consultant surgeonConsultant Palliative Care or lead nurseEnd of Life Care Pathway LeadOperating theatre representative – Senior nursePractice Development NurseService Improvement
Clinical LeadSpecialist Nurse for Organ DonationDonation Committee Chair
Key Inputs • PDA and comparative data• Data collected from other sources (interviews, conversations, general observations etc)• Annual Organ Donation Plan
• Individual updates• Minutes from previous Donation
Committee Meetings
Suggested Agenda Items to include
Quarter 11.Review PDA and comparative data2.High level assessment of progress and achievements3.Draft key headlines for Annual Report and Annual Organ Donation Plan4.Agree contributions and timelines for content development
• Discuss key updates• Discuss progress against action plan• Review PDA data provided by
Specialist Nurse for Organ Donation• Discuss next steps and priorities• Discuss risks and issues• Discuss individual cases, outcomes
and implications for future Organ Donation activity
Quarter 21.Discuss feedback on Annual Report and Annual Organ Donation Plan from Executive Board2.Revise Annual Organ Donation Plan if necessary3.Review progress and identify remedial actions
Quarter 31.Review PDA and comparative data2.Conduct mini-assessment of progress and achievements3.Identify remedial actions4.Confirm requirement for a mid-year review and key areas of focus
Quarter 41.Discuss insights from mid-year review2.Identify remedial actions3.Agree preparatory activities for Annual Report (meetings, data collection etc.)4.Consider key priorities for following year
*Other potential representatives include: Ethics Committee; Chaplaincy (multi-faith); Patient groups/ Foundation Trust Council (where applicable); Local donor family; communications department ; A representative from dialysis or transplant services
33
Professional Development Programme for Organ Donation
Building a Local Action Plan
• We would now like you to work with your strategic big win team from this morning and consider the key actions you would need to carry out to achieve the vision set for your big win
• To do this you will need to consider:
SMART objectives against your vision
Supporting actions
Prioritisation of actions i.e. immediate, short, medium and long-term
• We would like you to use the SMART template below to support your thinking and jot all your actions on post-it notes
• We will then ask you to come and plot your activity along the T-map as we did during the case study activity
Objectives for the next year
Actions required to
deliver objective
Measureable outcomes /
KPIs
Person responsible for leading action
Completion date
Resources required
35
Professional Development Programme for Organ Donation
Transformation Map
Increased
referral acco
rdin
g to
m
inim
um
no
tification
criteria
Increased
referral acco
rdin
g to
m
inim
um
no
tification
criteria
Increased
diag
no
sis of
brain
stem d
eathIn
creased d
iagn
osis o
f b
rainstem
death
Increased consent / authorisation ratesIncreased consent / authorisation rates Increased rates of donation in Emergency Medicine
Increased rates of donation in Emergency Medicine
Quick Wins VisionMedium Term Long TermShort Term
Increased organ donation rates by 50% in 5 years
2010 - 2013
Increased
do
natio
n
after cardiac d
eathIn
creased d
on
ation
after card
iac death
Increased quality and quantity of organs from improved
donor management
Increased quality and quantity of organs from improved
donor management
36
Professional Development Programme for Organ Donation
Summary
37
• Make sure you have a realistic and strategic vision that will support you to hit and achieve targets for organ donation in your hospital
• Use the organ donation planning cycle to help you support your planning, reporting and meeting together as a team and organ donation committee
• Take time to complete annual organ donation planning and reporting documentation to support you lead Organ Donation within your hospital
• Understand how you can best share workload for making changes in your hospital between the Clinical Lead, Donation Committee Chair and Specialist Nurse for Organ Donation
• Focus on those activities which are really going to make a difference in your hospital around the six big wins for organ donation
• Remember that this programme is an evolution not revolution - change will take time!