cno summit 2015 - peering into the future of nhs providers, david dalton
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Chief Nursing Officer for England’sSummit 2015
Creating Value Through Transforming Care
Peering into the future of NHS ProvidersDavid Dalton
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The Challenge – better care @ lower cost
Succeeding in a competitive environment with less money
Safeguarding high quality services
with less money
Safer Care
Improving Health
Reducing Inequalities
Prevention
Improving Outcomes
Access
Creating Value
Supporting Staff
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Dalton Review #DaltonReview2014
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New Models and Shapes Emerging
Individual LocalityCity/County
Area
Region
TertiaryComplex Secondary
DGH/Secondary
Home Care
Single SharedServices (JV)
Merger
Intermed.Care
JV
AccountableCare
OrganisationsIntermediate Group/
Chain
Federated Back Offices
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Dalton Review #DaltonReview2014
What is the Dalton Review about?• Variation in care is significant and its extent should not be tolerated
• Reliability is crucial – clinical and financial viability
• Successful systems and methods should be spread
• Encourage new entrepreneurial spirit
• Remove barriers + create incentives
Aims of the Dalton Review
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System leaders understand their own populations and therefore need to be enabled to implement the best clinical models for their patients.
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Successful organisations should determine evidence of best practice, develop a standard operating model and support staff to reliably implement and replicate this so that patients can benefit from reliable care pathways
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• How will we know if this has worked?
How will we know if this has worked?So what might a typical general hospital look like in five years time?
Federated Back OfficeWith 10 other Providers Management
Contract, orOrganisational Chain?
Single Shared Surgical Service with 2 other Providers serving 1m population
Service Line Contract for Specialist Services with Specialist Providers
Integrated Care Models for Long term conditions
and Urgent Care
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The Diagnosis
The variation in clinical practice and operations that exists today causes significant inefficiency
There are too many decision makers; too little shared information and not enough engagement of the front line
The prevailing leadership style ,and the culture it develops, inhibits achievement of reliability and excellence
Fragmented provider landscape prevents investment in new solutions as economies of scale are not realised;
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Our SolutionA group that delivers ACO types of operating at locality level with a single service model for acute clinical care covering a 2m population
A standard operating model that provides digitised information from patient onwards; hardwires decision support systems into workflow and optimises capacity utilisation
Leadership and governance that will instil a culture to fully exploit opportunities provided by the standard operating model and SRFT’s QI capability
Back office and corporate functions operated at scale
Partner with global leaders to bring expertise, investment and leverage
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New Integrated Care Organisation
THE PATIENT
Hospital
Community
Domiciliary
Primary Care
SocialServices
Mental Health
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Identify, Stratify and EngageUsing digitisation as a care service
Analytics that enable proactively management of patients across the continuum of care
Overdue for healthcheck Type II diabetes
Early stage heart failure COPD
HCP dashboard and task list:Directing outreach into patients homes to prevent admissions
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The Group’s Vision – Standardisation at ScaleOur bold vision is to establish a healthcare group that will deliver accelerated improvements in patient outcomes and productivity = Better care at lower cost
We will achieve this by:Building on the assets to develop a standard operating model that will:
Developing standardised care models, which are capable of replication into other localities of the Group, to include:
Use information repositories to remove unwarranted variation and address fragmentation of patient pathways, by:
• Standardising the patient pathways
• Standardising operational system and processes
• Developing a groundbreaking proof of concept that utilises standardised care pathways and predictive modelling to dynamically match resource deployment to demand
(including workforce & consumables)
• A vertically integrated health and social care service in each locality in the Group
• Single-shared clinical services across operating entities of the Group
• A single set of corporate services operating across the Group
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Evidence Based Care StandardsAnd Digitised Workflow
InnovationMoving Knowledge into practice; systematically and reliably; hard-wiring evidence into clinical workflow; making the right thing to do, the
easy thing to do; embedding SOPs.
SRFT has reduced cardiac arrests, saving £700k p.a. on the rapid response team alone
SRFTs current performance on pressure ulcers is saving £637k p.a. on a base line of 2011/12.
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Dynamic Matching of Resources to Demand New Zealand nurse staffing model
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Enterprise-wide Capacity OptimisationPredictive demand modelling and dynamic resource allocation
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Variation: We go looking for it
SCAPE Ward and Community StatusJanuary 2010 November 2014
SCAPE Wards & Areas 0 + 0 29 + 0
Green Wards & Areas 32 + 0 15 + 34
Amber Wards & Areas 15 + 0 2 + 2
Red Wards & Areas 1 + 0 0 + 0
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Delivering Standardisation @ Scale- Leadership ModelLeaders at all levels are crucial in creating the culture which can deliver the change they wish to see. Effective leaders in a Group will demonstrate their leadership by:
Clarity of Purpose • Aims & Values• Standards Based• What, how much, when• Assess & Measure
Mindset• Reliability• Deep staff engagement• Openness & Transparency• Teamwork trumps hierarchy
Behaviours• Hear Patient voice & listen to Staff• Visibility and Authenticity
– Signal Generator• Defer to expertise• Encourage collective solutions • Build relationships• Challenge inappropriate behaviour