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Strategy◦ What is it?◦ Influencing◦ AHP strategy standard
Clinical Governance◦ Elements of CG◦ Risk management◦ Evaluation and action
planning Audit Patient and Public
involvement
Staffing and new roles Use of Time Process Mapping Business Case
Development Marketing Introduction to AHP
Management Quality matrix
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A plan of action designed to achieve a particular goal ◦National◦Regional/Local◦Service specific
Your role
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Influence others to get results Are you trying to influence one person or a group?
What is your hierarchical relationship with them?
How capable/knowledgeable are they?
How well do you know each other? What are their priorities?
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ME
Physio OT Social Work Pharmacy
DGM
CEO
AH Network
National AH Group
Family
Elderly care working group
Community care strategy group
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Draw an organogram Who do you influence? How do you influence them? Who influences you? What influence do you have? What could work better?
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1. Common vision2. Awareness of others3. Awareness of key people4. Data and information use5. Making others feel valued6. Presentation impact7. Negotiating/bargaining
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Each table to develop ideas of how to use each influencing strategy in your work
Write on a flip chart to stick up
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The service has a documented strategy which is reviewed and updated annually.
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1.1 Does your organisation have a strategy?
1.2 Have you an up - to - date strategy for your service?
1.3 Is there a ‘value statement’ that is shared by staff in your service?
1.4 Service mission statement/vision; is this agreed and documented?
1.5 Is your strategy linked to: National, Regional Local?
1.6 Service portfolio – the range of services you provide is this documented?
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1.7 Major goals/objectives for your service; are these documented?
1.8 Do you have service strategies 1.9 Is the overall contribution of your service (from the patients’ perspective) documented?
1.10 Do you undertake an annual service review, and document findings?
1.11 Do you have organisational charts?
1.12 Do you produce a service annual report?
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Work with a partner from the same service or on your own
Use the evaluation matrix Evaluate the components Summary and actions to go on
post –its to be stuck on the wall when completed
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Clinical governance is the system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which clinical excellence will flourish
(Department of Health1998)
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1. Clinical effectiveness2. Risk management3. Patient experience4. Communication5. Resource effectiveness6. Strategic effectiveness7. Learning effectiveness
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Systems awarenessTeamworkCommunicationOwnershipLeadershipManagement
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Risk is the combination of the likelihood of an event and its consequences
Risks may have benefits as well as threats to an organisation's business
Risk Management is a continuous process by which risks are recognised and managed
Do you have a risk register?
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What is Clinical audit? Who has done it? Who gets support? Have you used audit? What do you do with the results? How do you feed it back into practice?
Have you identified training needs? What have your services done?
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Make a list of audits for your service. Prioritise:◦Organisational requirement◦Professional requirement◦Service development◦Service review◦Personal development
Make a list of audits for your service. Prioritise:◦Organisational requirement◦Professional requirement◦Service development◦Service review◦Personal development
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Do you include patients/service users in service development and evaluation?
Do you have a service lead for this?
What have you tried? Was it useful?
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Each table work together to complete the task set for you on one of the Clinical Governance strands.
Fill in one flip chart sheet and stick it on the wall
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45 minutes
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In an average 54 hour week what percentage of time does a leader spend on work planning reflecting and thinking?
◦A) 7.5%
◦B) 13%
◦C) 18.5%
◦D) 28%Source NHI 2007
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In an average 54 hour week how many hours does a leader spend in meetings?◦A) 12
◦B) 27
◦C) 38
◦D) 45
Source NHI 2007
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In this time the leader attended 26 meetings, how many started on time?
◦A) 4
◦B) 7
◦C)11
◦D) 16Source NHI 2007
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What percentage of people actively contributed/participated in the meeting◦A) 65%
◦B) 52%
◦C) 42%
◦D) 36%Source NHI 2007
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INPATIENTS TEAM EASTBOURNE
46.06%
5.11%
0.91%
0.65%
3.02%
3.94%
13.33%
4.89%
0.22%
2.61%
0.94%
5.52%
1.73%
0.80%
1.32%
0.33%
0.11%
3.90%
3.06%
1.56%
FACE CONTACT IND
FACE TO FACE GRP
TEL CONTACTS
WARD ROUNDS
CASE CONFERENCE
STUDY LEAVE
LIAISON
ADMIN
MANAGEMENT
HOME VISITS
TRAVEL
CLINICS
MTGS
IN SERVICE TRNG
TEACHING PHYSIOS
TEACHING STUDENTS
TEACHING HEALTH PROF
TEACHING PUBLIC
CLIN. SUPERVISION
OTHER
How you and your staff spend their time?
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8A 7 6 5 3
OTHER
CLIN. SUPERVISION
TEACHING PUBLIC
TEACHING HEALTH PROF
TEACHING STUDENTS
TEACHING PHYSIOS
IN SERVICE TRNG
MTGS
CLINICS
TRAVEL
HOME VISITS
MANAGEMENT
ADMIN
LIAISON
STUDY LEAVE
CASE CONFERENCE
WARD ROUNDS
TEL CONTACTS
FACE TO FACE GRP
FACE CONTACT IND
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Ageing workforce More expensive workforce Changing individuals’ needs Changing educational opportunities Variety of providers Need to:
◦ retain staff◦ develop staff◦ work differently
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Working at a highly specialised level within the boundary of the profession
Core Professional Practice
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Working at specialist level within and beyond the boundary of their profession
Training Regulation
Core Professional Practice
Extended Practice
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Write a list- what would it achieveHow would you progress this?
Write a list- what would it achieveHow would you progress this?
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Puts a spotlight on waste Streamlines work processes Defines and standardises the steps and sequence
Promotes understanding Builds consensus Key ‘tool’ for work re-design
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Physiotherapy Out-Patients - Management of Referral for OP appointment DRAFT ‘TO BE’ PROCESS
Sen
ior
Phy
sio
Phy
sio
Rec
eptio
n Yes
No
No
Date stamp and prioritisation stamp referral letter/card
Is this urgent appointment?
File routine requests in waiting list drawer in date
order
Referral from Esperance
Complete prioritisation stamp with type of
appointment/speciality and prioritise as urgent or routine
Referral from Consultant
Referral from Occupational
Health
Is referral from out of area?
Put in tray for Senior Physio to
check
Patient rings for appt
Pick up referrals from tray
Referral from Horder Centre
Referral from out of area
Patient rings for appt
Referral from GP
Is this a respiratory appt requested by
consultant?
Hand back to Reception staff
File referral in relevant filing
drawer
Referral from IP Physio (card in traty)
Register referral on Tiara (checking
other episodes etc)
This is an additional step, but does not change
management of referral – prioritised and letter sent as
for rest of process
YesNo
Send standard letter (from Tiara) to GP asking for reply if
they do not agree to referral
Send standard letter (from Tiara) asking
patient to make choice appointment (letter sent
within 1-2 days)
Send choice appointment letters
to calculated number of NP
assessment slots
Self-referralSelf-referral
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1. Are there any wasteful handovers?2. Are there any bottlenecks?3. Could some tasks be carried out by one person
instead of several?4. Are tasks carried out for our benefit or the
patient's?5. Could some tasks that are performed in another
process be performed here?6. Are the people who work in the process allowed to
make decisions?7. Which tasks help to achieve the purpose and
which ones create waste?8. Is there any duplication of work?9. How much rework is being carried out?
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Decide which service you need to review◦Are there problems?◦Do you think it could function better?◦Are there potential gains to be made?◦Are there non value steps in the service?
Invite the key people- give them sufficient notice
Don’t assume you know!
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Let’s see
how far we get!
Let’s see
how far we get!
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Introduction Background/context Proposed service Links to local /national priorities Predicted capacity Benefits to patients/
organisation/stakeholders Cost-benefit
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Service evaluation Predicted outcomes Governance arrangements Risks of doing it or not Lead- in time Financial impact statement Summary
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Use the headings in the template…..
Start a force field analysis
Use the headings in the template…..
Start a force field analysis
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Source DH 2006
Patient/Public
NationalTargets/drivers
Reviewing service
provision
Deciding priorities
Designing services
Shaping the service structure
Managing demand
Referrals,Individual needs
assessment,Patient choice re treatment
Managing performance,
quality, outcomes
Seek public and
patient views
Needs assessment
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Understand the ‘politics’ Get to know those who ‘buy’ your services
Make a clear business case Show how your proposal adds value Use information and data Show the likely impact
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Preparation Know your service
◦SWOT analysis◦Staffing and expertise◦Current service specification
Identify your “selling” points Branding Finance
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Needs analysis◦Population, users and public health
Know your competitorsWho can help you? InformationCommunicationPublicity
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Name of competitorYour assessment of their Strengths and weaknesses
Areas of direct competition Impact on your service
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Unique selling points
Key stakeholders internal/external
Stakeholder Interest and Influence
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Interest
Low
Influence
Voluntary SectorPatientsProfessional Bodies
MedicineSurgeryWomen’s HealthGPsPurchasersComplaints
Support ServicesDept.HealthEmployersSHASocial ServicesRegulatorHuman Resources
CEOExec TeamContract DeptFinance Dept
Low High
High
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Make a List
Make a List
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1. Strategy 2. Activity3. Patient
experience4. Finance5. Staff resource
effectiveness6. Staff
management and development
7. Information and metrics
8. Leadership and management development
9. Clinical excellence10.Communications and
marketing11.Service improvement
and re-design12.Risk management13.Corporate
governance14.Key performance
indicators
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Strategy Clinical governance New roles Process mapping Business case
development Marketing Introduction to AHP
management quality matrix
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Write down the first thing you are going to improve
Write down the first thing you are going to improve
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Any Questionsor further Discussion
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Will be made available to you
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www.jjconsulting.org.uk
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