Management Quality Achieving Excellence in Physiotherapy Service Provision

October 2011

IntroductionIntroduction Dr Robert Jones, Dr Robert Jones,

Head of Therapy Head of Therapy Services Directorate, Services Directorate, East Sussex East Sussex Healthcare NHS Healthcare NHS TrustTrust

Fiona Jenkins,Fiona Jenkins, Executive Director Executive Director Therapies and Health Therapies and Health Science Cardiff and Science Cardiff and Vale University Vale University HealthHealth BoardBoard

ObjectivesObjectives To understand the key concepts of To understand the key concepts of

Management Quality and Impact on Management Quality and Impact on patient carepatient care

Share knowledge and Experience around Share knowledge and Experience around UKUK (With audience participation!)(With audience participation!)

Encourage innovative thinking/action Encourage innovative thinking/action planningplanning

Damage limitationDamage limitation Introduce our Management Quality MatrixIntroduce our Management Quality Matrix

Its not an easy timeIts not an easy time

Infinite Demand

The Health and Social Care The Health and Social Care Bill 2011Bill 2011ThemesThemes

CommissioningCommissioning Increasing democratic accountability Increasing democratic accountability

“Public Voice”“Public Voice” Liberating NHS service provisionLiberating NHS service provision Strengthening Public Health Strengthening Public Health

servicesservices Reform of arms-length bodiesReform of arms-length bodies

Coming to you SoonComing to you Soon

Chronic Disease Management, Chronic Disease Management, including Mental Health and carer including Mental Health and carer supportsupport

New scienceNew science Building technologyBuilding technology Flexible designFlexible design E prescriptionsE prescriptions Prosthetics regeneration and bio Prosthetics regeneration and bio

engineeringengineering

Management Quality in Management Quality in Physiotherapy and the Allied Physiotherapy and the Allied

Health ProfessionsHealth Professions Key concepts of Management QualityKey concepts of Management Quality Impact on PhysiotherapyImpact on Physiotherapy Where does it come from? Where does it come from?

- the evidence-base and conceptual - the evidence-base and conceptual frameworkframework

Why is it important?Why is it important?

- patients and their families/carers- patients and their families/carers

      - clinical practice- clinical practice

      - the staff- the staff

      - the organisation- the organisation

- the Profession- the Profession

The Roles of Managers and The Roles of Managers and LeadersLeaders

Roles, duties and responsibilitiesRoles, duties and responsibilities The evidence-baseThe evidence-base

        - research- research

        - the literature - the literature    The politics of therapy The politics of therapy

management and leadership management and leadership todaytoday

Six Dimensions of Six Dimensions of QualityQuality

CommunicationCommunication ParticipationParticipation Employee Employee

developmentdevelopment MeasurementMeasurement DelegationDelegation IntegrationIntegration

The Three Phases of The Three Phases of ExcellenceExcellence

1.1.     LeanLean

2.2.     Supply Supply ChainChain

3.3.     StrategicStrategic

The Don’t DosThe Don’t Dos

1.1. Regard any new idea Regard any new idea from below with from below with suspicionsuspicion

2.2. Insist a hierarchy existsInsist a hierarchy exists

3.3. Criticise others’ ideasCriticise others’ ideas

4.4. Treat problems as a Treat problems as a sign of failuresign of failure

5.5. Express criticisms; Express criticisms; don’t praisedon’t praise

6.6. ‘‘Name and Name and shame’shame’

7.7. Control Control everythingeverything

8.8. Plan change in Plan change in secretsecret

9.9. Delegate difficult Delegate difficult decisionsdecisions

10.10.Count everything Count everything that moves . . . that moves . . . frequentlyfrequently

Useful QuestionsUseful Questions What is the vision?What is the vision? What are the service goals?What are the service goals? How are we measuring How are we measuring

performance?performance? What are the key processes What are the key processes

and behaviours ?and behaviours ? How would YOU make this How would YOU make this

happen?happen?

Management Quality Matrix: Management Quality Matrix: StandardsStandards

1.1. StrategyStrategy

2.2. Patient and service Patient and service user experienceuser experience

3.3. Clinical excellenceClinical excellence

4.4. FinanceFinance

5.5. Information/Information/metricsmetrics

6.6. ActivityActivity

7.7. Staff resource Staff resource effectivenesseffectiveness

8.8. Staff management Staff management and developmentand development

9.9. Service Service improvement and improvement and re-designre-design

10.10. Leadership and Leadership and management management developmentdevelopment

11.11. Risk managementRisk management

12.12. Corporate Corporate governancegovernance

13.13. Communications Communications and marketingand marketing

14.14. Key performance Key performance indicatorsindicators

How the Matrix is How the Matrix is ConstructedConstructed

StandardsStandardsComponentsComponentsSystematic review and Systematic review and evaluationevaluation

MeasurementMeasurementTargets are not goals in Targets are not goals in themselvesthemselves

Damage LimitationDamage Limitation

Towards ExcellenceTowards Excellence

Evidence-baseEvidence-base ComprehensiveComprehensive

nessness ResponsivenessResponsiveness Added valueAdded value SustainableSustainable Cost efficientCost efficient

Evaluating a Evaluating a wide range of wide range of performance performance parametersparameters

Draws on Draws on management management quality, quality, industrial and industrial and healthcare healthcare excellence workexcellence work

Concepts:Concepts: Performance Performance

ManagementManagement ‘‘Lean’Lean’ Six SigmaSix Sigma Balanced ScorecardBalanced Scorecard ‘ ‘Dashboards’Dashboards’ TQMTQM Benefits RealisationBenefits Realisation

Management Quality MatrixManagement Quality Matrix

Think about your serviceThink about your service Is everyone in the team 'pulling' in the same Is everyone in the team 'pulling' in the same

direction?direction? Does the direction benefit the patient?Does the direction benefit the patient? Are we measuring so that we know whether we Are we measuring so that we know whether we

are improving?are improving? Do staff have the training, motivation and respect Do staff have the training, motivation and respect

to provide value and bring about improvement?to provide value and bring about improvement? Are tensions around fear of change recognised Are tensions around fear of change recognised

and managed?and managed? Are problems/mistakes treated as opportunities Are problems/mistakes treated as opportunities

to improve?to improve?

““Quality is never an accident; it is Quality is never an accident; it is always the result of high intention, always the result of high intention, sincere effort, intelligent direction sincere effort, intelligent direction and skillful execution; it represents and skillful execution; it represents

the wise choice of many the wise choice of many alternatives.”alternatives.”

William A. Foster William A. Foster

““What gets measured gets managed.”What gets measured gets managed.” Peter Drucker Peter Drucker

Does Your Service Have Does Your Service Have Alignment?Alignment?

Between : Between : StrategyStrategy VisionVision Desired OutcomesDesired Outcomes PerformancePerformance

MetricsMetrics Measurement Measurement

indicates progress indicates progress towards value and towards value and responsiveness for responsiveness for patients. patients.

Facilitates best Facilitates best possible clinical possible clinical outcomes, efficiency, outcomes, efficiency, effectiveness and effectiveness and optimal resource optimal resource use.use.

Standard 1 Strategy:Standard 1 Strategy: The The service has a documented strategy service has a documented strategy

which is reviewed and updated which is reviewed and updated annually.annually.

1.2 Do you have an up-to-date strategy for 1.2 Do you have an up-to-date strategy for your service, that is currently available?your service, that is currently available?

1.6 Major goals/objectives for your 1.6 Major goals/objectives for your service; are these documented? What service; are these documented? What are they ? please listare they ? please list

1.9 Do you produce a service annual 1.9 Do you produce a service annual report outlining for example……report outlining for example……

Standard 2 Patient and Service Standard 2 Patient and Service User ExperienceUser Experience

Patients’ views and experiences are Patients’ views and experiences are actively sought and incorporated actively sought and incorporated

into service redesigninto service redesign 2.1 Does your service use patient 2.1 Does your service use patient

survey data to benchmark its services survey data to benchmark its services to patientsto patients If yes, can you provide evidence where If yes, can you provide evidence where

you have used this to improve services?you have used this to improve services? 2.13 Do you have a web site that the 2.13 Do you have a web site that the

public can access information about public can access information about your service?your service?

Standard 5 Information and Standard 5 Information and Metrics: Metrics: The service gathers The service gathers

timely, accurate and relevant data timely, accurate and relevant data as a by-product of clinical activity. as a by-product of clinical activity. Appropriate metrics are used for Appropriate metrics are used for clinical and managerial purposes.clinical and managerial purposes.

5.1 Does your service have a data 5.1 Does your service have a data collection system which is fit for purpose?collection system which is fit for purpose?

5.2 Does your service have a computerised 5.2 Does your service have a computerised data collection system fit for purpose?data collection system fit for purpose?

5.3 Do clinicians input data at the same 5.3 Do clinicians input data at the same time that treatment takes place (real time that treatment takes place (real time)?time)?

Standard 7 Staff Standard 7 Staff Resources:Resources:

There is a comprehensive There is a comprehensive knowledge and understanding of knowledge and understanding of the staff resources used by the the staff resources used by the service and they are deployed service and they are deployed

effectively and reviewed frequentlyeffectively and reviewed frequently7.2 What is the Whole Time Equivalent grade 7.2 What is the Whole Time Equivalent grade

profile ofprofile of your staff? your staff?

7.3 What is your ratio of registered to non-7.3 What is your ratio of registered to non-registered staffregistered staff

7.6 What is your annual percentage absence 7.6 What is your annual percentage absence

7.8 Does the service have sufficient expertise 7.8 Does the service have sufficient expertise to provide comprehensive in-service to provide comprehensive in-service education/training?education/training?

Standard 9 Service Standard 9 Service Improvement and Re-design:Improvement and Re-design: Your service actively undertakes re-Your service actively undertakes re-

design and service improvement.design and service improvement...9.2 Is service improvement embedded in 9.2 Is service improvement embedded in

staff job descriptions?staff job descriptions? 9.6 Have you undertaken ‘horizon 9.6 Have you undertaken ‘horizon

scanning’ of other services scanning’ of other services (internal/external) to inform your (internal/external) to inform your service improvement needs?service improvement needs?

9.11 Do you have staff trained with 9.11 Do you have staff trained with service improvement techniques to service improvement techniques to undertake service re-design?undertake service re-design?

Standard 10 Leadership Standard 10 Leadership and Management and Management

DevelopmentDevelopmentThe service has effective The service has effective

leadership and management leadership and management arrangements in placearrangements in place

10.1 Does the organisational structure 10.1 Does the organisational structure support effective leadership and support effective leadership and management?management?

10.4 Is leadership and management 10.4 Is leadership and management development programme in place for your development programme in place for your staff?staff?

10.10 What % of staff in leadership/ 10.10 What % of staff in leadership/ management positions have undertaken management positions have undertaken management training?management training?

How its usedHow its used

Share with Share with your teamyour team

Completed Completed standard by standard by standardstandard

EvaluationEvaluation SummarySummary Action planAction plan

USE

Continual Process for Continual Process for Quality ImprovementQuality Improvement

InnovateInnovate Whether your Whether your

service is under service is under attack or developingattack or developing

Look at what you do Look at what you do wellwell

Strive to be the best Strive to be the best you canyou can

Be a great leader…your team Be a great leader…your team needs you!needs you!

ReferencesReferences Loch C, Van der Heyden L, Van Wassenhove L, Loch C, Van der Heyden L, Van Wassenhove L, 2003.2003.

Industrial ExcellenceIndustrial Excellence. Berlin: Springer.. Berlin: Springer. Loch C, Chick S, Huchzermeier A. 2009. Loch C, Chick S, Huchzermeier A. 2009. Industrial Industrial

Excellence Award, Healthcare Questionnaire. Excellence Award, Healthcare Questionnaire. Fontainebleau, INSEAD.Fontainebleau, INSEAD.

Jones, R, Jenkins, F., 2006 Jones, R, Jenkins, F., 2006 Managing and Leading in the Managing and Leading in the Allied Health ProfessionsAllied Health Professions. Oxford: Radcliffe Publishing Ltd.. Oxford: Radcliffe Publishing Ltd.

Jones, R, Jenkins, F., 2006. Jones, R, Jenkins, F., 2006. Developing the Allied Health Developing the Allied Health ProfessionsProfessions. Oxford: Radcliffe Publishing Ltd.. Oxford: Radcliffe Publishing Ltd.

Jones, R, Jenkins, F., 2007. KJones, R, Jenkins, F., 2007. Key Topics in Healthcare ey Topics in Healthcare Management: understanding the big picture ProfessionsManagement: understanding the big picture Professions . . Oxford: Radcliffe Publishing Ltd.Oxford: Radcliffe Publishing Ltd.

Jones R, Jenkins F. 2010. Jones R, Jenkins F. 2010. Managing Money Measurement Managing Money Measurement and Marketing in the Allied Health Professions. and Marketing in the Allied Health Professions. Oxford: Oxford: Radcliffe Publishing Ltd.Radcliffe Publishing Ltd.

Jones, R, Jenkins, F., 2011Jones, R, Jenkins, F., 2011 Top Tools and Techniques in Top Tools and Techniques in Management and Leadership of the Allied Health Management and Leadership of the Allied Health Professions.Professions. London: Radcliffe Publishing Ltd. London: Radcliffe Publishing Ltd.

  Official Marine Corps Biography. William A Foster. Official Marine Corps Biography. William A Foster. Who's Who's Who in Marine Corps HistoryWho in Marine Corps History. History Division, United . History Division, United States Marine Corps. Retrieved 2007-11-03. States Marine Corps. Retrieved 2007-11-03.

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