04/20/23 12:59 AM NHS MK5.1

ASSIST – NPfIT Lessons Learned

Mark HorncastleBusiness Change Manager – CSCA (C&M and SASHA)Mobile – 07834 800392

C&M IM&T leads Lessons Learned

Outcomes from a workshop run in Nov 2004 across C&M SHA

• Planning and Governance– Propose to start 2005 project engagement early

– Value identified in Pre-Project planning / delivery activities

– Planning and Governance needs to be strengthened

– Strict mobilisation criteria

• Comms and Engagement of wider organisations– Clinical engagement

– Visibility of Trust drivers and targets

• Product visibility– Need to increase level of functionality delivered (more development effort)

– But want certainty of planning (set delivery timescale)

• Management of resources– Dipping into same pool

HOW DO WE MAXIMISE THE OPPORTUNITY?

= START EARLY & INTEGRATE INITIATIVES

Lessons Learnt from Deployment projects

• Visibility of current and forthcoming initiatives within the Trust– Re-organisation of management structure, roles and responsibilities has meant un-certainty

and lack of clarity around governance :• Where does NCRS fit?

• Focus elsewhere amongst the Exec Team

• Clinical engagement– Project Team made up of staff from IM&T

– Time lapse to recruit clinical members to project team

• Visibility of multiple ways of working across the Trust– Local ways of working (e.g. processes / procedures / capturing of information / generation of

letters etc.) resulting in non-standardised modes of operation

– Local knowledge (on-the-job training….local best practice….or bad practice!)

– Limited ‘holistic’ understanding of the operational aspects of the current services provided across the Trusts

• Standardisation comes before ‘technical platform’– Change / standardise business processes before thinking about deploying a new IT system

• Project Team– Recruit early….clinical and clerical

• Staff Empowerment– Need for staff to attend workshops and make decisions– Broad coverage of staff to attend sessions:

• Across the Trust• Manager and operational staff (most appropriate based on knowledge)

– Remove reliance on key personnel to be present at every session to make the decision….need to have confidence in staff representatives to make the right decisions based on operational knowledge

• Executive Commitment– Standardisation of business processes must be endorsed by Trust boards to ensure buy-in and

commitment from staff at all levels within the organisation– Clear leadership to drive through standard ways of working

• Communication– Communication is key to the success of the project and must be maintained….labour intensive

which requires communication champions identified across the Trust who are committed to the project life cycle

• Champions Network– Terms of reference is essential….staff must be committed to supporting and advocating the

project

Lessons Learnt from Deployment projects

HOW DO WE MAXIMISE THE OPPORTUNITY?

= START EARLY & INTEGRATE INITIATIVES

War stories (but no names!)

• Many projects have taken a 'passive' approach and are not seeking to realise ‘real’ benefit from their CFH projects

• Projects are often not involving HR when they are changing roles – this has led to Union involvement in some projects

• Some projects have placed almost total reliance on CSCA to develop processes / operating procedures - resulting in minimal organisational learning and buy-in. Trusts must 'own' the new processes.

• A significant proportion of projects have seen this as an IT programme and have resourced accordingly. Engagement has been a key issue across many projects.

Key characteristics of an 'excellent' Trust / LHC• Board level sponsorship and engagement

• Clear and shared understanding of why projects are being progressed

• Clear understanding of initiatives which are current and proposed

– are these activities appropriate (converging, diverging, colliding?)

– how will CFH impact these

• Clear understanding of care models and how these will change in the future

• Understanding of organisational (project) requirements in terms of

– Business Change (i.e. workflow)

– Workforce (i.e. changing roles)

– Technology (i.e. data migration)

• LHC working as integrated partners - shared focus, objectives, etc

• Understands requirement for and has identified executive, management and clinical champions

• Training strategy integrated to support Workforce Development & new ways of working

• ……..

In summary - uses CFH as a major enabler for service improvement - from design through to delivery

“A Another” LHC Key Drivers

The Integrated Service Improvement plan (ISIP) has helped to identify some areas where early attention will be required to ensure delivery, they are:

• Achieve financial balance and sustainable health community

• Development of seamless care pathways

• Reduction in diagnostic waiting time

• Delivery of 18 week target

The plan has also highlighted the lack of infrastructure and joint governance between the organisations to support delivery. The delivery of transformation will be achieved by;

• Maximising the benefits from Connecting for Health and integrating it into the care delivery system

• Delivery of Practice Based Commissioning

• Streamlining of care pathways across health sectors and the LHC

• Focusing on joint working

Is an Integration view enough?

• CSCA work ongoing to embed best practice as standard practice across the board for all organisations

– i.e. training workshop in C&M on 20/12

• CSCA learning lessons and looking at tools that enable NHS and CSCA to generate improved outcomes –

– Benefits

– Process design

– Stakeholder Management & Communications

– Training

– Readiness

• Pre-deployment activity being designed into projects

• ISIP has the ability to provide a clear focus around the wider agenda

High-level NCRS Benefits

Patient Administration System

Summary Functionality Key metric(s)Standards for Better Health

Relevant High Impact Change(s)

Registration All patients’ demographic data, including unique NHS number, once validated is used in all identification of patient contacts.

Time saving of not re-entering data Reduce risk of incorrect patient identification

GovernanceCore standard C 9

Clinic scheduling Support for direct interface to support the national e-Booking solution and ability to book clinics for all HCP’s at any site, from any location at any time. Scope

Number of clinics and number of vacant slots Reduced acute unit OPD waiting time Length of referral processReduced DNA because of patient choiceReduced cost of referral

Accessible and responsive care Core standard C 17

Change 5 Avoid unnecessary follow ups and provide follow up on the right care settingChange 8 Improve patients access by reducing queues

Bed Management Admission Discharge and Transfer and bed management with discharge planning, allows up to date information about bed state, actual, booked and potential discharges

Reduced last minute cancellationsReduction in IP Waiting listReduced Average length of stay

Clinical and Cost EffectivenessCore standard No C 5

Change 3 Manage variation in the patient’s discharge thereby reducing LOS. Change 4 Manage variation in the patient’s admission process.

Waiting List Management Waiting list management allows validation and prioritisation of patients as well as arranging pre op assessment appointments.

Reduced waiting time Validated waiting listsNumber of last minute cancellations

Clinical and cost effectivenessCore standard C5

Change 4 Manage variation in the patients admission process.Change 8 Improve patients access by reducing queues

Case note tracking identifies location of notes and reduces no of absent notes for elective appointments and for emergencies.

Number of patients seen without notes with the attendant riskNumber of appointments cancelled due to absent notes

GovernanceCore standard C9

Change 9 Optimise patient flow through service bottlenecks using process templates.

Coding All patient contacts accurately coded for contracting and workload assessment.

Audit of coded completed contacts. GovernanceCore Standard No C7

The measurable benefits identified are those that may be delivered through the successful implementation of a number of project types. The extent to which benefits can be achieved will depend on the current state within a local NHS organisation or Local Health Community.

Organisations taking the lead

• Mersey Care– Working with the executive team to develop a dependency map

of all projects and initiatives across the organisation to allow clear prioritisation of activities to enable the achievement of strategic objectives.

– Normalising processes ahead of the delivery of CfH

• Alder Hey– Identifying future service models and mapping technology and

business processes onto the Model of Care to ensure effective transition

• Lancs Care

• East Birmingham PCT

• ……..

• There are many more examples

Map Key:

Completion Date

On-going Time-framed activity

Timescale of initiative / programme of work

Stakeholder group directly impacted by initiative / programme of work

Service User

Carer Staff

On-going work

Older People’s Mental Health Services Dependency Map

Old

er P

eop

le’s

Men

tal H

ealt

h S

ervi

ces

Mer

sey

Car

e D

irec

tora

tes

Review Provision / Model of Day Services (Mar 06)

Development of CMHTs (Mar 07)

Single Point of Referral (Mar 07)

Single Assessment Process (date?)

Development / Describing Service Models (completed)

Continuing NHS Care (Mar 06)

Delayed Discharge Review (Mar 06)

Implement ECC (Mar 06)National:

NSF for Older People (2001)

Commissioner:Liverpool Older People’s

CommissioningNational:

National guidelines

National:Access Booking

& Choice

National:Indicators for Older

People’s

Service Development:OBC Completion (May 06)

Service Development:FBC Completion (Dec 07)

Commissioner:Continuing Care Commissioning

Social Services

National:Cross Charging

Act (2003)

Finance:Direct Payments (date?)

2005 2006 2007 2008 2009 2010

OBC / FBC User Group

Map Key:

Completion Date

On-going

Timescale of initiative / programme of work

Stakeholder group directly impacted by initiative / programme of work

Service User

Carer Staff

Direction of impact

On-going work

External Party driving initiative

Attend ESR Project Group Meetings

Implement Financial Recovery Plan (Mar 06)

Finance:Recovery Plan

Implement Knowledge & Skills Framework (Oct 06)

Organisational Development:Knowledge & Skills

Framework

National:Knowledge & Skills

Framework

Understand Trust priorities / dependencies / timescales….build an integrated picture of the changing Mersey Care landscape through:

Capturing the current and planned changes across the TrustUnderstanding the key drivers for each project (e.g. local, national…)Understanding the improvement dependencies across all projects

• The Executive is seeing the importance of collective time to think strategically – the links to operational effectiveness are clear

• The process matched and is responsive to existing concerns about:- The large number of projects- The need to prioritise- Mixed engagement with the values and aims of the Trust in everyday practice

• The Trust has felt in control of the process

• The gaps in organisational strategy have been revealed by the requirements of Connecting for Health – but are owned corporately and being filled prior to delivery of Connecting for Health

• The process has linked into existing processes such as business planning

• There has been some excitement about the nature of the conversations that the process has encouraged

• Connecting for Health is truly acting as an enabler rather than a driver

Mersey Care’s perspective on this work….

In Summary

Apply the lessons learned to our organisations and use CFH as a major enabler for service improvement – from design through to delivery

Questions