Dr. Martin Connor

1. Dr. Martin Connor Special Advisor Special Delivery Unit, DH

2. HMI Briefing Martin Connor 3rd October 2011

3. SDU so far • Established as management team at start September • Delivery through associated partners: • Clinical Programmes • ISD • CPCP • Quality and Patient Safety • NTPF • Ministerial remit to resolve problems • Supporting HSE performance management through existing processes: ISD and RDOs

4. The strategy cannot be about marginal adjustment – it has to be about system transformation

5. Values

7. OVERVIEW OF SDU ACCESS STRATEGY

8. New performance management arrangements

9. We hold leaders personally accountable for performance against KPIs We start here with simplified, clearer targets that better reflect the patient journey We establish systematic, comprehensive and high frequency weekly monitoring systems Numeric Objectives We clarify sanctions and incentives (an essential part of the leadership challenge) Escalation Monitoring: Frequency, Quality, Lag Intervention PERFORMANCE IMPROVEMENT WHEEL

10. Special measures Earned Autonomy OUTLINE OF NEW PERFORMANCE REGIME Definition Significance Expectation of change in hospital leadership Persistent performance issues or no confidence standards will be delivered Ongoing performance issues or low confidence standards will be delivered Very high frequency monitoring, high concern Some performance issues or medium confidence standards will be dlievered Closer monitoring, elevated concern Light touch monitoring, hospital entitled to priority for strategic developments On trajectory or high confidence standards will be delivered This scheme requires the introduction of a hospital-level scorecard with hard targets…

11. Quality, access, finance:The basis of the new scorecard

12. QUALITY Safe, high quality, patient centred service ACCESS FINANCIAL BALANCE

13. 3 YEAR TARGETS

14. OP Indicative Definite ? ? ? ? ? ? DIAG PACE OF CHANGE – ACCESS DELIVERY December 2012 December 2013 December 2014 ED 75% 85% 95% (No pt waiting > 9hrs) 6mths 21 weeks IPDC 9 mths OP Maximum waiting time targets

15. UNSCHEDULED CARE

16. SYSTEMATIC ANALYSIS

19. Daily pressure monitoring Escalation plans signed off Discharge/ bed mgt networks established ISA-based capacity planning for Winter ED ICT prepares 2012 shift to total journey times Weekly performance meetings commence Local capacity plans signed off Nov Dec Jan July Aug Sept Oct The Plan

20. Capacity and information completeness

21. CAPACITY PLANNING • The capacity available each day through December and January, including medical beds and clinician rosters, discharge teams and bed managers • The availability of diagnostic support through December and January • Primary care and GP availability within the area over the Christmas and New Year period • Plans to provide extra capacity in ED to handle the potential for increased attendances in those areas where this has been a feature of demand in the past • Planned increases in capacity in early January to manage any increases in patient flow that occur • Home help and community service availability across the holiday period • Availability of services to support discharge across the holiday period • The availability of step-down or intermediate care beds within the locality • The availability of outpatient slots to manage patients who can be safely sent home to return for 24 or 48 hour review • The profile of elective activity to ensure that waiting time targets are met in a way that is mindful of the need to maintain unscheduled care responsiveness

22. Capacity & Risk Assessment

23. Capacity Planning - Responsibilities

24. Capacity Statements

25. Weekly meetings reviewing regional sitreps (data + milestones), undertaking escalated performance management, strategy and policy, ministerial and board reporting Implementing agreed plans in five areas: ED information, EMP, AMP, Bed management development, discharge… daily 8am ops meeting and sitreps Weekly meetings reviewing hospital sitreps (data + milestones), escalating performance management, co-ordinating intensive support, overseeing local capacity plans, managing prior approvals CO-ORDINATING THE WHOLE

26. SCHEDULED CARE:Delivering 12 months

27. SYSTEMATIC ANALYSIS

28. Introducing clearance times • Waiting lists are an indicator of a failure to match capacity and demand, and a failure to make good the implicit promise of treatment • By themselves , they are not a good indicator of organisational effectiveness or the risks of target delivery • If we value equity, we will want to shift the focus away from the number of patients on the list and towards the maximum waiting time

29. Introducing clearance times • Clearance times are a proven means of identifying the potential for the system to deliver shorter waits, at the present level of activity • They are calculated by dividing the number of patients waiting within a certain time band by the amount of elective activity completed in a period by each specialty in each hospital • They are risk-adjusted by allowing for: • A certain amount of activity to be set aside for urgent cases • A certain percentage of suspended patients that will need treatment • A certain percentage of preadmitted patients that will need treatment • The withdrawal of the NTPF activity as traditionally applied

30. INPATIENTS

31. 12 months

32. DAYCASES

33. 12 months

34. Key Actions • Technical guidance published – mandates hospitals to submit weekly waiting list information • NTPF now focussed entirely on 12 month delivery and preparing programme for delivering 6 month maximum in 2012. • Primary targeting list (PTL) training day for hospital waiting list managers this coming Monday (you’re making the opening speech) – based on very successful NTPF event • Web-based patient level performance reports being prepared that will enable us to identify the individual consultants at risk of breaching the target by end- September, enabling effective contingency planning. • Weekly performance management undertaken by NTPF patient co-ordination nurses starts in September – each member of the 5.5 member team will take a set of hospitals in an ‘account management’ model and work with their hospitals to ensure they are on target • Finance team at NTPF planning detailed guidance on how the 12 month reimbursement will work – ready for early September. • Meeting with Liam Woods next Tuesday to ensure tie-up with HSE

35. FOCUS ON INFORMATION SYSTEMS

36. Progress • Web team now beginning to deliver product on ED and patient level tracking of surgical list by end September • NTPF now working to new agenda including their well-developed data management infrastructure for waiting lists • Development session completed between NTPF information dept and web team to begin project planning the web system for managing the inpatient/ daycase list – design teleconference next Wednesday

38. WEB-BASED DEMO

39. ED ICT web screen shots

44. Strategy

45. Referrals IP electives Independent Sector Unscheduled Care Outpatients Schedules Financial analysis Recovery support Policy & strategy Performance Mgt PCC DIAGNOSTICS TMS PBPOA ICAS FLOW AUDIT Discharge Intelligent information SCOPE OF SDU ACCESS STRATEGY

46. CONCLUSION OF PRESENTATION • Strategy definition is well underway • Team alignment amongst strategic agencies working well • New approaches developed and products starting to emerge • Execution (as always) the biggest risk: Clinical Programmes and SDU developing joint approaches to hospital-level support • Aiming for new accountability framework to commence January 2012 • New information systems give us a patient-centred view of the overall business