Robert Jones Fiona Jenkins

1. JJ Consulting Healthcare Management Ltd AHP Master class:Benchmarking, Management and LeadershipTools and Techniques for Thriving and SurvivingJJ Consulting Healthcare Management Ltd. Robert Jones Fiona Jenkins 5th October 2012

2. Benchmarking, why now? • The global situation • The fast changing NHS • The added value AHP services can bring • What makes efficient and effective services • Quality and cost

4. Plan for the day • Housekeeping • Confidentiality • Information we have provided • The importance of networking • Benchmarking today • Outcomes from the Master class • Your action plans

5. Is there any thing else you want from today?

6. The Global Picture

7. Change is Happening • Future job market/turnover • Population changes • Technologies • Dr Google • Globalisation of healthcare- digitisation

8. “Never waste the opportunities offered by a good crisis.”  Machiavelli

9. The Financial Context • Extraordinary Public Sector Debt • Public Sector Funding Restricted (Zero Growth) • Higher Inflation and Downward Pay Pressure • Tariff reduced by 1.5% - 2% per annum • Population Increase (elderly, LTC) • Medical and Drug Advances (Technology) • Shift from Secondary to Primary Care • Expensive Infrastructure • Financial Deficits in Organisations

10. The Fast Changing NHS: It’s not an easy time

11. The Next 5 Years …at least • Extraordinary public sector debt • Organisations with recurring deficits • Continuing tariff reduction • At least 2% inflation • Efficiency requirement • Less money to do more activity or work differently • Activity volumes too high to be affordable • Poor community and primary care infrastructure • Variation in efficiency e.g. length of stay • Too many follow-ups and too many DNAs • Impact of private sector growth

12. The Health and Social Care Act 2012: Themes • Commissioning - GPs taking more control charge • Increasing democratic accountability “Public Voice” • Liberating NHS service provision • Strengthening Public Health services • Reform of arms-length bodies

13. Re-structuring Infinite Demand Reorganisation

14. SOME SHORT AND LONG TERM STRATEGIES • Improved effectiveness and efficiency • Organisation development structure • Patient level costing • Improved productivity • Vertical and Horizontal integration • Quality, patient safety initiatives • Reduced activity- introduction of thresholds • Disease management - self care • Programme management efficiency programmes • Less money = less beds and staff • Cheaper management costs • Tendering • Any qualified provider • Mergers/ take over

15. The Added Value that AHPs can bring Doing this is not an option!

16. The Roles of Managers and Leaders • Roles, duties and responsibilities • The evidence-base     - research     - the literature  •  The politics of therapy management and leadership today

17. What is the special contribution of AHP managers and leaders?

18. Comprehensive clinical knowledge- all specialties, all sectors • Comprehensive understanding of illness, disease, trauma, their treatment and long term management • Wide understanding of public health and preventative agenda • Problem solving skills transferrable between clinical and managerial practice • Clinically credible management/leadership • Leadership of rehab and integrated care • Facilitation of safe timely discharge • Skilled in capacity management • Cost effective and clinically effective solutions • Innovative solutions to clinical and managerial problems • Culture of effective MDT working • Ability to re-design clinical systems for patient benefit and organisation requirements

19. AHP managers unique? • Clinical Heads of clinical services • Credibility with other clinical leaders • Extensive knowledge of the services they manage ( clinical and managerial) • In-built patient centred approach- built by years of clinical practice • Understanding and interpretation of the evidence-base • Understanding the diversity of clinical provision and the inequities • Knowledge of staff capabilities • Knowledge of workloads, clinical prioritisation, skill mix • Ability to manage the short tem needs and longer term strategic changes • Contribution to business planning built of sound clinical knowledge and managerial expertise

20. AHP Managers - really unique • Code of ethics and professional status = Integrity • Experience of the whole healthcare system = Unique perspective of the whole system • AHPs =Patient Centredness Therefore uniquely equipped to contribute to the wider organisational agenda

21. Added Value for SuccessAHP Managers and Leaders • Co-ordination of staff activity • Guide work towards goals of the organisation- and effect real change • Provide safe value for money services • Co-ordinate services across traditional boundaries and interfaces • Ensure optimum efficient use of workforce • Ability to re-prioritise based of implementation of evidence base to ensure change of practice is embedded

22. AHP Managers Can Deliver • Workforce, skilled flexible and efficient • Highly skilled clinicians, and well trained support staff • Staff who promote self care and reduced dependency • Leaders who can prioritise for efficiency gains • Team workers with a “can-do” culture

23. Can You Do It? • Be up to date, personally and professionally • Have a contemporary PADR • Review your CPD portfolio and CV • Review your leadership competencies • Network and share • Keep abreast of the wider NHS developments....is your network wide enough?

24. Does Quality Drive out Cost? • Placing quality at the heart of business strategy will result in improved healthcare outcomes • Focus on cost cutting will not deliver the solution • Poor healthcare outcomes can be measured through spiralling cost, overspends, wasted resources and poor investment • Poor quality increases costs through harm waste and variation • Collaboration between clinical decision-makers, managers/leaders and finance teams is essential, to drive down costs and improve quality

25. What makes an effective and efficient service?

26. What can be learned from others?

27. And Consider • Do you know what your users think of your service? • What is the strategy of your organisation? • Do your service plans fit with the strategy? • Are you providing the right services? • Is it time for some change? • Skill mix profile – is it optimal, is it affordable? • Staff profile, activity and service costs • How long per appointment, how many contacts? • Are you ready to re-design? • Is your service ready for change?

28. How does your service compare with others? How do you know?

29. Data, Information, Interpretation and Uses • What is data? • What is information? • What have you got? • How do you collect it? • How do you use it ? • What do you need ?

30. Benefits • Information for: • Management • clinical • finance • workforce

31. Staff Activity • What do staff do with their time? • How much of each activity • Who does it • Where it happens • Managers need an accurate picture of what staff are doing with their time • Have you got a benchmark by staff band? • What activity do you expect from a band 6?

32. Where does your service sit compared to this?

33. …….and this?

34. 1.37% 2.35% 1.77% FACE CONTACT IND FACE TO FACE GRP TEL CONTACTS 19.43% WARD ROUNDS CASE CONFERENCE STUDY LEAVE LIAISON ADMIN MANAGEMENT 0.40% HOME VISITS 1.18% TRAVEL 54.16% CLINICS 4.05% MTGS IN SERVICE TRNG TEACHING PHYSIOS TEACHING STUDENTS TEACHING HEALTH PROF TEACHING PUBLIC 15.30% CLIN. SUPERVISION OTHER Band 5 activity

35. OT

36. Comparison by Band

37. Run Chart for service improvement

38. Finance

40. Balanced Score Card

41. Are you a budget manager? • What's the split between staffing costs and non-staff costs? • Were you involved in budget setting? • How do you make your CRP? • What %? • Do you understand the finance data well enough?

42. Any Questions?

43. Does Your Service Have Alignment? Between : • Strategy • Vision • Desired Outcomes • Performance if so, how do you compare your performance with others?

44. Have you thought of Benchmarking? • An Invaluable means of enhancing understanding your service's performance compared with others • Requires collection and interpretation of data • Can be wide-ranging or very focussed • Can speak louder than your single voice • ….or identify where efficiencies can be made

46. Edited by Robert Jones and Fiona Jenkins Foreword by Karen Middleton • The Jigsaw of Reform: Pushing the Parameters • Money, Money, Money: Fundamentals of Finance • Commissioning for Health Improvement: Policy and Practice • Striking the Agreement: Business Case and SLAs   • Thriving In the Cash Strapped Organisation   • Information is Power - Measure it, Manage it • Information Management for Healthcare Professionals • Allied Health Records in the Electronic Age • Data ‘Sanity’: Reducing Variation   • Outcome Measurement in Clinical Practice • Improving Access to Services • Benchmarking AHP Services • Management Quality and Operational Excellence • Evaluating Management Quality in the AHPs • Evaluating Clinical Performance in Healthcare Services •  Project Management for AHPs with Real Jobs • Marketing for AHPs • Effective Report Writing   • Demonstrating Worth: Marketing and Impact Measurement

47. Average Face to face Contacts Trauma and Orthopaedics 4.8 treatments per episode of care is the benchmark

48. Average face-to-face contacts musculoskeletal out-patients • Benchmark contacts 3.31 • Benchmark first to follow up ratio of 1:2.31

49. Waiting Time from Referral to Treatment – Occupational Health The benchmark wait is 1-2 weeks

50. Paeds waiting time