Dr Sally Pearson Helen Munro Andrew Abbott, Courtyard Group

1. Developing the Gloucestershire Hospitals NHS Foundation Trust Strategic Performance Management Framework Dr Sally Pearson Helen Munro Andrew Abbott, Courtyard Group

2. Background

3. At Project Initiation in July 2008, the Trust had already made progress in developing its strategy • October 2007- Endorsement of an approach to Organisational Development (OD) • November to January 2008 - The ‘People First’ programme, representing the first stage of the OD approach engaging a wide range of staff in the generation of the Trust’s values • February 2008 – Board Seminar to : • Review outcomes of ‘People First’ Programme • Develop draft Values, Mission and Vision statements • Identification of the key strategic challenges for the Trust Mission improving health by putting patients at the centre of excellent specialist care Values Listening to patients, putting their needs at the centre of everything we do, by Working together to deliver excellent, safe health care in a clean environment, with Valued staff who are motivated, well trained and have a helpful attitude.

4. The Trust had also defined a strategic framework for developing the Vision and Mission into Strategic Objectives

5. This had resulted in a draft performance management framework

6. It became clear that existing systems and processes for measuring performance were not sufficient Upon reviewing this framework, at its Feb 2008 meeting the Board stated: • “The Board will wish to be assured of progress towards the strategic objectives and achievement of the in year priorities, across the 6 domains identified…...” • “This will require the current approach to performance monitoring and management at Board level to be reviewed, including the contribution of the existing Board sub committees.” This provided the mandate for developing a refined approach to performance management: • To review existing performance measurement and reporting processes and systems as to their ability to assure the Board of progress towards the Strategic Objectives, and to set out an options appraisal to address any gaps in existing systems • To introduce into the Trust appropriate best practice to better enable the organisation to manage its performance, with the implementation of the preferred option in line with developing needs and aspirations of the Trust • To assist in knowledge transfer from Courtyard Group to Trust staff, to ensure the Trust is self-sufficient as soon as possible and can carry forwards this work as appropriate within the Trust, without the need to engage external consultancy support

7. Project Approach

8. Project Approach Courtyard Group was engaged to define, implement and manage a project to develop the PMF. Project Organisation is detailed in Appendix A The approach for this project was to break it down into 2 main phases, progress against which was governed by the Project Board: Phase 1 – Discovery (July and August ‘08) 1.1 Project Initiation 1.2 Stakeholder Interviews 1.3 Feedback of key themes 1.4 Phase 2 proposal Authorisation to Proceed Phase 2 – Design and development (September – November ‘08) 2.1 Definition and Preparation Authorisation to Proceed 2.2 Implementation and Refinement Authorisation to Proceed 2.3 Business as Usual usage

9. Phase 1 outcome Refinement of the existing performance framework was recommended to the Project Board. This discovery work supported Courtyard’s initial recommendation, that before investing in any Performance Management IT systems, the basics of a PMF needed to be in place. From staff feedback about the current framework, it was acknowledged by the Project Board that: • The domains were not yet fully defined and the purpose of the scorecard and its development had not yet been communicated effectively across the Trust • The objectives within each domain were not clear enough - a mixture of strategic and operational objectives, measures, targets and initiatives • The critical success factors (CSFs) describing the essential elements that need to be in place to ensure achievement of the strategic objectives had not been defined • Therefore, appropriate measures could not be defined for all of the current objectives and necessary CSFs • Governance mechanisms within the Trust for the strategic objectives were not clear

10. In response to this feedback, a tiered options appraisal was requested to enable the Project Board to commission an appropriate solution

11. The agreed approach to developing the PMF during Phase 2 involved 3 key stages Definition and preparation Implementation and refinement Business as usual usage Vision and mission Collect data Review reports Define Strategic Objectives Develop reporting Agree remedial action Implement Governance Agree Critical Success Factors Manage actions Define Measures and KPIs Review processes Review effectiveness Agree Governance Refine processes Refine remedial action Cascade

12. Courtyard Group resources were focused on supporting these stages Definition and preparation Implementation and refinement Business as usual usage Vision and mission Collect data Review reports Define Strategic Objectives Develop reporting Agree remedial action Implement Governance Agree Critical Success Factors Manage actions Define Measures and KPIs Review effectiveness Review processes Agree Governance Refine processes Refine remedial action Cascade

13. Internal Trust resources were best placed to support these stages Definition and preparation Implementation and refinement Business as usual usage Vision and mission Collect data Review reports Define Strategic Objectives Develop reporting Agree remedial action Implement Governance Agree Critical Success Factors Manage actions Define Measures and KPIs Review effectiveness Review processes Agree Governance Refine processes Refine remedial action Cascade

14. The project is currently at this stage, requesting Authorisation to Proceed with KPI development Definition and preparation Implementation and refinement Business as usual usage Vision and mission Collect data Review reports Define Strategic Objectives Develop reporting Agree remedial action Implement Governance Agree Critical Success Factors Manage actions Define Measures and KPIs Review effectiveness Review processes Agree Governance Refine processes Refine remedial action Cascade

15. The Performance Management Framework

16. Strategic Objectives In order to fulfil the mission, the following Strategic Objectives have been drafted, based upon the previous iteration of the PMF, input from the stakeholder workshop held on 30 September ’08, and ongoing development by the Project Board : • Increase the proportion of patients who describe our services as excellent • Reduce harm to patients, staff, and visitors • Increase proportion of staff who describe us as excellent • Be regarded as an excellent partner organisation • Achieve the highest ratings for the quality of our Clinical Services • Optimise the use of our resources and ensure value for money • Develop our portfolio of services to meet the needs of the population The Board is asked to endorse this description of the 7 Strategic Objectives

17. Performance Perspectives In order to promote a balanced perspective of Trust performance, the approach and principles devised by Kaplan & Norton in developing the Balanced Scorecard were adopted, but adapted for use in the NHS The Board is asked to endorse the proposed performance perspectives, through which Trust performance in realising the Strategic Objectives is to be assessed STAFF CLINICAL EXCELLENCE PATIENT EXPERIENCE PARTNERSHIPS FINANCE & EFFICIENCY

18. Critical Success Factors • These can be described as what we must do well in order to achieve the strategic objectives • In addition, what behaviours do we want this CSF to engender (linking into Trust values) • The CSFs are placed in each performance perspective to ensure that a balanced view of ‘must do well objectives’ is promoted and all perspectives are considered • The Board is asked to endorse the proposed Critical Success Factors and Trust leads, which have been previously approved by the PMF Project on 11 November ’08

19. Improving health by putting patients at the centre of excellent specialist care • STRATEGIC OBJECTIVES • Increase the proportion of patients who describe our services as excellent • Reduce harm to patients, staff, and visitors • Increase proportion of staff who describe us as excellent • Be regarded as an excellent partner organisation • Achieve the highest ratings for the quality of our Clinical Services • Optimise the use of our resources and ensure value for money • Develop our portfolio of services to meet the needs of the population PATIENT EXPERIENCE 1. Measure and exceed patient expectations, improving the patient experience 2. Ensure Patients experience no unnecessary delays 3. Involve patients and their carers in decisions about their care 4. Provide an environment that exceeds patient expectations 5. Ensure patients are treated with dignity and respect 6. Improve the quality, availability and communication of Information to patients, carers and the public CLINICAL EXCELLENCE 7. Deliver an improvement in defined and measureable clinical outcomes 8. Deliver a comprehensive strategic clinical audit programme 9. Ensure a culture which supports and promotes high quality research and innovation 10. Be compliant with national standards for clinical care 11. Clinical Safety STAFF 12. Enhance and extend the range and uptake of pay and benefits available to staff 13. Recognise and celebrate success 14. Enable staff to meet agreed individual and team objectives and deadlines 15. Develop high performing leaders and managers 16. Ensure personal competence is optimised through effective learning and development PARTNERSHIPS 17. Be perceived as an excellent corporate partner 18. Communicate effectively with a wide range of stakeholders 19. Be responsive to Commissioner intentions FINANCE & EFFICIENCY 20. Generate a ‘surplus’ to reinvest 21. Understand and optimise the use of resources, developing an approach to continuous systems improvement – right first time, every time 22. Develop and maintain governance arrangements that are fit for purpose 23. Achieve the highest rating by external bodies

20. What next?

21. Key Performance Indicators • The Critical Success Factors need measures to quantify performance progression • These are called the Key Performance Indicators (KPIs), and are being developed to capture a snap shot of Trust performance • Key principles applied here are: • We must have a balance of ‘input’, ‘process’, and ‘output’ measures • We must consider both qualitative and quantitative measures • We must agree what good performance is, with thresholds for Red, Amber, Green status and timescales for achievement of targets • We must make optimal use of existing performance measures, systems, processes and people, to limit the burden of inspection • We must ensure mandatory reporting is satisfied • We must be prepared to stop reporting which is not mandatory or providing value • The Board is asked to support the PMF Project Board in developing the construction of the KPIs

22. Example KPI construction Patient Experience Perspective Critical Success Factor 2. Ensure Patients experience no unnecessary delays (Steve Peak) Key Performance Indicator No delays index (Helen Munro) • Operational Delays • Patient Survey feedback • 18 week RTT • A&E 4 hr waits • Patients waiting over the standard • Cancellations KPI construction

23. No Delays run through • Embed Excel file for no delays here

24. RAG status for ease of completion Green=Routinely collect existing measure Amber= collect, not routinely reported Red=new or difficult to measure Patient Experience 1. Measure and exceed patient expectations, improving the patient experience - Amber 2. Ensure Patients experience no unnecessary delays - Green 3. Involve patients and their carers in decisions about their care - Red 4. Provide an environment that exceeds patient expectations - Amber 5. Ensure patients are treated with dignity and respect - Amber 6. Improve the quality, availability and communication of Information to patients, carers and the public - Red Clinical Excellence 7. Deliver an improvement in defined and measureable clinical outcomes - Red 8. Deliver a comprehensive strategic clinical audit programme - Amber 9. Ensure a culture which supports and promotes high quality research and innovation - Amber 10. Be compliant with national standards for clinical care - Amber 11. Clinical Safety - Amber Staff 12. Enhance and extend the range and uptake of pay and benefits available to staff - Amber 13. Recognise and celebrate success - Red 14. Enable staff to meet agreed individual and team objectives and deadlines - Amber 15. Develop high performing leaders and managers - Amber 16. Ensure personal competence is optimised through effective learning and development - Red Partnerships 17. Be perceived as an excellent corporate partner - Red 18. Communicate effectively with a wide range of stakeholders - Red 19. Be responsive to Commissioner intentions - Red Finance & Efficiency 20. Generate a ‘surplus’ to reinvest - Green 21. Understand and optimise the use of resources, developing an approach to continuous systems improvement – right first time, every time - Amber 22. Develop and maintain governance arrangements that are fit for purpose - Amber 23. Achieve the highest rating by external bodies - Green

25. Recommendations Gloucestershire Hospitals NHS Foundation Trust Board is recommended to endorse: • The 7 Strategic Objectives • The 5 perspectives through which performance in achieving the Strategic Objectives will be assessed • The 27 Critical Success Factors required to achieve the Strategic Objectives • The Executive leads acting as responsible owner for each CSF • Authorisation to proceed with completing the KPI constructions for each CSF

26. Appendix B – The Balanced Scorecard