Making Change Happen

1. Making Change Happen Dr Paul Murphy Adam King Dimple Cosgrove 26 May 2010 “Driving improved organ donation within your hospital” 1

2. Session objectives By the end of this session, participants will: • Understand the importance of having a clearly defined vision for Organ Donation and start to articulate their own vision for Organ Donation within their hospital • Appreciate the benefits of annual planning and reporting to leading Organ Donation within their hospitals • Understand the skills, knowledge and process required to develop Annual Organ Donation Plans and Annual Reports • Be provided with practical hints and tips on developing local Annual Organ Donation Plans and Annual Reports • Understand the roles and responsibilities of the Clinical Leads, Donation Committee Chairs and Specialist Nurses for Organ Donation in the Business Planning Cycle • Have an opportunity to put theory into practice and build a local plan for organ donation 2

3. All Clinical Leads Non Clinical Champions Online Tool: Self-Assessment Tool, Document Sharing, Podcasts, Discussion Forum, PDP Atlas, Programme Progress Tracker The progression of your learning journey National Kick-Off Event (inc Law & Donation after Cardiac Death Master Class) National Kick-Off Event (inc Law & Donation after Cardiac Death Master Class) Podcasts: Eye & Tissue Donation, Epidemiology of Donation & Transplantation, Audit & Statistics and PDA: interpretation & Action Online Tool Self Assessment Tool, Document Sharing, Podcasts, Discussion Forum, Programme Atlas, Programme Progress Tracker Change Management & Leadership Fundamentals Change Management & Leadership Fundamentals Master Class 1 (Diagnosis of Brain Stem Death and Regional Peer Consulting Group Launch) Regional Peer Consulting Group (Introduction and coaching in action learning sets) Master Class 2(Donor Management & Physiology and Emergency Medicine) Making Change Happen(Development of action plan to implement changes in Trust) Making Change Happen(Development of action plan to implement changes in Trust) Master Class 3(Consent / Authorisation) Donor Simulation & Paediatrics(Additional Subject Areas) Regional Peer Consulting Groups(Coaching & networking event) Regional Peer Consulting Groups(Coaching & networking event) National Review Event(Review of Programme and Ethics and Media Skills Master Class) National Review Event(Review of Programme and Ethics and Media Skills Master Class) 3

4. Agenda 4

5. Fundamentals of Leading Change - Refresh During the Fundamentals of Leading Change session we: • Identified what can help to make change successful and what are the common reasons for failure • Identified the local barriers to promoting change within your hospitals • Introduced the change frameworks which you can use to guide change Management for Organ Donation • Discussed the importance of understanding who your stakeholders are to any change effort and tools for identifying and analysing your stakeholders • Defined the three way leadership between Donation Committee Chair, Clinical Leads and Specialist Nurse for Organ Donation and your respective roles as Change Leaders • Discussed techniques for tackling difficult conversations • Started to plan actions to identify and implement the changes you can make within your own hospital 5

6. Understanding the bigger picture PDP Strategic Big Wins 6

7. Developing a vision for Organ Donation 7

8. What success looks like for the PDP • The PDP for Organ Donation will contribute to the Organ Donation Taskforce objective to increase Organ donation rates by a minimum of 50% within 5 years – Making organ donation “Usual” • To achieve this vision the Programme will focus on 6 big win areas: 8

9. What does success look like under each of the 6 big wins? • We would like you now to split into six groups, one group per strategic big win • For your strategic big win we would like you to describe the future state of what a gold standard hospital would be doing under this objective i.e. • What would people in the hospital be doing around organ donation from a clinical perspective? • What would the Organ Donation Committee be doing? • What behaviours would you see? • What outcomes might have been achieved / what success stories are there? • Put your ideas on post-it notes and stick these on a flip chart • Group discussions for 30 minutes and then 30 minutes feedback 9

10. Why do you need a strategic direction for improving Organ Donation? What can happen without an effective strategic direction? • Lack of general direction and lack of a clearly defined ‘future state’ • Failure to appreciate the longer-term interests and too much emphasis on short-term success • Actions are un-coordinated and without shared purpose or meaning • Ineffective decision-making and poor prioritisation What is needed is a compelling view of what the future of Organ Donation looks like in your hospital 10

11. Ensuring alignment of your Organ Donation Strategic Direction • Your strategic direction for Organ Donation must be developed in the context of the wider vision for Organ Donation and the local visions of your individual hospitals NHSBT will identify the common organ donation themes and support Donating Hospitals to shape their local strategic direction for organ donation in alignment with the Taskforce vision Organ Donation Taskforce Objective To increase organ donation rates by 50% within 5 years Annual Plan Annual Plan Annual Plan Annual Plan Annual Plan Local Organ Donation strategies will be based on local needs, the overall hospital vision and the ODTF objectives Local Hospital Organ Donation Strategic Direction Local Hospital Organ Donation Strategic Direction Local Hospital Organ Donation Strategic Direction Local Hospital Organ Donation Strategic Direction Local Hospital Organ Donation Strategic Direction Overall Hospital Vision Overall Hospital Vision Overall Hospital Vision Overall Hospital Vision Overall Hospital Vision 11

12. Ensuring your strategic direction for Organ Donation is effective 12

13. Examples of Organ Donation Visions Transplant Australia exists to enrich and celebrate life. Our vision is for Australia to lead the world in organ and tissue donation and transplantation - saving lives, improving quality of life and providing much needed care and support. The vision of Donate Life America is to ensure that every person in the U.S. understands the need for organ and tissue donation and accepts donation as a fundamental human responsibility. We wish to see organ donation become a usual rather than unusual event as part of end-of-life care across the NHS Each individual should be given the choice and opportunity to offer their organs for the purposes of transplantation after their death. This choice should not be denied by the assumptions of NHS staff or a lack of facilities and infrastructure 13

14. How do you develop a strategic direction? • The process involves the combination of both creative and logical approaches • Development of the vision may involve several iterations as you test your ‘hypotheses’ and validate with your colleagues and stakeholders • The type of data which you can use to input into the development of your strategic direction include: • Review of the Organ Donation Taskforce Report and the Programme’s 6 Strategic Big Wins • Assessment of the national legal and policy frameworks for organ donation • Assessment of your hospital’s overall vision • Analysis of current Organ Donation practices within your hospital • Benchmarking against Organ Donation best practice within other hospitals • PDA data Draft strategic direction and collect data to test it Refine the direction and validate with others Communicate and embed the strategic direction 14

15. Communicating your vision for Organ Donation? Communicating your strategic direction to your colleagues and the wider hospital and receiving their buy-in is essential to the vision’s success Ways of communicating your vision include: • Written and verbal communication e.g. the Annual Organ Donation Report, the Annual Organ Donation Plan, training materials and other communications • Encouraging discussion of the Organ Donation strategic direction within your hospitals and amongst colleagues • Reinforcing key messages by linking it to the day-to-day activities of the hospital You know your vision has been embedded when: • Stakeholders are able to articulate the strategic direction and it’s impact in their own words • The strategic direction is discussed outside of situations in which it is required • Elements of the strategic direction become part of the organisational culture and ‘the way things are done around here’ 15

16. The Annual Organ Donation Planning Cycle 16

17. What is the Annual Organ Donation Planning Cycle? 17 • The annual organ donation planning cycle provides a structure of analysis, planning and reporting around which you can make the right changes to improve organ donation • Purpose of planning cycle: • Ensure content of plan reflects realistic ‘path’ from current state to objectives • Ensure delivery of plan is on-track and responds to changes in circumstances • Ensure oversight by Executive Board

18. What does the Organ Donation Planning Cycle look like? Benchmarking data April Annual Report (Financial Year begins) May March Annual Organ Donation Plan February Present to Executive June Key Board ODC Meeting Organ Donation Planning Cycle January July CLOD, SNOD & DCC* Annual Report August December Annual Organ Donation Plan Mid Year Review - November September Benchmarking Data October Mid Year Review PDA Benchmarking data 18

19. How can you plan effectively in line with the Organ Donation plan? • Assess: • Conduct analysis of internal and external environment to identify issues and potential opportunities • Plan: • Consider objectives to overcome issues / make the most of opportunities and establish activities and when these would happen to achieve objectives • Implement: • Deliver & track against plan, as well as reporting against progress Planning is not a one off activity – it requires regular assessment of progress and interventions. Remember 3 simple steps: Assess; Plan; and Implement 19

20. Assess Key Assessment Activities High Potential Donor Audit (PDA) Fishbone Analysis SWOT Analysis Impact To what extent is this person/ group affected by the Change? Low Low High Influence Benchmarking Unit Profile Stakeholder Analysis 20

21. Potential Donor Audit - Introduction What is it? The Potential Donor Audit (PDA) is an audit of all deaths occurring in Intensive Care Units for patients under the age of 75. A recent initiative is extending the audit to Emergency Medicine departments, however, this is still in progress. • Aims of the PDA? • Determine the potential for solid organ donation • Understand why solid organs were not retrieved where potential recognised • Identify all patients for whom death was diagnosed following brain stem tests • Raise the profile of solid organ donation • Heighten awareness of donation issues with clinical staff 21

22. Developing an Annual Organ Donation Plan and Report 22

23. What is an Annual Organ Donation Plan? • What is it? • An Annual Organ Donation Plan is a formal statement of a set of ‘Organ Donation goals’ for the hospital, the reasons why they are believed attainable, and the planned interventions (or activities) for reaching those goals • What are the benefits? • Clarity of vision • Objectives and actions • Describe the metrics • Define the seriousness of the venture 23

24. What is the Annual Report for Organ Donation? • What is it? • An Annual Report is a comprehensive report on an Organ Donation team’s activities throughout the previous year. It is intended to provide their stakeholders including NHSBT with information regarding the team’s activities and performance against their goals. • What is the purpose? • The Annual Report is intended to provide their stakeholders including NHSBT with information regarding the team’s activities and performance against their goals in an easy to digest format • Development of the report helps the Organ Donation team to reflect on their performance from the previous year and aid their future strategy development • The Annual Report is a celebration and communication of past and recent successes • Communicating the Annual Report within and outside of the local hospital will help to share lessons and develop learning 24

25. What does an Annual Organ Donation Plan look like? • Annual Organ Donation Plans are a decision making and communication tool and should be determined by the specific goals and stakeholders of the Organ Donation team. Typical high level structure includes: 25

26. What does an Annual Report look like? • Annual reports consist of but are not limited to the following contents: • \ 26

27. SMART Objectives The Annual Organ Donation Plan should be focussed upon SMART objectives 27

28. Example SMART Objectives The Annual Organ Donation Plan should be focussed upon SMART objectives 28

29. Managing and Tracking Against Plan 29

30. Balanced scorecard and Key Performance Indicators (KPIs) Purpose: • The balanced scorecard is a strategic planning and management system that is used to: • Align business activities to the vision and strategy of the organisation • Improve internal and external communications • Monitor organisation performance against strategic goals • Key performance indicators are quantifiable measurements, agreed to beforehand, that reflect the critical success factors of an organisation. • KPIs help an organisation: • Define and measure progress toward strategic and operational goals • Benefits: • Increase focus on strategy and results • Improve organisational performance by measuring what matters • Align organisation strategy with the work people do on a day-to-day basis • Focus on the drivers of future performance • Improve communication of the organisation’s vision and strategy • Prioritise projects / initiatives Adapted from Robert S. Kaplan and David P. Norton, “Using the Balanced Scorecard as a Strategic Management System,” Harvard Business Review (January-February 1996): 76. 30

31. Organ Donation KPIs Increase DBD organ donors Increase transplantable organs DBD Outcomes (What we want to achieve) Increase proportion solid organ donors donating eye tissue Effective partnership working Increase transplantable organs DCD Increase DCD organ donors Increase DBD conversion rates Customers / Partners (What we need to do for and with others) CLODs are in place Chairs of Donation Committees are in place Improve adherence to MNC Increase BSD testing Increase referral rates Increase DCD conversion rates Internal Processes (What we need to do well to reach our goals) Implement policies and best practice Embedded SNODs Increased approaches by trained person Increase donor family consent Increase submission data on time Complaints and Clinical Governance incidents Resources, learning and growth (What we need to enhance to succeed) Right proportion time spent in NHS organisations SNODs achieve and maintain competencies 31

32. Roles and Responsibilities 32

33. Suggested schedule for Donation Committee Meetings *Other potential representatives include: Ethics Committee; Chaplaincy (multi-faith); Patient groups/ Foundation Trust Council (where applicable); Local donor family; communications department ; A representative from dialysis or transplant services 33

34. Action Planning 34

35. Building a Local Action Plan • We would now like you to work with your strategic big win team from this morning and consider the key actions you would need to carry out to achieve the vision set for your big win • To do this you will need to consider: • SMART objectives against your vision • Supporting actions • Prioritisation of actions i.e. immediate, short, medium and long-term • We would like you to use the SMART template below to support your thinking and jot all your actions on post-it notes • We will then ask you to come and plot your activity along the T-map as we did during the case study activity 35

36. Transformation Map 2010 - 2013 Quick Wins Short Term Medium Term Long Term Vision Increased referral according to minimum notification criteria Increased organ donation rates by 50% in 5 years Increased donation after cardiac death Increased diagnosis of brainstem death Increased consent / authorisation rates Increased rates of donation in Emergency Medicine Increased quality and quantity of organs from improved donor management 36

37. Summary • Make sure you have a realistic and strategic vision that will support you to hit and achieve targets for organ donation in your hospital • Use the organ donation planning cycle to help you support your planning, reporting and meeting together as a team and organ donation committee • Take time to complete annual organ donation planning and reporting documentation to support you lead Organ Donation within your hospital • Understand how you can best share workload for making changes in your hospital between the Clinical Lead, Donation Committee Chair and Specialist Nurse for Organ Donation • Focus on those activities which are really going to make a difference in your hospital around the six big wins for organ donation • Remember that this programme is an evolution not revolution - change will take time! 37

38. What’s Next? 38

39. PDP for Organ Donation: Regional Event Calendar