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www. eastcheshire. nhs. uk Follow us @eastcheshirenhs Start The Year 2013 ‘Inspiring Innovation’ Thursday 11 April 2013 Kindly Sponsored by: With thanks to: GE Healthcare, Pennine Acute Hospitals NHS Trust, Tesco Macclesfield, Morrison's Local

Inspiring Innovation Lynn Mc. Gill Chairman ‘Delivering our vision. . . The best care in the right place’

A People Business

A Patient Story Why do this differently? How do we do more of it?

Team Work

3 key messages 1. Teamwork 2. Together 3. Smarter

Inspiring Innovation Thank you

John Wilbraham Chief Executive ‘ 2013/14 Your Year’

New World • New Commissioning and accountability structures • Higher patient expectations post Francis • Increasing clinical standards in specifications • National agenda of integration/specialisation • What is our response?

What is our response? • Disengage – Its all too complicated a • Keep doing what you’re doing Keep your head down it’ll all go away • Keep doing what you’re doing But worker harder • Change the way you do things

Changing the way we do things Best Care in the Right Place Listening into Action Permission to act What are the services we provide? Where do we provide them? Clarity of accountability Speed we make things happen Remove duplication

Inspiring Innovation Thank you

Andy Ward GE Healthcare

Karen Bryson QIPP Project Director ‘Start the Year Together 2013/14 QIPP’

Areas we’ll cover • What is QIPP and what does it mean for us and our patients? • A quick quiz – how well do you know your Trust? • The challenge for this year • Overview of the QIPP programme and immediate focus • How is the work led and how to get involved ?

QIPP One Plan – we will build on our success • Delivered a challenging CIP over last 2 years • 11/12 achievement – £ 8. 2 m recurrent – £ 2. 7 m non recurrent • 12/13 current forecast • Close to achieving our £ 10. 4 m target. – £ 7. 7 m recurrent – £ 2. 5 m non recurrent Recurrent savings have been delivered through a broad range of schemes which include: • Outpatient redesign phase 1 • Theatre productivity & efficiency facilitated through job planning • Business Unit restructure • Pharmacy Production Unit • Various procurement schemes

QIPP One Plan – getting us “fit for the future” • “Fit for the future” focus • Foundation Trust status – we need to deliver quality, performance and a balanced budget • Changes in user need and complexity – need to change to match this • Changes in care system – good & bad for East Cheshire NHS Trust, but we need to respond quickly • An integrated provider - our trump card! • Need everyone involved

What will this mean for patients? • Focus on quality – Better outcomes for patients – Delivering safe, effective and personalised care – Helping people stay healthy and independent • Improve the patient experience – Access – Care co-ordination – Remove traditional barriers between hospital based and community based services • Care closer to home – Deliver the best care in the right place

Quick quiz • Most frequent attendances at A&E in past 21 months • Highest admissions for 1 person in 10 months • % Increase in over 80’s at A&E • % beds in Orthopaedics not occupied by orthopaedic patients • Number of non core beds open today • Spend on Bank, Agency and Locums in 2012/13 • DNAs in Outpatients and “lost income” • Longest stay in a bed in 2012/13

The challenge this year Historical spend above “Credit 12/13 budget Card” Efficiency & productivity Budget 2013/14 £ 11, 700 Savings Budge t 13/14 Budge t 14/15 Budge t 15/16 QIPP targets • Targets on fair shares basis • Reflects contributions – cost v income • Affects clinical, nonclinical areas & corporate • Discussions with Clinical and Associate Director budget holders started • Targets will cascade through East Cheshire NHS Trust

One Plan – focus on flow and efficiency Efficiency Home Social Care PC Flow Orthopaedics Unplanned Frail Elderly AHP Comm Nursing Other comm functions Interme diate Care Family & Well Being functions A&E Children’s functions OP Theatres Diagnostics Beds Getting Planned activity back on track “in house” Frail Elderly/ Over 80 s – targeting high need, developing alternative models to manage in the community All main pathways Removing unnecessary costs Home

Need our collective effort NOW to take pressure off beds… MH Community Nursing Ortho Paeds ENT Community AHPs A&E General Surgery Private Sector OP Discharg e Geriatric Medicine MH PC Intermediate Beds F&WB Diagnostics Social, personal networks Others …. Push Pull Social Care

One Plan Team approach - part of day to day work Clinical Lead / Executive Sponsor AD and Responsible Manager leads Service Design, Admin Project Coordinators HR, Finance, Analyst You

Quarter 1 - ensuring focus and pace 14 Mar ONE PLAN Establish Structure & Focus Setting business unit targets, developing delivery plans , strengthen governance Assuring the Board Establishing PACE Workstreams agreed Teams agreed Cut 1 – target allocation Workstream leads discussion Existing CIPs reviewed Work up high level Mandate s 1 May 1 April 22 Mar 1 June Additional support in place C u t 2 F i n a l v e r s i o n Develop Mandate s, plans and timetable Board Reviews of QIPP Plan , Wave 1 priority programmes Start deliver y as plans firm up Board Paper on “Plan for Plan” Discussions with CCGs, LA, Other Providers, Partners 2012/13 recurrent PLUS Get on with existing programmes and target the CIPs we know “just need to get on an do” Establish operational controls on resource use and spend Start to embed a culture of accountability for, PERFORMANCE, PRODUCTIVITY & PROFITABILITY Position Review at end of Quarter 1 1 July 2 weekly program me review with Function al and Pathway Sponsors , CD & ADs

To get involved… • Share ideas via Your Voice. . . Listening Into Action team • Join the work streams - Contact project responsible officers (details are in your packs) • Support changes being developed • Think – Is there a low cost / no cost alternative ? – Is it essential?

. . . . so over coffee and during the day • We are interested in your ideas for improving the unplanned care pathway across the organisation – What works well and should be adopted across all pathway components ? – Areas that need to improve ? • Please note your ideas on the charts in the coffee area

Thank you

Inspiring Innovation Refreshments QIPP challenge Your Voice. . . Listening Into Action teams – inspiring the future.

Inspiring Innovation Staff Conversations IT Purchasing

Julie Owen, LIA Lead Pennine Acute Hospitals NHS Trust

Listening into Action Team Briefing Pack on at Listening into Action (Li. A) Pennine Acute NHS Trust Breaking paradigms, creating ambition, raising the bar ©Optimise Limited 2010 ref 1. 5. 4

Message from our Chief Executive I suppose leadership at one time meant muscles; but today it means getting along with people. Mahatma Gandhi You don't lead by hitting people over the head - that's assault, not leadership. Dwight D. Eisenhower The art of communication is the language of leadership. James Humes “I want leaders at every level in the organisation to engage with and support our staff so that they can be really involved in making the changes we all want to see. This is the key to giving our patients the care they deserve and our staff a real pride in working here. Nothing is more important. ” John Saxby, Chief Executive

Why Listening into Action. . . • Concerns about staff survey results • Lack of staff engagement and “low morale” • Some bad press • Lack of ownership and pride © Optimise Limited 2011

Initial barriers to Listening into Action No e tim © Optimise Limited 2011 Be do en t ne he th re at Cynicism

Quick Wins Car 4 Christmas raffle © Optimise Limited 2011

The trust is having an E-MAIL FREE DAY! Love your staff on Valentine’s Day Forget the e-mail! Visit or telephone instead Thursday 14 February 2013

Certificate of Appreciation JOE BLOGGS is hereby granted to: You Made a Difference for outstanding performance in Communication with his team * From Ann Onymous Divisional Nurse Manager Thank you for demonstrating the continued commitment required to achieve excellence and success. 3/19/2018

Our First 10 Teams • Reduced waiting times in Out Patient Clinic by 87% • Reduced admission documentation by 50% • Reduced the number of results not viewed by clinicians from 20% to 6% • Saved £ 28, 000 by reviewing and rewriting the A&E “Recipe Book” • Set up a mystery shopper scheme • Created a generic worker in Theatre by combining the roles of HCA and Porter • Set up a local Paediatric Allergy Clinic © Optimise Limited 2011

Effect on the staff “I’m a Staff Nurse- I never thought I would be e-mailing an Exec and asking where he was up to with the plans for the unit” “I’ve tried for 3 years to set up this clinic – I can’t believe It’s actually happened” “ I didn’t think that anything would really happen but people are really getting into this and realising what a bad attitude can do to patients “ We went straight back from the Pass it On event and held a Sponsor Group meeting to decide what our next project would be because we were all as high as kites!” “OK I have to admit……. . it does work” LIA PULSE CHECK SHOWS STAFF FEEL MORE INVOLVED AND VALUED AND ARE MORE AWARE OF WHAT THE TRUST IS DOING © Optimise Limited 2011

Next 20 Teams • Improving the pathway from A&E to the Medical Admissions Unit • Decreasing the time patients wait for discharge medications • Setting up a Payroll Helpline for staff • Reducing the waiting time in Obstetrics & Gynaecology Emergency Clinic by devising and installing a patient database • Providing a standardised Anaesthetic Room that is user friendly, efficient and safe • Setting up an Older People’s Assessment Team © Optimise Limited 2011

NEXT STEPS • 8 Big Staff Conversations hosted by Executive and Non- Executive Board Members about the Francis report • More Patient Conversations July and August • Themed Staff Conversations for particular groups – Health Care Assistants, A&E Junior Doctors Thanks for listening – any questions or comments?

Moira Smith Pennine Acute Hospitals NHS Trust

Booking & Scheduling one of the first ten teams at The Pennine Acute NHS Trust “ Clearing the way” ENT Clinics

We Set Out To Improve ENT Clinics Our Mission : Effectively utilise clinic templates through improved dialogue and process. Strap Line Timely Booking = Smoother Flow. My sponsor group

Our Process Identifying and engaging staff Meeting with mentor Identify sponsor group proactive staff pulse check Li. A Department notice board and bulletin Communicate and prepare for the conversation Staff wanting to make a difference around what matters

Three Cases for Change The pulse check Our Conversation Identified Clinic Start Time Audit. Patients were not being seen on time. Identified that patients appointments times were not evenly spread throughout the clinic Clinics were starting late. The Template Process needed to be improved. We Listened and took Action Identified that 96 minutes of clinic activity were lost over a four week period.

Patient outcomes Patients arriving at intervals throughout the clinic. Clinics starting on time Historically patient have waited up to 2 hours to be seen by a doctor in the ENT clinic. The longest waiter currently is 15 minutes for clinics where the templates have been changed Patient do not lose a days pay waiting to be seen.

Staff Outcome Fewer Complaints Improved clinic start times. Improved morale staff are not challenging clinicians and clerks don’t have to deal with patients all at once. Nurses know who to escalate to if clinics do not start on time.

Trust Outcomes Reduced complaints Improved Duty of Care for Doctors Saving on 2 nd appointments as Patients are not leaving due to the long wait.

Our Thoughts on Li. A Good Process Everyone can be involved Great Support It Works Ownership It Spreads Improves morale See results

A real Booking & Scheduling Success Story with clinics times evenly spread. Listening into Action Thank You Moira Smith Listening into Action Associate 0161 – 778 -3228

Inspiring Innovation Thank you

Julie Owen Pennine Acute Hospitals NHS Trust

Effective Use of Time One Document in Time Saves Nine No Repetitive Paperwork Better for Patients Doctors and Nurses Combined Paperwork. Doctors and Nurses don't waste time

Team Mission/Goal To eliminate repetitive paperwork for medical/nursing staff for emergency care in Medicine

Case for Change • To produce combined paperwork so medical/nursing staff do not waste time repeating information • To spend more time with patients • To reduce any anxieties that patients may experience when being asked the same questions

Patient Outcome • Improvement in patient care/ time spent with them • Reduce anxieties

Staff Outcomes • Less time completing paperwork • More time with patients

Trust Outcomes • More effective use of medical/nursing time • Improvement in good quality care • Less complaints

What impact has the Team had? • Made staff aware that there are people whom are listening to what they are saying in relation to too much paperwork and steps are being taken to address this • Displayed effective team work with medical and nursing staff working closely together • Involvement of staff from different roles within the organisation working together

Impact cont’d • Production of a combined document for medical/ nursing staff to work with • Displayed clearly that there is a huge amount of repetition in the documents that are currently used within the Trust

How do we measure & quantify our success? • Feedback from nursing documentation group • Effective inter-professional working

The Next Steps • To identify areas within the Trust to pilot the documentation • Effective use of feedback from the pilot areas • Make any amendments if required • The group to continue to work together effectively to produce the final document • Final document to be ratified at Nursing Documentation Group

Any Questions?

Inspiring Innovation Staff Conversations Reward and Recognition Patient Documentation

Lunch Inspiring Innovation

Plenary session ‘Reflections- Inspiration from today’ Inspiring Innovation

The questions. . . A reminder 1. In 6 m time what will success look like? 2. What are the changes that would make a BIG impact? 3. What will you do in the next 12 weeks to make change happen?

Inspiration from IT Staff Conversation 1. Taking stock – hardware, software and training needs 2. One system: central resources, mobile networks 3. Involvement – right people at the right time

Inspiration from Purchasing Staff Conversation 1. DHL Style order and tracking system and Trust wide ‘top up’ service 2. Est. two workstreams: a. High cost and b. High volume 3. ‘Supplies for Dummies’ guide and what does ‘good’ looks like?

Inspiration from Reward and Recognition Staff Conversation 1. Thank You 2. Effective communication i. e. . Communicating our successes in Team Brief 3. Staff- led categories for Staff Awards

Inspiration from Patient Documentation Staff Conversation 1. Single assessment document 2. Ability to complete at the bedside 3. Streamlining documentation

John Wilbraham Chief Executive ‘Inspiring innovation through staff led change’