Dr Sally Pearson Helen Munro Andrew Abbott, Courtyard Group

Developing the Gloucestershire Hospitals NHS Foundation Trust

Strategic Performance Management Framework

Dr Sally Pearson

Helen Munro

Andrew Abbott, Courtyard Group

Background

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, byWorking together to deliver excellent, safe health care in a clean environment, with Valued staff who are motivated, well trained and have a helpful attitude.

The Strategic Framework

MissionWhy we’rehere

VisionWhere arewe trying toget to

Strategic ObjectivesWhat we need

to achieve

‘In Year’Priorities

What we’re doing to achieve the strategic

objectives

ValuesOur Style

Analyse impact on;

Situational Analysis;External changes;-National-Local

Internal issues; - how we

are performing

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

This had resulted in a draft performance management framework

Patient Experience • to increase the proportion of patients who can express high satisfaction as a result of a positive experience-Planned care convenient for patients-Privacy Dignity & Responsiveness-Eliminating un-necessary waits & duplication-Communication- Environmental improvements

Staff •To increase the proportion of staff who feel positive about the Trust and their Job •Leadership & teamwork-Training, development- Valuing and recognising good performance-internal Communication-Staff engagement-Job design and role clarity

Development of Our Services•To increase the proportion of our services viewed as specialist

-Reconfiguration-Repatriation-Dispersal-Balancing demand & capacity

Clinical Excellence • To achieve the highest rating for the quality of our services from external bodies -Rapid adoption and consistent compliance with national guidelines, standards and targets-Maximising clinical safety-Competent teams-24/7 for emergency care-Information systems to monitor clinical outcomes-Research and Innovation

Working in partnership •To be regarded as excellent corporate partners by our Commissioners, other agencies & providers and Customers

- Service delivery responsive to commissioners-Corporate social responsibility-Communication

Finance and Efficiency •To achieve the highest rating of for the management of resources from external bodies -Generating surpluses to reinvest for improvement-Trust wide approach to quality improvement and process redesign-Service Line Reporting & Patient Level costing-Simplification of internal systems

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

Project Approach

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


2.2 Implementation and Refinement


2.3 Business as Usual usage

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

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

PMF feature Silver Gold Platinum Comments

6 domains defined CSFs for each domain along with statement of purpose

Objectives and initiatives defined

SMART objectives and contributing initiatives documented

Accountabilities agreed Who is responsible and who is accountable for the objectives and initiatives

Mandatory reporting aligned

S4BH, NHSLA, Monitor, Management reporting, aligned to framework

KPIs and PIs defined Measures, targets, thresholds, data sources and reporting agreed

Key Corporate projects aligned

Aims of UTOPIA, IM&T, OD, NSFI, Service Line Mgt etc. aligned to objectives

MS Excel based Scorecard with RAG

Performance measurement scorecard produced with RAG indicators

Reporting sophistication enhanced

Online delivery, online measurement capture, Dashboard reporting etc

Balanced Score Card cascaded

Divisional and Speciality levels cascade, or across programmes and projects

IT enabled process automation

Process automation through IT solutions – portfolio and Performance Management

Portfolio Management A process for managing investments such that you know that you are working on the right things, in the right way, getting them done well and getting the benefits

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

Agree Critical Success Factors

Define Strategic Objectives

Define Measures and KPIs

Agree Governance

Collect data

Develop reporting

Implement Governance

Review processes

Refine processes

Review reports

Agree remedial action

Manage actions

Review effectiveness

Refine remedial action

Cascade

Courtyard Group resources were focused on supporting these stages




Vision and mission Collect data

Develop reporting

Review processes

Refine processes

Review reports


Manage actions



Cascade


Agree Governance




Internal Trust resources were best placed to support these stages





Develop reporting

Review processes

Refine processes

Review reports


Manage actions



Cascade


Agree Governance




The project is currently at this stage, requesting Authorisation to Proceed with KPI development





Develop reporting

Review processes

Refine processes

Review reports


Manage actions



Cascade


Agree Governance




The Performance Management Framework

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 :

1. Increase the proportion of patients who describe our services as excellent

2. Reduce harm to patients, staff, and visitors

3. Increase proportion of staff who describe us as excellent

4. Be regarded as an excellent partner organisation

5. Achieve the highest ratings for the quality of our Clinical Services

6. Optimise the use of our resources and ensure value for money

7. 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

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

FINANCE &

EFFICIENCYPARTNERSHIPS

PATIENT EXPERIENCE

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

STAFF12. Enhance and extend the range and uptake of pay and benefits available to staff13. Recognise and celebrate success14. Enable staff to meet agreed individual and team objectives and deadlines15. Develop high performing leaders and managers16. Ensure personal competence is optimised through effective learning and development

PARTNERSHIPS17. Be perceived as an excellent corporate partner18. Communicate effectively with a wide range of stakeholders19. Be responsive to Commissioner intentions

CLINICAL EXCELLENCE7. Deliver an improvement in defined and measureable clinical outcomes8. Deliver a comprehensive strategic clinical audit programme9. Ensure a culture which supports and promotes high quality research and innovation10. Be compliant with national standards for clinical care11. Clinical Safety

FINANCE & EFFICIENCY20. Generate a ‘surplus’ to reinvest21. Understand and optimise the use of resources, developing an approach to continuous systems

improvement – right first time, every time22. Develop and maintain governance arrangements that are fit for purpose23. Achieve the highest rating by external bodies

PATIENT EXPERIENCE1. Measure and exceed patient expectations, improving the patient experience2. Ensure Patients experience no unnecessary delays3. Involve patients and their carers in decisions about their care4. Provide an environment that exceeds patient expectations5. Ensure patients are treated with dignity and respect6. Improve the quality, availability and communication of Information to patients, carers and the public

STRATEGIC OBJECTIVES

1. Increase the proportion of patients who describe our services as excellent

2. Reduce harm to patients, staff, and visitors

3. Increase proportion of staff who describe us as excellent

4. Be regarded as an excellent partner organisation

5. Achieve the highest ratings for the quality of our Clinical Services

6. Optimise the use of our resources and ensure value for money

7. Develop our portfolio of services to meet the needs of the population

Improving health by putting patients at the centre of excellent specialist care

What next?

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

Example KPI construction

Patient Experience

2. Ensure Patients experience no unnecessary delays (Steve Peak)

Perspective

Critical Success

Factor

Key

Performance

IndicatorNo delays index (Helen Munro)

KPI

construction

• Operational Delays

• Patient Survey feedback

• 18 week RTT

• A&E 4 hr waits

• Patients waiting over the standard

• Cancellations

No Delays run through

• Embed Excel file for no delays here

RAG status for ease of completion

Patient Experience1. Measure and exceed patient expectations, improving the patient experience - Amber2. Ensure Patients experience no unnecessary delays - Green3. Involve patients and their carers in decisions about their care - Red4. Provide an environment that exceeds patient expectations - Amber5. Ensure patients are treated with dignity and respect - Amber6. Improve the quality, availability and communication of Information to patients, carers and the public - RedClinical Excellence7. Deliver an improvement in defined and measureable clinical outcomes - Red8. Deliver a comprehensive strategic clinical audit programme - Amber9. Ensure a culture which supports and promotes high quality research and innovation - Amber10. Be compliant with national standards for clinical care - Amber11. Clinical Safety - AmberStaff12. Enhance and extend the range and uptake of pay and benefits available to staff - Amber13. Recognise and celebrate success - Red14. Enable staff to meet agreed individual and team objectives and deadlines - Amber15. Develop high performing leaders and managers - Amber16. Ensure personal competence is optimised through effective learning and development - RedPartnerships17. Be perceived as an excellent corporate partner - Red18. Communicate effectively with a wide range of stakeholders - Red19. Be responsive to Commissioner intentions - RedFinance & Efficiency20. Generate a ‘surplus’ to reinvest - Green21. Understand and optimise the use of resources, developing an approach to continuous systems

improvement – right first time, every time - Amber22. Develop and maintain governance arrangements that are fit for purpose - Amber 23. Achieve the highest rating by external bodies - Green

Green =Routinely collect existing measure Amber = collect, not routinely reported Red =new or difficult to measure

Recommendations

Gloucestershire Hospitals NHS Foundation Trust Board is recommended to endorse:

1. The 7 Strategic Objectives

2. The 5 perspectives through which performance in achieving the Strategic Objectives will be assessed

3. The 27 Critical Success Factors required to achieve the Strategic Objectives

4. The Executive leads acting as responsible owner for each CSF

5. Authorisation to proceed with completing the KPI constructions for each CSF

Appendix B – The Balanced Scorecard

Documents

Dr Sally Pearson Helen Munro Andrew Abbott, Courtyard Group