Transforming quality and costs at Hinchingbrooke Hospital
Translating evidence into better care: the impact of clinical leadership and culture
Massoud Fouladi, Cofounder of Circle Partnership Hisham Abdel-Rahman, Hinchingbrooke Clinical Chairman
Nuffield Trust Summit, Thursday 7th March
‘Clinical and financial basket case’
Financial
• £10 million deficit amounted to 10% of revenue
• £12 million backlog of capital repairs
• Agency costs £4 million pa due to inability to fill vacancies
• £40 million historic debt
Quality
• ‘Dysfunctional’ colorectal service (RCS report)
• A&E services rated poor by commissioners
• ‘Red’ PCT rating for serious incidents
management
• Small district general hospital serving 150,000 population with 22 GP practices and approximately £100 million budget
• 235 beds, accident and emergency, maternity, intensive treatment unit and full complement of secondary care services
• Innovative 10-year franchise arrangement in which Circle operates the Trust and underwrites financial risks
Changing culture: Creating a social movement through our partnership model
1,200 of the 1,700 strong workforce attended a four-hour ‘partnership session’ to agree collectively the business plan
Changing culture: Alignment of everyone to common goals and plans
Circle’s operating system Devolved power structure and continuous improvement methodology
You achieve excellence by…
• Learning, adapting and improving at all levels of the organisation
• Developing four core capabilities
1. System designed for excellence, with the capacity to detect failure built-in
2. Problem solving to build new knowledge and drive improvement
3. Sharing new knowledge throughout the organisation
4. Leading by developing these skills in others
Mandated clinical leadership: Flat structure with majority clinician board
Case study: ‘Stop the Line’: Toyota Andon System applied to healthcare
Rapid cycle improvement process
Case study: Colorectal service transformation
Early successes
Clinical results
• First of 46 hospitals in A&E
• 60% drop in serious incidents
• Cancer target compliant for first time
• CQC compliant for first time since inspections commenced
Patient experience
• Feedback up 852 to 24,000 per annum
• Top 10 of 46 for patient experience
• Food satisfaction up, parking fines scrapped, bedside
TVs installed
Financial
• 7% annualised savings delivered
• Trust in financial balance at zero cost to taxpayer
• £3.7 million Circle investment in transformational change
Has Circle delivered at Hinchingbrooke?