Parallel Session: Achieving High Quality, Financially Sustainable Healthcare

ACHIEVING HIGH QUALITY, FINANCIALLYSUSTAINABLE HEALTHCARE

Why are you here?

• Achieving financially sustainable healthcare now and in future is likely to change how and where people access services

• This means that NHSScotland needs to consistently deliver:• high quality care• at a lower cost• against rising expectations and demand.

• This session will investigate and develop current thinking and practice around the critical links between improving quality and delivering on efficiency

Who will you hear from?

• Chair: Simon Belfer, Director of Finance, NHS National Services Scotland

• Session Lead: Professor Cam Donaldson Yunus Professor of Social Business & Health, Glasgow Caledonian University, author of ‘Credit Crunch Healthcare’

• Sally Campbell - Managing Director of Cheshire HR Service

• Discussion and audience voting

• Wrap up

• Introduction

• Challenge delegates on their thinking around ‘traditional’ delivery of efficiencies and how this can impact on improving quality.

• Describe the journey to delivering best value in HR services.

Three session aims

• Explore the links between quality and efficiency

• Opportunity to share innovative ideas and suggestions to influence this work

• Able to contribute to the national work being undertaken to support NHS Boards in this area

2020 Vision for Health and Care in Scotland

• Our vision is that by 2020 everyone is able to live longer healthierlives at home, or in a homely setting.

• We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management.

• When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm.

• Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions.

• There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

The challenge inside the 2020 vision

• Over the next few years, demand and the circumstances for delivery will be radically different

• We will need to continue to provide high quality health and care services, meeting what the people of Scotland expect

• We will be measured by securing the best possible outcomes for people from the care and support they receive.

Examples of the challenges

• Healthcare inflation

• Reducing health inequality:• Despite efforts to address, we have made very little progress.

• Ageing population:• By 2033 the number of over 75 is likely to have increased by almost 60%

• Continuing shift towards long-term and multiple conditions, with complex needs

• By 2033, demography could grow spend on health and social care by over 70%

• Dementia:• Estimates will rise from 71,000 to 127,000 sufferers in the next 20 years

• Tremendous financial costs to the NHS and social services

• Health and cost impact on carers - more likely to take prescribed medication, visit GP with higher levels of stress and physical symptoms

Public Service Reform – Christie response

• decisively shifting towards prevention

• integrating more public services locally, driven by better partnership, collaboration and effective local delivery

• investing in the people who deliver services through enhanced workforce development and effective leadership

• focussing on better performance, through more transparency, innovation and use of digital technology.

Professor Cam Donaldson

Yunus Chair in Social Business & HealthGlasgow Caledonian University

Collaborating for Quality

Achieving high-quality, financially-sustainable

health care

Cam Donaldson

Scottish Exhibition and Conference Centre, Glasgow

11-12th June 2013

Celebrating the NHS, London Olympics opening ceremony

Otherwise known as ‘leftie...crap’!

Two main directions follow

• Health care reform to enhance incentives for efficiency:

• user charges

• ‘internal markets’

• remuneration

• integration

• The need for economic evaluation of health care:

• assessments of cost effectiveness and cost benefit(a challenge to physicians)

• systematising evaluation thinking

(a challenge to managers)

Two main directions follow

• Health care reform to enhance incentives for efficiency:

• user charges

• ‘internal markets’

• remuneration

• integration

• The need for economic evaluation of health care:

• assessments of cost effectiveness and cost benefit(a challenge to physicians)

• systematising evaluation thinking

(a challenge to managers)

The focus of ‘Triple Aim’

• Patient experience (quality)

• Population health

• Cost (Value and financial responsibility)

Important antecedents

• Rational collective action

• Integration

My triple aim at Triple Aim

• Is integration sufficient?

Platitudes of health care reform

• Reforms all over the world state that the ‘new’ system will:• adopt ‘a balance of care’ approach

• be about ‘effectiveness and efficiency’

• adopt ‘an evidence-based approach’

• ‘involve communities and other stakeholders’.

• But no-one ever says how!!! i.e. what’s the process?



• Are we recognising and managing scarcity?

Managing scarcity: the clinical challenge

• Any decision to change the way care is delivered will impact on HEALTH OUTCOMES. This will:

• improve A

• remain unchanged B

• decrease C

Managing scarcity: the clinical challenge

• Any decision to change the way care is delivered will impact on COST. This will:

• decrease 1

• remain unchanged 2

• increase 3

“Allocation of funds and facilities are nearly always based on the opinion of consultants but, more and more, requests for additional facilities will have to be based on detailed arguments with ‘hard evidence’ as to the gain to be expected from the patient’s angle and the cost. Few could possibly object to this.”

Who said this?

• “Allocation of funds and facilities are nearly always based on the opinion of consultants but, more and more, requests for additional facilities will have to be based on detailed arguments with ‘hard evidence’ as to the gain to be expected from the patient’s angle and the cost. Few could possibly object to this.”

Cochrane AL. Effectiveness and Efficiency: random reflections on health services. Nuffield Provincial Hospitals Trust, London, 1972.

Deciding whether it’s worth it:A challenge to clinicians

2 = ×

3 × ×

A B C

1

HEALTH OUTCOMES

COST

= recommend change to new treatment

X = recommend status quo

= judgement required

An economics-based framework for needs assessment: the management challenge

An economic approach addresses need from the perspective of resources:

1. What resources are available in total?

2. In what ways are these resources currently spent?

3. What are the main candidates for more resources and what would be their effectiveness and cost?

4. Are there any areas of care which could be provided to the same level of effectiveness but with less resources, so releasing those resources to fund candidates from (3)?

5. Are there areas of care which, despite being effective, should have less resources because a proposal from 3. is more effective (for £s spent)?

Can be applied at ‘micro’ or ‘macro’ levels

Shameless promotion: part II

But it’s not new

Who said this?

“If I had a plan, it would be simply to take the poorest and least organised hospital in London and, putting myself there, to see what I could do – not touching the Fund for years, until experience had shown how the Fund might best be available.”

A novel idea!

“If I had a plan, it would be simply to take the poorest and least organised hospital in London and, putting myself there, to see what I could do – not touching the Fund for years, until experience had shown how the Fund might best be available.”

Florence Nightingale (1857)



• Are we recognising and managing scarcity?

• Where does ‘population health’ fit?

LessonsWe need to work towards:

• maintaining publicly financed systems

• thinking more about explicit evaluation and priority setting at alllevels of the system

• dealing with chronic disease management: integration plus priority setting?

• working ‘with’ rather than ‘on’: people as well as systems

• engaging the public: what is socially relevant?

• rethinking the notion of the ‘clinician-scientist’.

Sally Campbell

Managing Director of Cheshire HR Service

Developing a new model of HR Services

Cheshire HR Service - Overview

• Established in 2006, experienced in supporting NHS organisations in various sectors of healthcare

• Hosted by East Cheshire NHS Trust as an ‘arms-length’ division with an operating framework to provide increased autonomy

• Provider of a full range of business focused HR and L&D services

• We offer customers a wealth of experience and knowledge of working with the complexities of the changing healthcare environment

• Our mission ‘to deliver excellence in people management’

Cheshire HR Service - Timeline

Pre 2006

Separate HR Teams – Acute,

Community, PCT

2007 - 2011

NHS HR Shared Service

5 Organisations

2011 - 2013

NHS HR Service Provider –

50+ customers

2013+

NHS Service Provider with

Commercial Partner

2006 2013

The HR Challenge

• Safety & Effectiveness

• Value for Money

• Quality

• Increased Patient & Staff Satisfaction

NHS Outputs

• Potential to save £616m-£1bn nationally

• 56% of HR function could be provided as a shared service

• 20-50% operational savings

• Best practice approaches

DoH Back Office Report 2010 • People and skills taking centre

stage

• Risk management and governance giving HR pivotal role

• OD and change capability high demand

Drivers

• Small shared HR Service already existed

• Changes to commissioning structure – new organisations forming

• Introduction of Electronic Staff Record (ESR) across NHS

• Different payroll arrangements

• Absence of coherent HR strategy/lack of strategic HR input

• Cumbersome and outdated HR processes, inadequate technology

• Poor levels of satisfaction with HR

• Increased measurement and monitoring of HR indicators

Our Key Drivers

• Separate HR Departments• Multiple sites• Multiple Processes and Procedures• Multiple contact points• Disparate, outdated technology

platforms• Manual and duplicate data entry• Strategic staff performing

administrative tasks

• Results• Costly, disparate HR functions.• No performance metrics• No customer service focus

• Shared HR Service– Harmonised and centralised HR

services– Single point of contact for HR

customers– Single employee access portal and

data entry– Enhanced Technology platforms– Enhanced HR reporting

• Results– Cost reduction– Customer focused HR delivery– Strategic staff re-focused on strategic

delivery

Transforming HR Services

Our vision for a model service

Future proofing

Strategic health of organisation

Policy & Process

Administration

Process improvement

automisation, Self-service

/HR Service Centre

Centres of expertise

Customer retained HR activities

Systems Support Service

Recruitment Service

Learning & Development

Service

HR Consultancy

Service

Wellbeing Service

Business Partnering

Our Services

Business PartneringInefficient case mix, lots of ER activity, chasing of information,

limited business skills

Analytical skills, strategic consultancy, workforce planning skills, psychometric testing, service improvement training

OD, workforce planning, productivity, service change, governance and compliance, business strategy

20

09

-2

011

Tier 1:

HR Direct

24/7 Online Advice and Tools

Tier 2:

Advice Line/Administrators

Case Handlers/HR Advisors, recruitment/general

administration, online system management, MI Reports

Tier 3:

Specialist Advisors

Case Managers, specialist advisors, people coaching, mediation, people development, policy development

Services underpinned by Systems Support

Multiple Systems

Non-Standard Complex Processes

Multiple Locations

TransactionalEfficiencies

Baseline

Remove

Complexity

Remove complexity

Standardise Processes

Remove complexity


Implement Common System

Establish new organisation

Remove complexity



Centralise transaction processing

Establish new organisation

Remove complexity



Centralise transaction processing

Implement e-enabled common system

Migrate to Virtual transaction processing

Multiple Systems

Non-Standard Simple Processes

Multiple Locations


20%

Multiple Systems

Standard Simple Processes

Multiple Locations


40%

Common Systems


Multiple Locations


50%

Common Systems

Single/ Few Locations


60%

e-enabled system

Virtual Locations


75%

Increasing process maturity



Multiple Systems

Multiple Locations


Baseline

Multiple Systems

Non-Standard Simple Processes

Multiple Locations


20%

• Diversity of cultures from multiple organisations and ownership of HR

• Allocation of resources

• Geography/location

• Managing Change

• Business Continuity

• Developing technology against competing demands

• Achieving change in behaviours – customer/business focus

• Developing internally – capability to “let go” and become commissioning partners

Challenges

• Supported organisations in making savings year on year

• Increased customer satisfaction – organisation, manager, staff

• Technology benefits for HR and customers – modern, fast, efficient, compliant

• Improved job satisfaction in HR (above the best national average score)

• Skill Mix/Career Development - Right people undertaking right tasks

• Increased confidence and capability of managers

Was it worth it?

Internal HR

The Organisation New Capabilities

Self Diagnose their current state on maturity mapSet realistic expectations aligned to culture and practiceIdentify quick winsMake sure leaders are a partner on the journey

HR Business Partnering and StrategyManaging SLA’s/outsourced servicesBusiness Case DevelopmentDemonstrating value through informationRenegotiating “the deal” between HR and managers

Absolutes Internal HR

Investment in technologyCommitment to concept of new mode of controlClear governance arrangementsSimplify customer facing end

An OD/Change Programme which focuses on:Defining roles/mind the gapsDeveloping capability to let go and take on the newChange in behaviours/ taking a customer perspectiveHR Business Partners as commissioners of HR servicesDon’t put off dealing with capability issues

What did we learn?

Discussion and audience participation

So Just How Effective Are We?

Question 1

Who are the greatest band of all time?

1. Pink Floyd

2. Beatles

3. Abba

4. Chas & Dave

Question 2

How easy or difficult would it be for your organisation to introduce ‘an economics-based framework for needs assessment’ into its management processes?

(please enter a number from 1-4, where 1=very easy and 4=very difficult)

Question 3

How would you assess the culture of transparent measurement and learning and wider application of quality improvement techniques throughout your organisation?

(please enter a number from 1-4, where 1=very easy and 4=very difficult)

Question 4

How ready is Scotland to deliver the scale and speed of change required?

1. Lost cause2. Behind3. Ahead4. Well ahead

Question 5

The theme of this year's conference has been collaborating for quality. Which of the following statements best describes your view on the level of collaboration that currently exists across Health & Social Care?

1. There is no collaboration2. We collaborate across our organisation, but collaboration

with social care partners could be better3. We have good collaboration across health & social care4. We collaborate actively with a range of partners in public,

third and private sectors

Question 6

How engaged are you personally in collaborative work between Health & Social Care partners?

1. Not at all2. Very occasionally3. A reasonable amount4. Almost all the time

Question 7

What is the most important area for collaborative work over the coming years?

1. Primary Care2. Secondary Care3. Care at home and in the community4. Support Services (IT, Finance etc)

Question 8

What would be the biggest help/support to you as individuals/organisations with your change agenda?

1. Information from other health systems/different sectors2. Time with peers/colleagues to discuss opportunities3. Supported development programmes 4. Internal consultancy support to the assessment

of options for change

Question 9

To what extent has today given you new information or fresh ideas and impetus to engage?

1. Not at all2. Not much3. Quite a lot4. Huge

Question 10….(Chairman’s Special Question)

How much UK tax should Google pay? Enough for:

1.Billy Connolly to get a haircut2.A chocolate bar for everyone in this room3.A Google chrome laptop for every P1 child in Scotland4.Cam Donaldson to get a new Ferrari each year

Wrap-up

Health & Medicine

Parallel Session: Achieving High Quality, Financially Sustainable Healthcare