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?