Disrupting targets; Empowering staff

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Henry Stanley Stevens
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1 Disrupting targets; Empowering staff CHC GOVERNANCE CONFERENCE March 2018 welshambulanceservice

Overview Explain the transformation which has been taking place in ambulance services in Wales; Emphasizes the importance of the new Clinical Response Model in providing the headspace to deliver

2 Overview Explain the transformation which has been taking place in ambulance services in Wales; Emphasizes the importance of the new Clinical Response Model in providing the headspace to deliver organisational and system change; Share our experience of bringing about culture change across the service as part of our wider organisational development plan; Highlight some of the things we would focus on if we were starting our journey again; #WASTAGM17

3 What we do [INSERT INFOGRAPHIC HERE] #WASTAGM17

4 About Us [INSERT INFOGRAPHIC HERE] #WASTAGM17

5 Our Transformational Journey Transport Organisation ( Scoop and Drop ) 1998 Formation of WAST Medical Assessment Model 2011 Working Together for Success 2013 McLelland Review Clinical Transformation Clinically Focused Emergency Service Embedded in the Unscheduled Care System

Weaknesses in corporate governance Challenging industrial relations climate Talented but disengaged

6 Our Burning Platform 2013 Operating context Increasing demand and acuity Financial constraint / resourcing gap Deteriorating performance Flawed operating / performance model Frequent senior management turnover Weaknesses in corporate governance Challenging industrial relations climate Talented but disengaged workforce Intense political and media scrutiny Repeated review and re-organisation Doubt about the organisation s future

7 Catalyst for change

8 McCelland Review 2013

9 Collaborating for change Local Health Boards Police and Fire AACE Board Workforce Trade Unions Ministers Officials NHS Wales Our Commissioners

Accountability Establishment of EASC Collaborative

10 Transforming Ambulance Services in Wales System Change WAST Organisational Transformation Improved Outcomes Clear Accountability Establishment of EASC Collaborative Commissioning Ambulance Quality Indicators Creation of CASC Role Clinical Response Model

11 McCelland Review 2013 Recommendation 1 - EMS operate as clinical service embedded in the unscheduled care system. Recommendation 6 - Up-skilled workforce enabling greater autonomy and clinical decision making. Recommendation 8 - Move away from the primary focus on 8 minute response time standard to a more intelligent suite of targets which provide greater emphasis on patient outcomes and experience.

12 CRM The case for change Standard introduced in 1974 No clear evidence base for eight minutes Predominantly time based targets Not clinically focused or linked to outcomes or focused on quality 1.4 resources deployed per call Political and media pressure to hit target Clock stop model evolved Encouraged perverse behaviours

13 Clinical Response Model 2015 CATEGORY RESPONSE MODE DEPLOYMENT MEASURES CATEGORY RESPONSE MODE DEPLOYMENT MEASURES Blue lights Multiple Resources 65% within 8 minutes Blue lights Multiple Resources 65% within 8 minutes RED 8 minutes RED 8 minutes ( calls per ( calls per day out of 1300) day out of 1300) AMBER AMBER (65%) (65%) Blue lights Blue lights Right clinician/resource in a Clinical Interventions Right clinician/resource in a Clinical Interventions timely manner, based on Patient Outcomes timely manner, based on Patient Outcomes clinical need. clinical need. GREEN GREEN (30%) (30%) Hear and Treat Planned non-emergency Hear and Treat Planned non-emergency Normal Road Speed transport (ambulance/taxi): Normal Road Speed transport (ambulance/taxi): Telephone advice / clinical Telephone advice / clinical assessment assessment Clinical Outcomes Clinical Outcomes Patient Satisfaction Patient Satisfaction SIMPLE CLINICALLY FOCUSED... PRUDENT SAFE

Five Step Model CATEGORY RESPONSE MODE DEPLOYMENT MEASURES RED Blue lights 8 minutes Multiple Resources 65% within 8 minutes ( 60-70 calls per day out of 1300) AMBER (65%) Blue lights Right

14 Five Step Model CATEGORY RESPONSE MODE DEPLOYMENT MEASURES RED Blue lights 8 minutes Multiple Resources 65% within 8 minutes ( calls per day out of 1300) AMBER (65%) Blue lights Right clinician/resource in a timely manner, based on clinical need. Clinical Interventions Patient Outcomes GREEN (30%) Hear and Treat Normal Road Speed Planned non-emergency transport (ambulance/taxi): Telephone advice / clinical assessment Clinical Outcomes Patient Satisfaction

PACEC REVIEW (1) Clear and universal acknowledgement that CRM was the appropriate and right thing to do ; No new risks to patient safety introduced by CRM and no serious safety concerns; Likely that

15 PACEC REVIEW (1) Clear and universal acknowledgement that CRM was the appropriate and right thing to do ; No new risks to patient safety introduced by CRM and no serious safety concerns; Likely that without CRM there would have been significant risk for patients, particularly in winter; Positive impact on performance reliability of response times increased substantially; Fewer resources used per incident, regardless of categorisation Much more clinically focussed service; WAST much more visible to wider health system and a central player rather than passive recipient.

Investment needed in Information Systems; Opportunity to increase hear and treat;

16 PACEC REVIEW (2) Need to review categories of calls outside red, in particular Amber; category too large; not sufficiently discriminate; unacceptably long waits. Investment needed in Information Systems; Opportunity to increase hear and treat; Need to reduce variability across Wales; Investment in alternative pathways and responses required.

17 What we have learnt Work tirelessly to gain political, clinical, trade union and staff support; Continuously check that stakeholders, remain on the journey; Use the 5 step pathway as framework; Undertake a Demand & Capacity review first Re-profile our resourcing prior to model change Continuously engage, engage, engage staff and trade unions Proactively engage and support the media to change the message Ensure all conversations are clinically led Be transparent with our data Recognise that new model approval is the start not the end Manage expectations among the workforce Build resilience among senior leaders marathon and not a sprint!

18 Transforming Ambulance Services in Wales System Change WAST Organisational Transformation Improved Outcomes New Board New Leadership Improved Governance Clinical Modernisation Workforce Modernisation Cultural Change NEPTS

Transformation Programme Outcomes Patient Satisfaction Improved

Clinical Modernisation Modernising the Workforce Resource

Governance Leadership and Behavioural Change Vision

19 Transformation Programme Outcomes Patient Satisfaction Improved Clinical Outcomes AppropriateTimeliness Better Value for Money Clinical Modernisation Modernising the Workforce Resource Utilisation Non- Emergency Patient Transport Services Corporate Governance Leadership and Behavioural Change Vision Communications - Community Engagement - Internal Communication - Stakeholder Relationships

20 Bringing about cultural change

21 Getting the right people on the bus Right values Vibrant, Caring Compassionate Right attitude (do they have what it takes?) Can do, ambitious, optimistic, art of possible Right approach (do they care about me?) Authentic and Real, Visible and Connected Role models Leaders are more important than experience Passion. Set conditions of wellbeing and happiness in their team

Working with unions Clear and unequivocal statement of intent set expectations of TU working; Regular communication and sharing - open door access to CEO and Directors Listen and respect they re

23 Working with unions Clear and unequivocal statement of intent set expectations of TU working; Regular communication and sharing - open door access to CEO and Directors Listen and respect they re doing a job; Language Staff side to partners Invest the time - make the effort to build and maintain relationships; Early...early...early involvement; Start from a position of trust; Don t make promises you can t or won t keep Don t be put off by the set backs

24 Embedding the change Together, we will make WAST a great place to work Be consistent in your messaging Be consistent in your behaviours Be consistent in your expectations Challenge and be open to being challenged Take action when necessary Keep listening keep checking in

Improving outcomes Staff Survey 2016 - best improvement (10% increase in engagement score from 3 years ago) across NHS Wales Achieving close to full establishment in Paramedic and EMT

25 Improving outcomes Staff Survey best improvement (10% increase in engagement score from 3 years ago) across NHS Wales Achieving close to full establishment in Paramedic and EMT numbers (now overrecruiting) Partnership working with Trade Union colleagues including one of our union partners winning Approach towards Partnership at the UNISON Cymru Wales Health Awards

Transforming Ambulance Services in Wales

26 Transforming Ambulance Services in Wales System Change WAST Organisational Transformation Improved Outcomes Improving Quality Improving Performance Improving Media Profile Renewed Credibility De-escalation BUT Still Much To Do Need Consistency New Opportunities

27 Developing a long term strategy Primary Care Minor Injuries Health promotion Patient Diagnostics Public access Widening our service Offer Leadership and Workforce Multi-disciplinary Scope of Practice Up-skilling Research University Status Quality at the Heart of Everything We Do. Service integration Blue light collaboration Community resilience Working Together Embracing Technology Enabled workforce Enabled fleet Virtual see and treat Enabled patients

28 Close Diolch am wrando #WASTAGM17

Transforming Welsh Ambulance Service: scrapping times, supporting patients!

Transforming Welsh Ambulance Service: scrapping times, supporting patients! Dr Brendan Lloyd Medical Director Welsh Ambulance Services Trust Founding Senior Fellow FMLM Dr John Kotter: Leading Change 8-stage