April 12 th 2016 Consultant Job Planning for 7 day services - Northumbria s journey Dr Eliot Sykes Business Unit Director Northumbria Healthcare NHS Foundation Trust eliot.sykes@borthumbria-healthcare.nhs.uk
Some key points We have had 7 day Consultant working in place for over 10 years We use job planning effectively THESE TWO STATEMENTS ARE NOT LINKED
Some key points We have had 7 day Consultant working in place for over 10 years We use job planning effectively We have a clearly defined relationship with our medical workforce Job planning is seen as a 2-way process, valued by all parties and closely linked to appraisal, personal and service development STATEMENTS 1,3 & 4 ARE LINKED
Can you tell me how to get to Keswick please?
And I wouldn t start from here!
Where to start? Defined relationship with top talent This is the way we do business Clinically led No back door deals No corridor conversations
Northumbria 503,000 pop. 2,500 sq.m +/- 1,100 beds 9,300 staff 255 Consultants 280 Doctors 10 inpatient sites Turnover > 440 million Largely Emergency driven 65:35 Provincial Medical School Mature symbiotic relationship with Newcastle
We are a bit odd.. Mobile workforce with Trust wide contracts 30% off site Flat structures Stability with flexibility Willingness to try Community Hospital decant Rural pressures = drive for innovation centralise when clinically better, devolve where clinically safe Lots of Hub & Spoke Ageing population
1998: 3 Trusts merged 2 years of rows Clinical Policy Group Service reviews = chaos Shared data 1999: Clinical Leadership Development Programme 7 days over 9 months multidisciplinary absolute requirement for management roles 2003 : Compact of Behaviours Merged 3 Consultant led Maternity Units
2004 : Surgery / Ortho / O & G / ITU Extended working day 08:00 20:00 On-call = work Sole commitment is to emergency stream & emergency theatres Rolling Consultant rounds Rapid assessment clinics Every patient seen every day Medicine Foundation Programme Pilot Single door point of entry Consultant led Acute Care Stream = reborn ACP s Split FOH / BOH Develop H@N Teams NNPs All clinically driven on Safety & Quality
2004 : Changed Consultant recruitment method Competencies of a Northumbria Consultant 2 days Psychometrics - Hogan, neo-pie Clinical scenarios 1hr 30 min structured interview x values Weighted scoring 70% bar Platform for development Team and individual profiles
Emergency Surgery and Elective Care Business Unit Organisational Chart April 2016 Business Unit Director Eliot Sykes Deputy Director Marion Dickson General Manager Helen Routh Obs and Gynae Theatres and Anaesthetics Upper GI Pre Assessment Bereavement Workforce Decontamination Bed Re-Configuration CSSD CQUIN WIMMS EPRR NSECH WGH General Manager Clare Bannister Bowel Cancer Screening Endoscopy CIP Contact Centre Switchboard Bed Re-Configuration Med Chart NTGH HGH Strike Planning TAeR Rob Graham OSM WGH Obs and Gynae Safeguarding CIP Redevelop WGH Neuro- Physiology Kevin O Neil OSM NSECH Site Lead Urology Orthotics movement of work back to base sites. Paul McNeillie OSM WGH Site Lead Theatres Anaesthetics Pre Assessment Pain Management Janice McNichol Head of Midwifery Midwifery strategy All Midwifery issues including staffing Complaints Mark Graham Clinical Governance Quality Dashboard All Governance Medical Devices FOIs Julie Gillson Chief Matron Nursing Strategy All Nursing Issues including staffing Complaints Kim Broadfield OSM NTGH Site Lead Interpretation Services Breast Plastics Oral Surgery Redevelop NTGH Jackie Hall Junior OSM HGH Site Lead Outpatient s Trust wide Hexham Dental Upper GI Lisa Nevins Junior OSM Colorectal Endoscopy Bowel Cancer Screening Clinical Leads Clinical Director Surgery Clinical Lead Breast Clinical Lead Colorectal Clinical Lead Endoscopy Clinical Lead Upper GI Sarah Robinson Mike Carr Reza Kalbassi Ben Box Keith Seymour Clinical Director Obs & Gynae Deputy Clinical Director of Theatres Clinical Lead Anaesthetics Dep. Lead Anaesthetics Paul Franks Tony Sproston Scott Muller James Golding Fiona McMenemie Ravi Alagar Devyn Emmerson- Ducasse Management Trainee NTGH James Grove Management Trainee Theatres Trust Wide Clinical Director Trauma & Ortho CL Trauma & Ortho WGH CL Trauma & Ortho NTGH Professional Lead Dental Bowel Cancer Screening Clinical Lead Urology Kevin Emmerson Chewy Joseph Roland Pratt Jane Lee Dave Nylander Trevor Dorkin Sophie McNair Civil Service Trainee Medical records Kate Young Management Trainee Obs and Gynae WGH
Close partnership / leadership between clinical manager and manager = success Paired at all levels Information Business Unit Structure Accountability To our patients (quality) To our business purpose (financial bottom line) Freedom and opportunities
This has allowed our : B/U system to thrive Aligned workforce stability and managed CIP s Equity, openness & fair play Recruitment +++ Teaching & Training +++ Staff survey +++ A happy crew THE BIG PLAN
Why not be radical?. A whole system change.. Create a Specialist Emergency Care Centre Split Elective / Emergency work 24/7 resident Consultant in Emergency Care Extended working day 7/7, 9 clinical teams Change DGH s for elective / community care KIDD. Develop Ambulatory Care & Frail Elderly Direct access to palliative care Builds on our existing decant model
Outpatients Diagnostics Day cases Elective Surgery Sub acute in-patients Acute inpatients A&E Emergency Admissions Minor injuries Outpatients Diagnostics Day cases Elective Surgery Sub acute in-patients Acute inpatients A&E Emergency Admissions Minor injuries Outpatients Diagnostics Day cases Elective Surgery Sub acute in-patients Acute inpatients A&E Emergency Admissions Minor injuries
Focused around 31 major sites emergency site Outpatients Diagnostics Day cases Elective Surgery Sub acute in-patients Acute inpatients A&E Emergency Admissions Minor injuries hot diagnostics Specialist Emergency Hospital Acute inpatients A&E Emergency admissions Outpatients Diagnostics Day cases Elective Surgery Sub acute in-patients Acute inpatients A&E Emergency Admissions Minor injuries Outpatients Diagnostics Day cases Elective Surgery Sub acute in-patients Acute inpatients A&E Emergency Admissions Minor injuries
Training
The new emergency care hospital
7 Day Working Job planning supports this, it cannot make it happen Addresses difficulties & shortcomings Co-ordinates workforce & resources Business Units oversee everything No surprises please No deals No No extra staff 42 week year Everything annualised
Understand the issues Fear Exposure Lack of usual support systems Health issues Perverse incentives Social pressures Support for change
Before the meeting Clear understanding of the Trust s priorities Clear understanding of the BU s priorities Shared agreement on service need Supported by shared open access data (3 clicks) Clinical - performance / safety / quality Financial Patient SLA reports All discussed in speciality boards
Before the meeting Understand individual s desires and aspirations Service development Personal development Changes to work pattern Changes to case mix
Aim to match the two before the meeting. Job planning should be a formal sign off The process may have had a long gestation
What we learnt Listen! Agree cross BU tariffs earlier Two rounds of job planning beneficial Limit job plans to two sites where possible Keep it safe over egg sessions and then remove after review Onerous but worth it Difficult Doctors require a different route entirely.
The next steps? - integration E-rostering E-appraisal E-360 E-SLA reporting E-governance E-data/patient experience E-job planning Remain agile - change leads to further change