Introducing the SOA orthopaedic Vanguard project 30th June 2016 Rachel Yates SOA Chief Officer/NOA Director/GIRFT Director/Director of National Orthopaedic Policy Unit
Background
Key background the logic model supplied to NHSE that supported our bid
Pen portrait The National Orthopaedic Alliance will provide a framework for improving quality in orthopaedic care in England. This will be based on a kitemark based membership model founded on evidence based descriptors of what good looks like in orthopaedic provision. We will create tools for providers and commissioners to enable them to consistently achieve quality and efficiency including a clear benchmarking system. In addition, we will develop flexible contracting mechanisms to ensure that commissioners can adopt the quality assured new model of care in different local health systems. We shall also be seeking opportunities to support other specialties in adopting similar quality based membership models to drive improvements in care. Robert Jones and Agnes Hunt NHS Foundation Trust Royal Orthopaedic Hospital NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust
Objectives 1. Agree what good looks like in orthopaedics and setting a formal kite mark for this. 2. Recruit/assess/support members. 3. Grow membership across the country to spread provision of consistent high quality care. 4. Support the development of franchised services by members. 5. Support the development of a quality assured system for orthopaedic care. Robert Jones and Agnes Hunt NHS Foundation Trust Royal Orthopaedic Hospital NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust
Clinical objectives Agree what good looks like in orthopaedics and setting a formal kite mark for this. Develop a clinical quality kitemark by: Developing a codified set of standards, protocols and processes for members Developing a set of benchmark targets for members Learning from what already exists in other specialties The clinical quality kite mark will include: A set of Quality Standards/ and Standard Operating Practices (and evidence and examples of best practice) Quality assured service specification Assessment of current members against the established standards A peer led assessment of where safety and quality outcomes can be improved
The wider fit Vanguard program Acute Chains (eyes and cancer) Use of data, outcomes, experience GIRFT etc Quality and efficiency agenda Carter etc Clinical Service Accreditation Alliance (UKAS) Clinical Services Quality Measures NHS England STPs
Timeline
Early thoughts re NOA membership structure Continuous Improvement Bronze Developing Member Self Assessment which will be Peer Reviewed within 6 months of joining Improvement Plan in place and developmental opportunities identified Use the support available to them, Buddying, Mentoring Toolkit and Workshops to progress to Silver D e v e l o p m e n t A c t i v i t y Silver Centre of Evidence and Improvement Buddying / Mentoring Improvement Plan in place and developmental opportunities identified Use the support available to them, Buddying, Mentoring Toolkit and Workshops to progress to Gold D e v e l o p m e n t A c t i v i t y Continuous Improvement Gold Centre of Excellence and Innovation Peer Reviews Mentoring Ongoing development of standards and processes
Assessing members against the standard Needs to be SMART Need to avoid being to easy to achieve Sign up alone should not give a quality mark? Minimum period of 6 months Pre qualification Agree the principles of membership Agree to benchmark in all relevant areas Identification of improvement areas Bronze Benchmarking data in all relevant specified areas Achieving standards in 25% Improvement plans in remaining areas Silver Achieving standards in 50% Buddying/mentoring Involvement in setting standards working groups Gold Achieving standards in 80% Buddying/mentoring Setting standards Peer review
Who will benefit from the project? Patients Evidence of Patient centred care Good outcomes, good experience Reliable safe processes Commissioners Buying quality Better discussion with providers Clear guidance on what good looks like Providers Self support Quality improvements driven by Peer review and through natural competition Co dependency, developing of wider networks Efficiency savings Nationally Driver of the GIRFT, NHSI and Carter agendas but clinically driven this is not done to anyone Levers, new payment methods, incentivisation, quality efficiency agenda Model of improvement
What s underway?
Finalise project documentation and funding All project business case documentation was successful submitted. Funding for 2016/17 has been confirmed at 700,000 requiring franchising and replicating the model to other specialties to be pushed into 2018/19. Making this year s focus predominantly about the creation of the kitemark and guidance and organisational development. Additional funding of c. 100,000 has been confirmed to fulfil the New Models of Care team s evaluation requirements.
Creating a National Orthopaedic Alliance We are reflecting on how to formalise the SOA membership model this will be driven by a new website that is being developed. We are engaging with existing and potential members. St George s Tooting have joined the SOA and a first meeting is being set up with them and invoicing will follow. It is proposed that the Manchester Orthopaedic Alliance are given Associate Member status as a group (we have a similar arrangement with the Federation of Specialist Hospitals) to facilitate our collaboration with the DevoManc project on the basis that a number of trusts will seek full membership in due course.
Begin liaison with the DevoManc MSK team Peter Kay is leading on this within WWL. Discussions have taken place to seek to deliver MSK services across DevoManc to the NOA accreditation specification/model once it is established. DevoManc have become Associate Members of the SOA
Project team Jo Chambers NOA and SOA Lead CEO (ROH) Peter Kay Clinical Lead (WWL) and National Clinical Director of MSK within NHSE Rachel Yates Director of NOA and Chief Officer of SOA Programme Management (Rachel is supported by Ann Hoey who running the PMO) Jonathan Wilson Lead Finance Director (RNOH) Beverley Gore Workforce, Kitemark Development, Benchmarking and Buddying Programme Lead (Seconded from WWL for a further year) Sally Xerri Brooks Communications Lead (ROH) Benchmarking Esyllt Edwards (RJAH) Lucy Farnworth Project Coordinator (Being seconded from WWL to support Rachel on a number of projects including NOA/SOA) Galatea Huggett Rachel s assistant and providing team administrative support (RNOH) Recruiting additional communication support.
Literature review An external literature review was funded from our Q4 15/16 allocation to provide a neutral third party base of evidence and policy documentation for each clinical lead. The work streams are a mixture of cross cutting and surgical sub specialty. This is underway and is being undertaken by NERA Consulting and BMJ. They will trial with two area to test their methodology and deliverables. The trials will be Hip Revision and Subacromial Decompression of the Shoulder Primary care/secondary care interface referral Pre operative assessment Efficient theatre utilisation Enhanced recovery Discharge process Patient Outcomes and Experience Patient involvement / shared decision making Procedures of limited value Coding and costing Referral to Treatment time management Safety Appraisal New procedures/minimum numbers Procurement Commissioning Spines Hip and knee Sports knee Foot and ankle Upper limb Cancer Bone Infection Anaesthetics, perioperative care and enhanced recovery Pain services Rehabilitation Rheumatology Paediatrics Tumours
Literature review outputs The information will come from a range of sources, including the following: Published research (clinical journals). Current pre existing policy relating to the relevant conditions and procedures Information from professional bodies Peri operative guidance and best practice Rehab and discharge guidance and best practice. Latest evidence relating to the condition and procedures. Notes and publications on payment mechanisms and commissioning. Outputs will be available in August Information Packs to include: Navigation / summary of key material and where to find it Three examples of existing best practice Note of areas that require development Templates for pathways, commissioning guidance, Case studies etc
Evaluation Evaluation Model both local and national We have now received our central funding from NHS England of 100,000. We have agreed a specification for Evaluation with NHS England Evaluation Team which we have shared with providers who are on the approved providers list with a closing date of 17/7/16 for proposals Macro economic impact assessment We have proposals from NERA and York University and we are currently reviewing the proposals. Is there an appetite to collaborate/co fund with Moorfields and The Walton Centre?
Looking ahead
Start building the kitemark model The Literature Review will have created a library of information covering all aspects of orthopaedics/msk. This will provide structured evidence to clinicians developing standards for the award of the kitemark. Work stream leads (clinical, operational and commissioning) meeting to kick off projects and form groups for each subject. Clinical leads will be funded to lead subject groups and others are volunteer members of the groups. Membership is not just SOA based. Begin arrangements for consulting with professional bodies/sub specialty societies etc to seek endorsement for the outputs of this exercise.
Building/procuring the self assessment model/methodology Similar models exist for self assessment against accreditation criteria in the RCSEng and RCP and NHSE is providing access to ones in use for pathology to begin a review of existing potential solutions. Develop methodology for aggregation of impacts Scenario and Sensitivity Analysis Evaluation Agree key variables of interest/identify data sources Develop monitoring tool N.B. Dr Foster have also offered potentially free or nominal cost access for a bespoke dashboard to support the vanguard and discussions are ongoing.
Communications Marketing and membership recruitment will be key elements of activity once the accreditation model is in place. First steps will include the issuing of a communications strategy and toolkit to all SOA member communication teams and a kick off meeting. Reviewing relevant events requiring NOA representation and requests have come in for attendance at sub specialty annual conferences, e.g. BESS and BOA. We have received one FOI request for a copy of the Value Proposition and a request from the College of Occupational Therapists regarding the degree to which they will be consulted in undertaking this project.
Immediate next steps Literature review Membership of kitemark steering group and workstreams Confirm work stream leads and participants Issue literature review packs, output templates and timetable