The Vanguard Method in Health and Care: A special one-day event profound results through challenging conventions
9:30 Introduction and Welcome (Andy Brogan) 10:00 Transforming Hospital Performance (Steve Allder) 11:00 Break 11:15 Beyond Integration (Julie Boothroyd & Team) 12:30 Lunch 13:15 Commissioning Purposeful Systems (Helen Joy) 14:00 Break 14:15 Making It Stick (Steve Allder) 15:00 Open Forum / Questions to the panel 15:30 Close and Networking (Tea/coffee)
The Vanguard Method
Initiatives since 1997 Volume/ Action taken Green & White papers introduced 26 Parliamentary Acts 14 Funding Medical Workforce Clinical (Nursing) Workforce NHS Real Estate/ hospitals Competition/ Choice Regulatory oversight Commissioning strategy Objective benchmarking Consultant/ GP/ Dental Contracts Doubled Increased Increased New/ major refurbishments Introduced and promoted Increased World Class Commissioning introduced Introduced and promoted Newly negotiated. and Agenda for change, Map of Medicine, turnaround, demand management, the improvement movement, National Service Frameworks, Evidence Based Medicine, guidelines, clinical pathways, personal budgets, Essence of Care, Energising for Excellence, Speak out Safely, Whistle-blowing legislation, Safeguarding, Benchmarking, Dr Foster, Friends and Family Tests, Any Qualified Provider, PCGs, PCTs, Practice Based Commissioning, Better Care Better Value indicators, Patient Recorded Outcome Measures, PbR, Clinical Negligence Scheme for Trusts, CQC, Clinical Support Units and procurement, CCGs, 5Cs, NHSE, European Working Time Directive, QIPP, QoF, targets, Monitor and.
Things Better Thinking System Performance Better Things
Think different but the same Get different but the same Thinking System Performance Start Here
Changing Thinking A Leap of Fact
1 What is the purpose (outside-in)? 6 Thinking 3 Capability of response 5 System Conditions 4 Work Design: Value plus everything else 2 Demand : T&F, V&F What matters?
Quality through specialisation and standardisation Economy through scale and productivity Control through management of cost and risk Improvement through plans and standards Accountability through attention to numerical goals
Transforming Hospital Performance
Hospitals are commonly designed for economies of scale True economy is in flow not scale Scale thinking is Kryptonite for flow
Op#cian GP Booking centre Appointment Follow Up Other Recep#on Follow up appointment HRT VA Nurse VA/ IOP Recep#on Discharge Onward referral OCT Visual fields Wai#ng area Nurse IOP Dila#on Surgery Pa#ent educa#on Pharmacy Optometrist Doctor
L = Capable of Learning to handle the demand type C = Already Competent to handle the demand type E = Expert. Capable of training others to handle the demand type
Op#cian GP Booking centre Appointment Follow Up Other Recep#on Follow up appointment HRT VA Nurse VA/ IOP Recep#on Discharge Onward referral OCT Visual fields Wai#ng area Nurse IOP Dila#on Surgery Pa#ent educa#on Pharmacy Optometrist Doctor
DEMAND VALUE EXPERTISE
Beyond Integration
Control achieved through hierarchy, rules, standards & specifications is illusory. Real control requires decisions about what to do, how to do it and how to measure it to be at the interface with citizens. Conventional management controls are Kryptonite for real control.
Understanding Demand: the 2 Cs I know about demand because I know: Where it presents What it presents as What we did to it COMMON I know about demand because I know: Why it presents in human terms CRITICAL
Commissioning Purposeful Systems
A fifth of the UK Government s total public sector deficit A sixth of the NHS Budget Almost twice the total projected spend on care for older people in 2014 Enough to fill the funding black hole facing local authorities projected by 2020 with 1.6 billion to spare 16bn 500,000 extra nurses 570,000 extra police officers 380,000 extra hospital consultants 570,000 extra social workers 725,000 extra care assistants 50 x the amount the Audit Commission say councils could save through efficient assessment and review
Making It Stick
Scale & P ace
Give Up & Replace
FROM TO Economies of scale Standardisation Providing prescribed services Design Local by default Designed against demand, variety Helping to build social resilience Price Choice = choice of provider Scale Contractual, contingent Accountability for results Commissioning Cost Choice = choice of goals Attitude Mutuality, problem solving Accountability for method Efficiency of roles, functions, agencies Compliance with specifications, best practice and plans In the boardroom Management & Leadership Effectiveness Achievement of purpose and method for improvement In the work Standards, targets, budgets Role, function, agency centric Aggregated lagging measures are the focus Measurement Capability to deliver purpose Person, community, system shaped Personal and community (not population) outcome measures are the focus Personal and community outcome measures are absent or subordinated to lagging measures Lagging measures of demand and cost are used to keep score, not to manage
#localbydefault