Strategic KPI Report Performance to December 2017 Trust Board 25 th January 2018
Strategic KPI summary SROs: All Directors Objective KPI SRO Target Apr May Jun Jul Aug Sep Oct Nov Success Is Deliver A Great Care Experience Be Recognised as a Leading Innovator in Healthcare Nationally Financially Secure Improve the Experience of Working in Healthcare Patient experience: FFT recommended DoN 91% 91% 93% 92% 93% 94% 96% 95% 95% Safety: SHMI national ranking MD 34% 34% 34% 43% 43% 43% 40% 40% 40% Healthiness of population: early detection Financial position: variance to financial plan DoF 0 (717) 290 427 (869) (1,162) (1,170) (1,241) (1,120) Staff: satisfaction & engagement DoHR 71.5% Emergency attendances: constrain growth DoO 3.8% 2.0% 0.6% 1.9% 0.4% 0.1% -0.7% -0.9% -1.1% Emergency admissions: constrain growth DoO 2.4% -12.2% -9.9% -8.0% -8.2% -6.2% -6.4% -5.9% -5.9% Reduce delayed transfers of care DoO 3.5% 4.8% 4.5% 5.2% 4.7% 5.3% 5.7% 5.7% 5.0% End of life: reduce in-hospital deaths DoN -5% 13.3% 10.0% 5.5% 1.5% 4.4% 4.8% 4.4% 4.0% Complaints regarding attitude and communication DoN Monitor 44 26 35 37 32 28 34 37 Clinical variation Increase Incident Report Per 1,000 Bed Days MD DoG Outpatients: reduce follow-ups DoO 15% 13.3% 8.7% 8.5% 8.5% 8.0% 8.3% 7.8% 7.3% Constrain care home emergency attendances DoN 4% 7.1% 1.8% -1.2% 5.6% 7.5% 6.4% 4.8% 3.7% Achieve professional standards: clinical support services DoO 6/6 1/6 2/6 1/6 3/6 3/6 2/6 3/6 3/6 Top 10% for efficiency DoF 10% 19% 19% 19% 19% 19% 19% 19% 64% Agency expenditure: reduce expenditure DoHR -27% -10% 3% 2% -3% -0% 2% -4% -3% Use of Resources (Single Oversight Framework score) DoF 3 N/A 3 3 3 4 4 4 4 Staff: communication from management DoHR 35% Staff: training and appraisal DoHR 85% Staff: contributions to care and improvement DoHR 91% Not reported in 2017/18 76% 75% In development In development 45% 43% 45% 51% 95% 95% Staff: improve on vacancies, turnovers and rota gap DoHR 4% 20% 11% 9% 4% 3% -11% -13% -4% 2/9
Strategic KPI: Improve Patient Experience Friends and Family Test (FFT) overall score has been maintained at 95% or above. ED is the main area for recommender increase (Nov 81.44% from 78.86% in Oct) with most negative comments being about waiting Improving performance against the ED 4 hour standard is the priority areas for improving the responder score. Strategic KPI: Improve SHMI National Ranking SHMI results for December are 99.2 against a baseline of 100 and a target of 98. The gap between weekday and weekend SHMI is widening so attention has focussed on overnight resilience, and new Hospital @ Night plans go live in April. Improvements have also focussed on 14 hour consultant reviews as part of improving 7 Day Service standards. New learning from deaths policy is in place, which will be harmonised with CHUFT, and focussing on outliers. 97% of patients to be willing to recommend the care they experience across Inpatient, Outpatient, A&E and Maternity. Aim to also be in the top 20% of the CQC inpatient survey, yearly To achieve top 10% for safety the Trust should aim to achieve a Standardised Hospital Mortality Indicator (SHMI) of 98 in the first year. 98% 96% 94% 92% 90% 88% 86% 100.5 100.0 99.5 99.0 98.5 98.0 97.5 97.0 Friends and Family Test Recommended FFT Recommended Target Baseline Standardised Hospital Mortality Indicator SHMI Target Baseline Strategic KPI: Financial Position The Trust reported an in month deficit of 1.1m in November. Full detail is contained within the Finance Report to the Finance & Performance Committee Deliver our financial plans to demonstrate our continued contribution towards the improvement of the local STP financial position. 1,000 500 0-500 Variance to Financial Plan -1,000-1,500-2,000 3/9
Strategic KPI: Constrain Growth in Emergency Attendances In November the Trust had 6,980 ED attendances against a plan of 7,180. Admission avoidance services are delivering reductions in emergency admissions. Results from December show an increase but still below plan levels. In November the Trust had 2,789 emergency admissions against a plan of 2,940. Admissions rose in December above plan levels but below the expected level without action. The development of a community strategy will also support ongoing reductions in emergency attendances. Strategic KPI: Constrain Growth in Emergency Admissions Admission avoidance services are delivering reductions in emergency admissions. The development of a community strategy will also support ongoing reductions in emergency attendances. Constrain growth in emergency department attendances to 3% from previous year. CCG contract plan delivers the strategic objective over the year. Strategic KPI: Constrain Emergency Attendances from Care Homes Attendances from care homes were 193 in November against a baseline of 200 and a target maximum of 206. Data from December shows this rising to 239. A pilot undertaken with Care UK demonstrated the benefits from closer working with care homes, and the "red bag" scheme has been implemented. An overarching programme is being pulled together to coordinate the current initiatives underway across the system, including developing an ibcf bid. Attendances from care homes to increase at a rate below the general rate of ED activity growth (4% in year 1), to demonstrate care home residents are being better supported. Provide increased community-based care to constrain emergency admissions to 2016/17 levels 8,500 8,000 7,500 7,000 6,500 6,000 250 230 210 190 170 150 3,200 3,000 2,800 2,600 2,400 2,200 ED Attendances Actual Plan 16/17 ED Attendances From Care Homes ED attendances 4% Target Baseline Emergency Admissions Actual Plan Pre-QIPP 4/9
Strategic KPI: Reduce the Number of Official Delayed Transfers of Care In November the Trust had a DToC level of 5.0% against a plan of 3.5%. Results from November show 101 deaths against a target of 95 and baseline of 100, with the Trust reporting 4% more in hospital deaths than last year. Initial December figures show 146 deaths against a baseline of 137. Strategic KPI: Complaints Regarding Attitude and Communication The number of complaints about staff attitude and communication has fluctuated throughout the year and is down overall from April At times of high discharges or capacity constraints DToCs quickly build up and take up to two weeks to recover. A new DToC escalation process has been developed and approved at November's ICN to support the ongoing weekly review meetings. Social Services are now working on Saturdays to help prevent backlogs building up. Strategic KPI: 5% Reduction in In-Hospital Deaths Delayed Transfers of Care officially attributable to Social Care delays. The strategic ambition was to reduce this to 3.5% over 5 years, but the Trust is now required by NHSI to deliver 3.5% in the first year. Planned initiatives are now entering A net 5% reduction implementation phase with the roll target against the out of the SPICT tool (to aid number of in hospital identification of EoL patients) on deaths has been set Kirton and Lavenham. using the 16/17 The ibcf bid for an in-reach and profile, excluding admission prevention service for EoL critical care. This is patients was approved in December a proxy measure with implementation now in until the Trust is able progress. to record preferred A system wide EoL workshop is place of death for all being held on 17th Jan. EoL patients. Levels of complaints are being monitored in 2017/18 to establish a baseline for improvement from 2018/19 onwards. 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 150 130 110 90 70 50 50 40 30 20 10 0 Official DToCs DToCs rate Plan Strategy In Hospital Deaths Actual 5% target Baseline Complaints Regarding Attitude and Communication 5/9
Strategic KPI: Reduce Outliers in Clinical Variation To be agreed at quality committee next month. A strategic KPI is being developed to monitor and investigate outliers in clinical variation, as identified through inpatient length of stay and outpatient new to follow-up ratio. To reduce outliers (1.5 Standard Deviation) in inpatient length of stay, and outpatient new to follow-up ratio. (In development) Strategic KPI: Increase Incident Report Per 1,000 Bed Days To be agreed at quality committee next month. A Strategic KPI is being developed to increase our incident reporting rate and noharm incident reporting rate, in order to drive a culture of openess and incident reporting. The Trust currently benchmarks in the bottom 35% nationally for both incidents and no-harm incidents, but this may already be radically improving. It is expected that significant progress in this KPI could be made through changing our reporting mechanisms alone, before embedding a cultural change. To be ranked in the top 25% of nonspecialist acute trusts, for the rate of incident reporting per 1000 bed days, and no-harm incident reporting per 1000 bed days. (In development) Strategic KPI: Integrated Therapies, Pharmacy and Diagnostic Imaging Compliant With Professional Standards Pharmacy and therapies are generally delivering their professional standards. Diagnostic imaging is not meeting the standards and December's peformance worsened against November's position. Diagnostic imaging demand and capacity modelling is underway. Service performance against the agreed professional standards in order to support patient care and discharge. Clinical Support Professional Standards Standard Sep Oct Nov Dec ED X-ray<30min 90.0% 80.0% 83.0% 82.9% 77.4% ED CT<1hr 90.0% 88.4% 66.9% 85.5% 80.8% IP DI <24hrs 90.0% 84.6% 85.2% 89.8% 84.8% Avg TTA time 95 mins 89 92 76 77 Urg therapy <4hrs 100.0% 100.0% 100.0% 100.0% 99.8% High+ therapy<7hr 85.0% 83.6% 85.1% 87.4% 80.8% 17/18 trend 6/9
Strategic KPI: Reduce Number of Follow-Up Outpatients Attendances by 15% At the end of November the Trust has delivered a 7.3% reduction in follow-ups against the 15% target, after accounting for the increasing 22 20 18 backlog. Results from December show an in month reduction of 17%. All clinical leads are presenting follow-up and follow-up backlog reduction plans to the Medical Director in November. Detailed implementation plans are being agreed with each specialty based on these presentations. Follow-up attendances are targeted to reduce by 15% a year, based on face to face consultant led appointments. Backlogs are added back in to ensure reductions aren't delivered by increasing these. 16 14 12 10 Follow-Up Outpatient Attendances Follow-Ups 15% reduction plan Pre-QIPP plan Strategic KPI: Top 10% for Efficiency With the update to the Model Hospital for 2016/17 reference costs in December the Trust has moved from the 19th percentile to the 64th percentile for efficiency as measure by cost of Weighted Activity Unit (WAU). The measure is driven by the Trust's reference costs submission. Further work analysing the movement is being undertaken and will be reported back to a future Finance & Performance Committee. Achieve top 10% efficiency as measured by Carter Strategic KPI: Reduce Agency Spend Agency spend in November increased after October's accounting correction - 950k spend against a trajectory of 700k and an NHSI ceiling of 587k. Spend in December has dropped to 836k but remains above the NHSI ceiling of 533k. Regular meetings are continuing to ensure actions to replace locums and agency staff are taken. Wider initiatives around retention and engagement have also started. An agency best practice checklist is being developed to guide managers. NHSI have set an agency cap of 8.0m while the Trust has developed plans to limit spend to 9.6m. Achieving 8.0m requires a 27% reduction against total 16/17 agency spend. 1,200 1,000 800 600 400 Agency Ceiling Agency spend Agency ceiling Trajectory 16/17 7/9
Strategic KPI: Use of Resources (Single Oversight Framework score) The Trust is scoring a rating of 4 against a plan rating of 3. The outlying ratings are: - plan variance - agency variance The underlying deviation from plan means the Trust is not assuming receipt of STF funding in its financial position, which causes the greater deviation and the rating of 4. The current agency spend figure against the NHSI ceiling is driving the rating of 3. Achieve a Single Oversight Framework score consistent with the Trust's plan submission, based on year to date performance. Single Oversight Framework Use of Resources Score Plan Sep Oct Nov Dec Capital cover 4 4 4 4 4 Liquidity rating 4 4 4 4 4 I&E margin rating 4 4 4 4 4 Plan variance 1 4 4 4 4 Agency rating 1 3 3 3 3 Use of Resources 3 4 4 4 4 6 month trend Strategic KPI: Improve staff satisfaction in training and appraisal Division 2's performance reported in Q2 showed an improvement against Division 1's score reported in Q1. Initial results from the national staff survey feedback is positive, although detailed results are currently embargoed. Strategic KPI: Reduce Staff Absence The sickness rate has remained at 4.24%. A reduction in short term absence has been offset by an increase in medical staffing absence from 1.84% to 2.29%. November continues the trend of Anxiety / Stress / Depression / other Psychiatric illnesses. Almost all the psychological cases are predominately non-work related. The appraisals and development support rapid action plan continues to be implemented: Continue to develop user friendly paperwork and provide clearer guidance on how to fill out the appraisal forms Make sure staff are given enough time for their appraisal and are properly prepared Ensure that appraisals are meaningful and will help colleagues' professional development Hot spots are being targeted with a specific focus on back-related issues on Martlesham Ward, and Community and Pharmacy teams. HR Services are currently managing 84 long term cases and 197 short term cases. Staff satisfaction with training and appraisal is measured annually through the national staff survey, and locally by division each quarter. Achieve a staff absence (sickness) rate of 3.5%, against a historic baseline of 4.1%. 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Training and appraisal satisfaction Satisfaction Target Staff Absence Absence rate Baseline Target 16/17 8/9
Strategic KPI: Reduce Staff Turnover Staff turnover improved to 9.6% in November from 10% in October. Exit interviews identify communications as the main issue driving turnover. A communications improvement plan, especially during the merger period, is in place. Maintain historic turnover rates at 8.1% against a national average for medium acute trusts of 14.51%, based on a rolling 12 months performance. 15% 13% 11% 9% 7% Staff Turnover 5% Staff turnover Target National average 16/17 Strategic KPI: Reduce Staff Vacancy Rate The vacancy rate improved to 7.2% in November from 8.3% in October. Hard to recruit posts continue to be managed and monitored through EMC and WDEC. Recruitment and retention policies and processes are being aligned during merger preparations. Achieve a vacancy rate of 6.18% based on meeting our best performance in 16/17 against a baseline of average performance of 8%. 10% 8% 6% 4% Vacancy Rate 2% 0% Vacancy rate Baseline Target Strategic KPI: Reduce Ward Rota Gaps Ward staffing levels remained above 92% in November, at 92.8%, but dropped from 94.6% in October. Work to ensure bank registrants are available, and to promote early roster approval to encourage early booking, continues, reflected in the continuing achievement against this standard. Achieve 90% fill rates on all inpatient ward nursing and healthcare assistant rosters. 98% 96% 94% 92% Ward Rota Staffing Levels 90% 88% 86% Rota Staffing Baseline 9/9