Post on 30-Dec-2015
transcript
Photo – landscape with ECC
Leadership in Challenging Times
Dr Gareth Goodier
Chief Executive August 2013
What is Leadership?“A leader is the man who has the
ability to get other people to do what they don’t want to do, and like it”
- Harry S. Truman
Harry S. Truman, American President 1945 - 1953
“Leadership the art of getting someone else to do something you want done because he wants to do it”
General Eisenhower meeting with paratroopers of the 101st Airborne Division, June 5, 1944
“A leader is a person with a magnet in his heart and a compass in his head”
- Robert Townsend
“Leadership is the capacity to translate vision into reality”
- Warren G. Bennis
What is Leadership?
What are difficult times?
The last three years at Cambridge:
•Relative reduction of budget >5% p.a. for that period 2009-2012•Stringent monitoring of hospitals with penalties for poor performance
The Evidence! Winner of Acute Healthcare Organisation
of the Year in HSJ Awards (2008) Dr Foster patient safety review scored
99.3/100, the only FT in EoE to get the top ‘band 5’ rating (Dec 2009)
Top hospital in Sunday Times ‘Best Places to work in the Public Sector’ (March 2010)
Joint 1st in for HSMR (RR 64.3) (Feb 2011) Dr Foster “Trust of the year” for
Midlands/East of England – based upon patient experience feedback and two measures of standarised mortality (NSMAR and SHMI)
Dr Foster “Hospital of the year” 2012 -based upon four measures of mortality and 13 measures of clinical efficiency
What did we do?
• Strategic Decisions:– Formed Shelford Group– BI Tool development– EMR business case development– New clinically devolved leadership– Focus upon quality
What did we do?• Formed Shelford Group• Group of England’s leading academic teaching
hospitals based on 18 measures of clinical quality, Research and Development, budget size, Foundation Trust status etc
• University Hospitals Birmingham NHS Foundation Trust• University College London Hospitals NHS foundation (UCLH)• Sheffield Teaching Hospitals NHS Foundation Trust• Oxford University Hospitals NHS Trust (OUH)• Newcastle-Upon-Tyne Hospitals NHS Foundation Trust• King’s College Hospital NHS Foundation Trust• Imperial College Healthcare NHS Trust• Guy’s and St Thomas’ NHS Foundation Trust• Central Manchester University Hospital NHS Foundation Trust
(CMFT)• Cambridge University Hospitals NHS Foundation Trust (CUH)
• Lobbied UK Government Ministers (Treasury, Business, Innovation & Skills, Tertiary Education, Monitor, Department of Health) for increased tariff for tertiary level hospitals
• Benchmarked performance• Compared savings plans • Shared ideas• Variation of Care – using information to reduce
undesirable clinical variation at the level of the team and the individual medical consultant on such things as LOS (including day Rx), utilisation of diagnostics, theatre time, use of medications, harm prevention, hand hygiene etc
What did we do?
What did we do?1. Nursing Productivity
2. Medical Productivity
3. Workforce Transformation
4. Portfolio Strategy
5. Recording Care
6. Variation of Care
7. Patient Flow
8. Utilisation of IS
9. Drugs
10. Procurement & Supply Chain
CUH embarked on a 3 – 5 year process of transformation through which operational improvements lead to step changes that were sustained and enhanced by a major upgrade in technology.
Nursing Productivity
• Ensuring optimal use of the skills and time of nurses and midwives
Medical Productivity
• Making optimal use of the medical team skills and time
• Outpatient Department patients per EFT
• Operation mins per EFT (Surgery)• Discharges per EFT• HSMR by specialty
Workforce Transformation
• Ensuring clinically devolved organisation structure
• Who does what?
• Medical leadership
Portfolio Strategy
• Identifying which services should be developed, where and with whom they should be provided, and which services could be run by others
• “Profit and loss” by procedure code
Recording Care
• Improving quality of clinical records and coding, as well as ensuring the processes are in place for the hospital to be paid for the care delivered
• All observations and evidence suggest that at best there is a TWO to THREE fold variance in clinical behaviour/treatment practice across medicine.
• Where there is poor clinical evidence (e.g. ADHD) the variation increases to a TWENTY fold difference
Variation of Care
“The most expensive item in the hospital is the Doctor’s pen”
Clinical Variation In Cardiologists
0
10
20
30
40
50
60
A B C D E F G H I J K L M N
Cardiologist
% A
bn
orm
al
Opinions of 14 Cardiologists on theabnormality of 38 post-exercise ECGs
Variation In Treatment
Coronary revascularisation procedures,per 100 000 population, 2004
Clinical Variation In Revascularisation Coronary
Cataract Surgeries
Clinical Variation In CataractsConsultant Day Case
Rate % July 07Day Case Rate % July 08
1 83 100
2 91 96
3 26 37
4 80 96
5 83 100
6 82 99
7 79 98
8 59 93
9 96 100
Total 70% 95%
Clinical Variation• A 23- fold difference in the rate at which children in different parts of
England are
• prescribed Ritalin to control behaviour…
PCT Prescriptions dispensed per 1,000 children
Wirral 144
Isle of Wight 107
Great Yarmouth and Waveney
100
County Durham 97
Medway 85
PCT average 43
Stoke on Trent (lowest rate)
6 Source: Commons library/ONS, HSJ July 2008
Variation in prescribing
OECD (2009)
Variation in investigations
Source: OECD Health Data 2011
Variation in procedure rate
Patient Flow
• Eradicating process delays in the patient journey Length of stay reduction
• Dr Foster Hospital of the Year 2012 (assessed against 13 measures of clinical effectiveness)
Utilisation of Diagnostics
• Review and optimise ordering behaviour across the hospital
• Estimated ~25% too many diagnostic investigations
• By devolving budgets and cross charging, the incentive is with the clinical unit.
Drugs• Improving medicines management• Ensuring appropriate prescribing and
reducing undesirable variation in prescribing
• Antibiotic stewardship
Procurement and Supply
• Gaining efficiencies in procurement and supply chain processes
• Strengthening procurement team• Assessment of contracts and
contract processes• Investigate all aspects of supply
(clinical and non-clinical)
What traits does a leader require for challenging times?•Know thyself•Focus on influencing others (particularly clinicians)•Organisation culture – clinical engagement•Know how to maximise use of information to inform change•Manage change
Leadership In Challenging Times
Temple of Apollo at Delphi
“gnothi sauton”
know yourself …
Ancient Greek inscription at the Temple of Apollo, according to the Greek writer Pausanias (10.24.1)
“γνωθι σεαυτόν” or
Influencing Others
• Communication skills– Verbal, including speeches and
presentations– Non-verbal
• Interpersonal skills• Influencing skills• Negotiating skills• Emotional Intelligence
Focus on Culture
Values, Behaviours, “the way we do it here…”
• Electronic• Easily accessible• Intuitive • Real-time• Reliable and accurate• Detailed to patient and consultant
level• Available to all disciplines• Used to inform decision-making,
manage performance and DRIVE CHANGE
Information is fundamental
Benchmarked performance data
• Dr Foster Intelligence
• Shelford Group• Visits to ‘centres of
excellence’ (eg. Southampton bus trip)
The Dr Foster Unit at Imperial College, London
• Trust/partnership• Information systems• Training and education in
management
Clinical Engagement
Clinical Engagement
• Broadly accepted that developing clinical leadership is essential to the delivery of good clinical services and healthcare reform
• Variable nature and range of clinicians involved in leadership roles
• Include Nurses and Allied Health Professionals engaged in clinical work
Leadership…“It is not the critic who counts;
Not the man who points out how the strong man stumbled, or where the doer of deeds could have done better.
The credit belongs to those who are actually in the arena, who strive valiantly, who know the great enthusiasms, the great devotions, and spend themselves in a worthy cause;
Who, at the best, know the triumph of high achievement and who, at the worst, if they fail, fail while daring greatly So that their place shall never be with those cold and timid souls who know neither victory nor defeat ”
Theodore Roosevelt