Celebration Event 21 st October 2014

1. Celebration Event21st October 2014

2. Leading Across Boundaries Programme Welcome

3. Agenda for today • 10.15 Welcome and Introduction • 10:45Project Presentations x 2 • 11:15Break • 11.45Creating sustainable leadership • 12.45 Lunch – Market Stalls and Networking • 13.45Project Presentations • 14:15Awards • 14:45Key Note Speaker – Gavin Boyle, Chairman of • East Midlands Leadership Academy • 16.00 Close

4. Leading Across Boundaries • The Academy has recently joined Twitter we would like you to “Tweet” to • Raise and respond to questions • Provide feedback on speakers comments • Comment on key topics • Collaborate & network • Please use the following hash tag #emlaAcrossBoundaries • Follow @nhsEMLA to keep up to date with what’s going on in our region

5. LEADING ACROSS BOUNDARIES CELEBRATION EVENT – 21st October 2014 Welcome Paul O’Neill – Director of East Midlands Leadership Academy

6. SYSTEMS LEADERSHIP WHAT IS IT?

7. #emlaAcrossBoundaries LEADERSHIP WORD 1, WORD 2, WORD 3

8. #emlaAcrossBoundaries SYSTEM – Definition (about 100 characters)

9. Good Organisational Leadership: • Single Vision • Aligned Strategy and Business Plan • Focus on Quality and Finance • Strong Governance • Standardised policies and procedures • Agreed measures of success • Owned and Understood Values and beliefs • Consistent and Positive Culture • Distributed Leadership • Strong team identities and effective working • Having all of these traits working well together is not very common in large healthcare organisations. • Consider working with multiple organisations – how many of these are true?

10. Key findings • Delivering system-level integration will require a combination of a collaborative approach to leadership and directive, effective organisational leaders. • Both of these different leadership approaches can and ideally should be modelled within the system, but this is challenging at an individual level. • Health and social care organisations are complex adaptive systems. Successful approaches to developing system leaders recognise this and the need for a new leadership approach, although paradigms of ‘command and control’ leadership are prevalent. • Studies show that the world’s most successful health care systems make widespread and systematic use of improvement methods. These encourage learning by doing, using small tests of change to observe, reflect and explore what works best for a particular context. David Fillingham Belinda Weir October 2014

11. Learning in a complex adaptive system • Learning needs emerge and change • Inter-organisational and inter-professional teams are critical to successful change • What works is context specific… so local organisation and health economies will need to adapt not just adopt • A successful change will require attention to technical aspects (‘the anatomy’) and cultural aspects (‘the physiology’). • (Zimmerman et al 1998)

12. Learning from other sectors: markets, hierarchies, networks Source: adapted from Powell (1990)

13. LEARNING FROM THE PRIVATE SECTOR • Learn to operate without the might of the hierarchy behind them and use their individual skills rather than their formal position to achieve results • Be able to compete in a way that enhances rather than undercuts the competition – to do this these leaders must become successful collaborators • Conduct their business to the highest ethical standards; trust is crucial to successful alliance-building • Develop a process focus – concentrating not only on what is to be achieved but how

14. Knowledge and skills framework

15. Discuss in Pairs: • What have you learned that you didn’t know before you did this programme? • In what ways (if any!) have you changed the way you work with others?

16. Discuss in Groups: • How successful has your project been? (score 1-10) • How much has the learning from this programme contributed to its success? (score 1-10) • Add these two scores together. • Make sure everyone on your table knows what your total score is!

17. Let’s get Curious!

18. The ability to work across boundaries and to put the needs of the system ahead of, or at least alongside, those of their own institution will be one of the hallmarks of the leaders who will thrive in the new world.

19. Frail Elderly Care Pathway Part 1 & 2 • Chesterfield Royal Hospital NHS Foundation Trust & Derbyshire Community Health Services NHS Trust

20. Integrated Care and the Discharge to Assess and Manage Process

21. Integrated care • ‘The current fragmented services fail to meet the needs of the population and greater integration can improve the patient experience and the outcomes and efficiency of care’ • (Kings Fund, March 2013) • The aim for Northern Derbyshire as outlined in our System Plan is to keep people: • Safe and Healthy – free from crisis and exacerbation • At home – out of social and health care beds • Independent – managing with minimum support

22. Right care, Right place, Right timePatient centred wrap around careMore efficient with NO duplication

23. “In a fully integrated system, patients’ needs not organisational boundaries would decide how care is provided” • Nuffield Trust, 2014

24. Our LAB team • Ruth Cooper – GP and Integrated Care Lead, Hardwick CCG • Kath Shakespeare – Consultant Geriatrician, Chesterfield Royal Hospital (CRH) • Lisa Falconer – Matron, Acute Frailty Unit, CRH • Kim Ashall – General Manager, Derbyshire Community Health Services • Carolyn Nice – Group Manager, Adult Care, Derbyshire County Council • Kirsty Ball – Senior Commissioning Manager, North Derbyshire CCG

25. Why are we trying to keep people out of hospital? • 10%

26. Frailty Unit Pilot at Chesterfield Royal Hospital • Unit for the acute care & re-ablement of frail older patients • MDT working with a patient centred approach & comprehensive geriatric assessment • Enables timely discharge with coordinated and integrated plan for treatment & follow up

27. Why D2AM? • Thinking about risk differently…

28. Medically ready for discharge Therapy assessments Care needs ascertained Care package Discharge TraditionalDischargeModel

29. ICT PILOT • Two pilot sites working with two identified GP practices of a substantial size • Community based teams of Therapists, Nursing Staff, Social Care and GP support • Teams supported by the Care Co-ordinators within the two GP practices

30. The teams

32. What went well The teams Enthusiasm Permission Knowledge Process Impact Communication

33. Even better if… • … we had senior nurse input • … there was one IT system and better network coverage • … we could access equipment more quickly • … we had more patients through the pilot • ... we had more comprehensive services out of hours • … the community teams had more experience managing risk • … the pilot was the day job

34. Next Steps • Full evaluation • Rollout from the Frailty Unit • Roll out across Chesterfield Royal • Discharge process at out of area acute sites

35. Questions for the team

36. Theatre Improvement • Northampton General Hospital

37. Leading Across Boundaries Programme Winning Ways

38. Our Great Team • Northampton General Hospital NHS Trust • Mr Paul Jervis (ENT Consultant) • Dr Ramaswamy Karunakaran (Consultant Anaesthetist) • Mrs Sue McLeod (General Manager) • Mrs Lorna Gould (IQE Advisor) • Mrs Linda Bazeley (Theatre Improvement Project Lead)

39. Our football team, Northampton Town F.C; ‘The Cobblers’ statistics. A tale of woe…. • Exec team and external companies • Poor data quality • Theatre Dashboard not being used • Data analysis / time/ equipment /I.T./ training • Start and finish times • No shared vision • Lots of different club Chairman • No one counting the goals • Couldn’t see the league table • Lack of investment • We didn’t hear the whistle • We didn’t know where the goal was

40. More woe…. • No Red Cards • No set pieces • No pre-match chat • No post match celebrations • No plan for the season • Behaviours unchallenged • No standardisation • Few planning meetings • Debriefs • No capacity and demand planning

41. Our club strategy…. • Player / Manager • Coaching • Project team • Years secondment for Theatre Matron • EMLA • Learning new skills

42. Second half…. • Agree length of match • Kick off and finish on time • Improve team play • Understand the off-side rule! • Avoid relegation • Session times, 85% utilisation target • Improve start and finish times • Same teams working together • Greater understanding of business • Sustainability

43. Thank you for listening. Any questions?

44. Leading Across Boundaries Programme Break

45. Leading Across Boundaries Programme Reducing Internal Waits Royal Derby Hospital

46. Reducing Internal Waits • Why did we ‘chose’ the project? • Who we are? • What did we expect from ‘Leading Across Boundaries’? • What did we need to know? • How did we plan to do it? • What did we find? • How did we tackle the problem? • How will we solve the problem?

47. Why did we do this project? • Acute Trusts have constant pressure from ED 4-hour target • 4-hour target is a whole-system measure • Inefficient IP processes = Inadequate acute bed capacity = Poor flow = Failed 4-hour target • Ageing population/Complex co-morbidities • We need to create capacity within the system

48. Why did we do this project? • The Emergency Care Intensive Support Team (ECIST) reviewed all RDH in-patients with a LOS over 7 days in August 2013. • 20% of adult inpatients were only in hospital because they were awaiting a test, specialist opinion or similar

49. Hypothesis ‘We can reduce length of stay for a significant proportion of our adult in-patients by expediting tests, assessments, specialist opinions or similar.’

50. December 2013: The A team