AHP Master class:Benchmarking, Management

and Leadership

Tools and Techniques for Thriving and Surviving

JJ Consulting Healthcare Management Ltd.

Robert Jones Fiona Jenkins

5th October 2012

JJ Consulting

Healthcare Management Ltd

Benchmarking, why now?The global situationThe fast changing NHSThe added value AHP services can bring

What makes efficient and effective services

Quality and cost

10.00am Introduction to the day

The fast changing NHS and the added value that AHP services can bring

What makes an effective and efficient service?

11.15amBREAK

Does quality drive out cost?

How does your service compare with others?

Data, information, interpretation and uses

Benchmarking, and its application to AHP services

Analysing staffing levels, skill mix and workloads

1.00pm LUNCH1.30pm Analysing continued: Inpatients, outpatients, community

Service re-design options after benchmarking

Management quality matrix how can it help you?

Business cases for surviving and thriving

4.30pm How do you make the most of your management structure?

Plan for the dayHousekeepingConfidentialityInformation we have providedThe importance of networkingBenchmarking todayOutcomes from the Master classYour action plans

Is there any thing else you want from today?

The Global Picture

Change is HappeningFuture job market/turnoverPopulation changesTechnologiesDr GoogleGlobalisation of healthcare-

digitisation

“Never waste the opportunities offered by a good crisis.”  Machiavelli

The Financial ContextExtraordinary Public Sector DebtPublic Sector Funding Restricted (Zero

Growth)Higher Inflation and Downward Pay PressureTariff reduced by 1.5% - 2% per annumPopulation Increase (elderly, LTC)Medical and Drug Advances (Technology)Shift from Secondary to Primary Care Expensive InfrastructureFinancial Deficits in Organisations

The Fast Changing NHS: It’s not an easy time

The Next 5 Years …at least Extraordinary public sector debtOrganisations with recurring deficitsContinuing tariff reductionAt least 2% inflationEfficiency requirementLess money to do more activity or work

differentlyActivity volumes too high to be affordablePoor community and primary care

infrastructureVariation in efficiency e.g. length of stayToo many follow-ups and too many DNAsImpact of private sector growth

The Health and Social Care Act 2012: Themes

Commissioning - GPs taking more control charge

Increasing democratic accountability “Public Voice”

Liberating NHS service provisionStrengthening Public Health servicesReform of arms-length bodies

Infinite Demand

Improved effectiveness and efficiency

Organisation development structure

Patient level costing

Improved productivity

Vertical and Horizontal integration

Quality, patient safety initiatives

Reduced activity- introduction of thresholds

Disease management - self care

Programme management efficiency programmes

Less money = less beds and staff

Cheaper management costs

Tendering Any qualified provider Mergers/ take over

The Added Value that AHPs can bring

Doing this is not an option!

The Roles of Managers and Leaders

Roles, duties and responsibilitiesThe evidence-base    - research    - the literature  The politics of therapy management and leadership today

Comprehensive clinical knowledge- all specialties, all sectors

Comprehensive understanding of illness, disease, trauma, their treatment and long term management

Wide understanding of public health and preventative agenda

Problem solving skills transferrable between clinical and managerial practice

Clinically credible management/leadership

Leadership of rehab and integrated care

Facilitation of safe timely discharge

Skilled in capacity management

Cost effective and clinically effective solutions

Innovative solutions to clinical and managerial problems

Culture of effective MDT working

Ability to re-design clinical systems for patient benefit and organisation requirements

AHP managers unique?Clinical Heads of clinical servicesCredibility with other clinical leadersExtensive knowledge of the services they manage

( clinical and managerial)In-built patient centred approach- built by years of

clinical practiceUnderstanding and interpretation of the evidence-

baseUnderstanding the diversity of clinical provision and

the inequitiesKnowledge of staff capabilitiesKnowledge of workloads, clinical prioritisation, skill

mixAbility to manage the short tem needs and longer

term strategic changesContribution to business planning built of sound

clinical knowledge and managerial expertise

AHP Managers - really unique

Code of ethics and professional status = Integrity

Experience of the whole healthcare system = Unique perspective of the whole system

AHPs =Patient Centredness

Therefore uniquely equipped to contribute to the wider organisational agenda

Added Value for SuccessAHP Managers and Leaders

Co-ordination of staff activityGuide work towards goals of the

organisation- and effect real changeProvide safe value for money servicesCo-ordinate services across

traditional boundaries and interfacesEnsure optimum efficient use of

workforceAbility to re-prioritise based of

implementation of evidence base to ensure change of practice is embedded

AHP Managers Can DeliverWorkforce, skilled flexible

and efficientHighly skilled clinicians, and

well trained support staffStaff who promote self care

and reduced dependency Leaders who can prioritise

for efficiency gainsTeam workers with a “can-

do” culture

Can You Do It?Be up to date, personally and

professionallyHave a contemporary PADRReview your CPD portfolio and

CVReview your leadership

competenciesNetwork and shareKeep abreast of the wider NHS

developments....is your network wide enough?

Does Quality Drive out Cost?Placing quality at the heart of

business strategy will result in improved healthcare outcomes

Focus on cost cutting will not deliver the solution

Poor healthcare outcomes can be measured through spiralling cost, overspends, wasted resources and poor investment

Poor quality increases costs through harm waste and variation

Collaboration between clinical decision-makers, managers/leaders and finance teams is essential, to drive down costs and improve quality

What can be learned from others?

And ConsiderDo you know what your users think of your

service?What is the strategy of your organisation?Do your service plans fit with the strategy?Are you providing the right services?Is it time for some change?Skill mix profile – is it optimal, is it affordable?Staff profile, activity and service costsHow long per appointment, how many contacts? Are you ready to re-design?Is your service ready for change?

How does your service compare with others?

How do you know?

Data, Information, Interpretation and Uses

What is data?What is information?What have you got?How do you collect it?How do you use it ?What do you need ?

Benefits Information for:Management clinical finance workforce

Staff ActivityWhat do staff do with their time?How much of each activityWho does itWhere it happensManagers need an accurate picture of

what staff are doing with their timeHave you got a benchmark by staff

band?What activity do you expect from a

band 6?

Time (in weeks)18171615 14131211109876543 21

Pe

rce

nt

6.0%

4.0%

2.0%

0.0%

Occupational healthWomen's/Men's healthNeurology (inc stroke)PaediatricsPain managementMusculo-skeletal

Specialty

54.16%

15.30%

4.05%

1.18%

19.43%

1.77%

0.40%

2.35% 1.37%

FACE CONTACT IND

FACE TO FACE GRPTEL CONTACTS

WARD ROUNDS

CASE CONFERENCE

STUDY LEAVE

LIAISON

ADMINMANAGEMENT

HOME VISITS

TRAVEL

CLINICS

MTGS

IN SERVICE TRNG

TEACHING PHYSIOS

TEACHING STUDENTS

TEACHING HEALTH PROF

TEACHING PUBLIC

CLIN. SUPERVISION

OTHER

OTTime Spent on each Activity Across the Whole of Therapies Services

(Percentage of Total Contracted Hours)

Face contact ind

Face contact group

Tel contact patient / relative

Ward round

Case conf.

Liaison other services pt related

Admin. Pt related

Home visits

Clinics

Other pt related

Liaison other services not pt related

Admin. Not pt related

Management duties

Study leave

Travel

Staff team mtgs

In service training

Teach your prof group

Teach student

Teach others

Clin. Super.

Other non pt related

Comparison by BandSummary of all Paybands

Percentage of time spent of each activity

0%10%

20%30%40%50%

60%70%80%

90%100%

BAND8&8A BAND7 BAND6 BAND5 BAND4 BAND3 PHYSIO STUDENTS

Perc

enta

ge

Face contact ind Face contact group Tel contact patient / relativeWard round Case conf. Liaison other services pt relatedAdmin. Pt related Home visits ClinicsOther pt related Liaison other services not pt related Admin. Not pt relatedManagement duties Study leave TravelStaff team mtgs In service training Teach your prof groupTeach student Teach others Clin. Super.Other non pt related

Run Chart for service improvement

Finance

Balanced Score Card

Are you a budget manager?What's the split between staffing costs and non-staff costs?

Were you involved in budget setting?

How do you make your CRP?What %?Do you understand the finance data well enough?

Any Questions?

Does Your Service Have Alignment?Between :

Strategy Vision Desired Outcomes Performanceif so, how do you compare your

performance with others?

Have you thought of Benchmarking?An Invaluable means of enhancing

understanding your service's performance compared with others

Requires collection and interpretation of data

Can be wide-ranging or very focussedCan speak louder than your single voice….or identify where efficiencies can be

made

Edited by Robert Jones and Fiona Jenkins Foreword by Karen Middleton The Jigsaw of Reform: Pushing the Parameters Money, Money, Money: Fundamentals of Finance Commissioning for Health Improvement: Policy and

Practice Striking the Agreement: Business Case and SLAs   Thriving In the Cash Strapped Organisation   Information is Power - Measure it, Manage it Information Management for Healthcare Professionals Allied Health Records in the Electronic Age Data ‘Sanity’: Reducing Variation   Outcome Measurement in Clinical Practice Improving Access to Services  Benchmarking AHP Services   Management Quality and Operational Excellence Evaluating Management Quality in the AHPs Evaluating Clinical Performance in Healthcare Services  Project Management for AHPs with Real Jobs Marketing for AHPs Effective Report Writing   Demonstrating Worth: Marketing and Impact

Measurement

4.8 treatments per episode of care is the benchmark

• Benchmark contacts 3.31

• Benchmark first to follow up ratio of 1:2.31

The benchmark wait is 1-2 weeks

Introducing our Benchmarking Toolkit-

Where did it come from?

How to use itYour organisationYour professional groupIn-patient servicesOut-patient servicesCommunity services

Analysing Staffing Levels, Skill Mix and Workloads

Look at the data you brought with you- compare this with others.. and set the benchmark for areas you have overlap in

If no one has benchmarked the same data as you.. just join in and go through the process on analysing with others the benchmark where there are areas of overlap.

Go through each worksheet in turn

Create a benchmark from the data you all have

Nominate one person from your table to be the holder of your table bench mark data

Analysing Continued…Inpatients, outpatients, communityCompare you table benchmark data with

the national benchmark data which we have just given you

Create a benchmark for your table from the REAL data you have

Come and write up your benchmark information on the flip chart

Where there was no one with similar information to benchmark….come and write this up on the flip chart sheets

1. What does the benchmark show you?2. What actions are you going to take?

The Allied Health Professions – Essential guides series is unique in providing advice on management, leadership and development for those in the Allied Health Professions (AHP). This highly practical volume offers a wide range of assessment tools and techniques in such critical areas as management quality, organisational and management structure, benchmarking, outcome measurement, and Integrated Care Pathway design as well as capacity and demand management, activity analysis, report writing and presentation skills.

“The NHS is facing the greatest period ofchallenge in its history. The key to success

isleadership. Allied Health Professionals

willbe a central part of this leadership

response.In this work, Robert and Fiona continue

theirseries supporting Allied Health

Professionalsin that leadership journey. It is an

importantcontribution to this critical effort.”- From the Foreword by Jim Easton

Management Quality Matrix how can it help you?

1. Strategy2. Patient and service user experience3. Clinical excellence4. Finance5. Information and metrics6. Activity7. Staff resource effectiveness8. Staff management and development9. Service improvement and re-design10. Leadership and management development11. Risk management12. Corporate governance13. Communications and marketing14. Key performance indicators

Management Quality in the AHPs

Key concepts of Management QualityImpact on AHPsWhere does it come from? - the evidence-base and conceptual frameworkWhy is it important?

- patients and their families/carers   - clinical practice   - the staff   - the organisation - the Profession

The Three Phases of Excellence

1.   Lean 2.   Supply

Chain

3.   Strategic

Six Dimensions of Quality Communication Participation Employee

development Measurement Delegation Integration

Management Quality MatrixEvaluating a

wide range of performance parameters

Draws on management quality, industrial and healthcare excellence work

Concepts:Performance

Management‘Lean’ Six SigmaBalanced Scorecard ‘Dashboards’ TQM Benefits Realisation

Think about your serviceIs everyone in the team 'pulling' in the same

direction?Does the direction benefit the patient?Are we measuring so that we know whether we

are improving?Do staff have the training, motivation and respect

to provide value and bring about improvement?Are tensions around fear of change recognised

and managed?Are problems/mistakes treated as opportunities to

improve?

Business cases for Surviving and ThrivingRob sort the hand out if you can

Purpose of the Business casePut forward a proposal for change or development

Structured format to develop the case

Benefits realisationCostsTimescaleStrategic fit

Option Appraisal GuidanceSet out possible options in

turnDescribe each option outlineIdentify costsAnalyse pros and consEvaluate each option via

weighting or scoringCompare options, rank them

and recommend preferred option with reasons why

How Do you Make the most of your Management Structure?

Make them work for you…..............................what ever they are, however they change

Don’t fight themInfluence themSpeak the right languageMake yourself indispensableMake the right connections/contacts/alliesKeep your focus on the patient…..and the organisation’s strategic direction

To Summarise

Is There Anything We Haven't Covered?

The Challenge of ImplementationAction plan…what are you going to do by: Next Friday?

A month from today?

Evaluation

How was it?Are you going to use the

benchmarking data?What more could you do after today?Is there more you need to do be

business like?

Be a great leader…your team needs you!

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