Care Outside Hospital Delivering Successful Projects

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• Care Outside Hospital Delivering Successful
  Projects
• John Burton
• Associate
• Care Outside Hospital Team

1st November 2007
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Projects that we have known- just to tune you
in.

• Individually think.
• A great thing that happened once when I was in a
  project team was when
• A project I was involved in failed to achieve its
  objectives because..
• In my experience project team working goes like
  this.
• Then discuss on your table

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This session will outline an approach for
successful project working developed following
work with seven health communities.

• It will cover how to
• Develop and run a series of workshops and reviews
  designed to assist the team in progressing
  through the project delivery process
• Build a team with the right mix of skills and
  experience to successfully design and deliver a
  Care Outside Hospital Project
• Support the team in using a range of tools and
  techniques.
• But we shall start with an overview of the Care
  Outside Hospital Programme

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The White Paper posed a major challenge to
deliver more care in the community

• Health care has traditionally been focused in
  large acute hospitals. But
• Patients expect services to be designed around
  their needs
• Technology means activity no longer needs to be
  done in hospital
• The aging population requires a greater emphasis
  on supporting ongoing individual well-being
• To deliver this vision, the NHS needs to make a
  significant reorientation in the way care is
  delivered, involving community-based, responsive,
  adaptable, flexible services
• NHS Operating Framework 2008/09 is expected to
  place renewed emphasis on the need to deliver
  population scale shifts of services into the
  community

We aim to provide more care in more local,
convenient settings, including in the home.
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The Department of Health Care Closer to Home
Project

• 30 pilots to define clinically safe pathways that
  provide
• The right care in the right setting, with the
  right equipment
• Performed by the appropriate skilled person

• Evaluation published in June 2007.
• Found
• Much activity can indeed be delivered in the
  community
• Considerable patient benefit (access /
  convenience) can be secured
• Equal or better clinical outcomes can be
  delivered
• Activity largely additional to existing acute
  activity

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Lord Darzis once in a generation review Our
NHS, Our Future has reaffirmed the need to
focus attention on bringing care closer to home

• Focus on creating a fairer NHS
• Improving access to primary and community care
• Making services more personal
• Integrating care through one-stop centres and use
  of IT
• Clinical pathways are central to improving
  services
• Local teams in each SHA reviewing 8 key pathways
• National teams bring these local insights
  together
• Several pathways linked to care outside hospital
• Final report due in June 2008

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The NHS Institute is today launching a suite of
resources designed to help the NHS nationally
shift care closer to home.

• The Opportunity Locator helps you identify many
  m worth of activity that could be shifted into
  the community
• Focus on the key areas for patient access and
  satisfaction
• Determine scope for improvements in value for
  money
• The Priority Selector allows you to translate
  your strategic vision into operational plans that
  deliver population-scale service change
• Agree a balanced and realistic programme of
  change
• Secure ownership of the plan across the PCT, PEC
  and PBC
• Steps to Success dramatically improves your
  ability to deliver care outside hospital projects
• Implement accelerated projects delivering greater
  results
• Achieve genuine improvements in services

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They all fit within a cyclical process
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Prioritise Opportunities lets you develop a
programme of change that brings together the best
of many potential initiatives
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The Opportunity Locator also gives you a detailed
analysis of where the greatest opportunities
exist for your PCT

• Analysis across 7 key indicators
• Emergency Admissions
• Intermediate Care
• Outpatients First Attendance
• Outpatient Follow Up
• Self Care
• Prevention
• Diagnostics
• Indicators can be broken down
• Specialty
• HRG
• Diagnostic
• Condition
• Access the raw data

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Armed with the insights from the Opportunity
Locator, the team generates a long-list of
initiatives broadly following the five steps below
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Once the long-list is finalised, the Priority
Selector supports you to decide which initiatives
to take forward
?
?
?
?
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Finally, your Team selects a medium list of
initiatives for further consideration

• Initial considerations
• Are there any 'must-do' Priority 1 projects?
• Are there any linked Priority 2 projects that
  should be considered further?
• Are there any Priority 3 projects that should be
  considered further to address localised/inequality
  issues?
• Are there any Priority 4 projects on the cusp
  that should be considered further?
• Then mini-charters are created for each
  project, detailing
• Objective and main scope
• Broad benefits and outcomes
• Stakeholders to engage
• Key risks dependencies
• Collective funding implications
• And coherent waves of projects are identified as
  the agreed commissioning proposal

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The NHS Institutes role is to provide answers to
the question How can we make change happen in
practice, quickly and broadly?

• Field testing with 14 pilots across 5 health
  economies in 2006
• Provide insight into how to bring services closer
  to home successfully

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Getting the Basics RightAn independent
evaluation by the Health Services Management
Centre

• Challenges
• Which opportunities should we take forward?
• How can we make change happen?

• Key factors
• Creating the right context
• Managing projects well
• Engaging stakeholders and clinicians
• Overcoming barriers to change
• Measuring and monitoring progress
• Setting stretching but realistic timescales and
  ensuring sustainability and spread

All the pilots have identified significant
service gains
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Steps to Success has five steps

• Get Ready establishing the right team to
  deliver the project and briefing them on the
  process and their role within it
• Start agreeing the scope of the project
  including understanding the clinical case for
  change and assessing stakeholder interests
• Plan designing the new pathway or service,
  including determining benefits and setting a
  baseline against which to measure them, and
  agreeing the business case for change
• Do implementing the new pathway or service,
  based on understanding the practical operational
  needs and supported by project management tools
• Keep Going handing over the project to
  business as usual, realising
• the benefits, completing an end of project
  review, and preparing the
• end-of-project report

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Once you know what projects you want to take
forward, Steps to Success provides easy to grasp,
clear actions focused on shift so that the
projects achieve your goals
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The Gate Review Process
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The right people need to attendGate Reviews

• You should convene a gate review meeting between
  each major phase in the project.
• It is important to involve the right people in
  these meetings. You need people who are
  knowledgeable about the project as well as senior
  people who can authorise the next step to
  proceed.
• Typical attendees at reviews for projects
  shifting care outside hospital include
• Project Lead
• Clinical Lead
• Project Champion
• Organisational Senior Leader (not involved in
  the day-to-day activity)
• Data analyst
• Representatives of acute services
• Representatives of primary care (GPs, practice
  nurses etc)

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Convening a gate review

• Key activities for those convening a Gate Review
  include the following
• Identifying attendees
• Giving notice of the meeting (ideally giving
  six weeks notice)
• Preparing and circulating the agenda and papers
  in advance (including the relevant Gate criteria)
• Booking an appropriate venue
• Agreeing how the decision of the Gate Review
  will be reported to stakeholders

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An example Gate Review Report Gate 3
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Passing Through the Gate

• Gate review meetings should be seen as an
  opportunity to report progress against the
  project plan and identify any problems in an open
  and candid way.
• Depending on the assessment of the project
  progress against the gateway criteria, the
  project team have several options for moving
  forwards after the gateway meeting, including
• Moving into the next phase
• Deferring the project
• Increasing resources to address problems
• Terminating the project
• Reviewing the scope of the project or changing
  the approach (e.g. reframing the problem more
  broadly and strategically one step up or
  more operationally, at a smaller scale or in more
  detail one step down)

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Project Progress Report
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Get Ready Responsibility Charting

• Responsibility charting will help you to clarify
  any confusion, assumptions and misunderstandings
  about who does what. It is useful because it
  can
• Make sure that someone is responsible for each
  task.
• Identify who needs to be given communication
  about each task.
• Prevent duplication of effort.
• It can unearth a range of issues, including gaps
  in responsibility, misunderstanding,
  miscommunication and areas where too many people
  are given responsibility for the same thing.

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Responsibility ChartingHow will it help you in
delivering care outside hospital?

• There are two ways that this tool can help to
  deliver care outside hospital projects
• 1) Ensuring clarity about who is responsible for
  what in an operational setting
• A lack of clarity about who is responsible for
  what, in an operational setting, can waste
  peoples time, cause confusion and result in
  delays to projects.
• 2) Ensuring clarity about who is responsible for
  what in project or change management
• How often are the same old things discussed and
  agreed but never taken forward? Achieving new
  pathways will depend upon good project
  management. You will need to be clear who is
  responsible for what action.

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Developing a responsibility chart

• 1. List activities or tasks
• List activities to be completed in a matrix
  these become the row headings. For example
• Developing budgets, allocating resources
• Deciding which patient cohort to focus on
• Telling patients about what is happening.
• Giving information to patients about who to
  contact if there is a problem.
• 2. List the people involved
• List all the people involved in the process, they
  are the table headings. They can include
• People directly involved in the process.
• Managers and committees who apply controls on
  the process.
• Other people who may impact the performance of
  the process.

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Developing a responsibility chart - continued

• 3. Identify each persons responsibility with
  respect to the activity
• It is suggested that all care outside hospital
  projects should have the following individuals on
  a team
• A Project Lead who has the capacity and
  capability to take on the role
• A Clinical Lead who provides valuable clinical
  input and can play a crucial role in further
  clinical engagement
• A Project Champion who is someone of seniority
  that can promote the project to both internal and
  external stakeholders

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The key responsibilities of individuals and
groups within the project should be communicated
using a governance chart
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Support for using these tools
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Steps to Success User Guide - Contents
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How to access these resources

• A rolling programme of release from 1 November
• Go to www.institute.nhs.uk/careoutsidehospital
• Contact us at careoutsidehospital_at_institute.nhs.uk
  
• Additional information and guidance
• Latest news updates via email bulletins
• Series of webex / webcasts between November and
  Christmas
• Support to SHA
• LDP scene-setting sessions
• Co-producer throughout LDP period
• Additional support on cost recovery basis where
  wanted
• Action learning sets
• Skills development