Achieving Benefits Through Change

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Achieving Benefits Through Change
ISIP Roadmap for Transformational
ChangeSupporting Materials Module B Getting
Started with ISIP
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Introduction

• Presenters name here
• Presenters contact details here
• Further information
• http//www.isip.nhs.uk/

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Purpose
The purpose of these materials is to help ISIP
Leads to

• Convince senior stakeholders of the value of
  integrated service improvement
• Engage senior stakeholders in collaborative
  activities to create a compelling and shared case
  for change as a key starting point for integrated
  service improvement
• Gain sufficient commitment from senior
  stakeholders to establish and maintain LHC-wide
  governance for a strategic portfolio of
  integrated change
• Work with senior stakeholders to communicate the
  case for change so that there is commitment
  across the LHC to engage in integrated service
  improvement

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Convince Senior Stakeholders of the Value of
Integrated Service Improvement
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Frontline Perspectives

• Subjected to a snowstorm of initiatives
• The links between initiatives and projects are
  unclear
• Faced with conflicts and difficulties in planning
  and prioritising resources
• Buried in bureaucracy to track and manage benefit
  realisation
• Restricted in silos by localised implementation
  teams

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Major Challenges Ahead

• Local Health Communities will wish to consider
• Their scope, are all sectors, including
  independent providers, involved
• How best to energise people to work together on a
  shared agenda
• Given that
• The paint still isnt dry after the last
  organisational upheaval
• Skill-sets for change planning delivery are in
  short supply

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Major Challenges Ahead

• Investment is required before the benefits can be
  realised
• There needs to be integration with the LDP
• Measuring the benefits to the patient and the
  cost to the NHS is problematic
• Reconciling national and local priorities is
  difficult
• Addressing longer term priorities in the context
  of short term financial stress can be painful
• Creating and maintaining momentum is hard

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Introducing ISIP

• Integrated Service Improvement Programme
• A fresh approach to change
• Not a methodology but a source of guidance, tools
  and techniques to enable and support
• Collaborative decision-making and control
• Design and implementation of benefits led
  integrated change
• Changes involving people, process and technology
• Stakeholder involvement and engagement

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Central Commitment

• ISIP provides a way for Local Health Communities
  to
• Be more efficient and productive,
• Transform service delivery and enhance service
  quality,
• While extracting maximum value from investments
  in people, process and technology.

Letter from Duncan Selbie 15 December 2005
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Key Benefits of ISIP

• Links directly to national and local strategy,
  with a benefits focus
• Aligns people, process and technology in order to
  maximise return on investment from national
  enablers
• Engages all stakeholders who contribute to the
  patient journey - including patients and staff
• Govern and manage major projects using a
  programme management approach

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For example
The ISIP approach helped us rationalise over 70
disconnected plans into a coherent service
transformation plan, focusing scarce resource to
get on and deliver - North Derbyshire Local
Health Community
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So where do we start with ISIP?
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Roadmap for Transformational Change
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Getting Started with ISIP
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Engage senior stakeholders in collaborative
activities to create a compelling and shared
case for change
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Create the Case for Change
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Create the Case for Change

• Preparation
• Collect relevant information
• Identify stakeholders understand their issues
  and priorities
• Collaborative Activities (or off-line analysis
  followed by validation)
• Construct / use Care Delivery System (CDS) to
  carry out a high-level assessment of LHCs
  current capability and performance.
• Identify drivers and challenges and assess their
  impact on the CDS e.g. SWOT analysis
• Identify and agree shared priorities for
  integrated / transformational change

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ISIP Care Delivery System
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Challenges and Drivers
DRIVERS
CHALLENGES
Reducing Health Inequalities
Ageing population
Reducing waiting times
Increasing prescription costs
Greater patient and public involvement
Technological complexity
Implementing Gold Standard
Changes to PCT service provision
Patient Choice
Financial balance





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Developing the Big Picture
Care Delivery Now
LHC Vision Future State
How quickly
Where we treat people
Quality of service
Financial stability
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5 Dominant Integrated Change Programmes
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• Establish and Maintain LHC-wide Governance for a
  Strategic Portfolio of Integrated Change

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Set-up LHC Governance
?
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The LHC

• Consists of all patients, clinicians, managers
  and other staff who are involved in the
  management of health and the provision of
  healthcare within a defined population
• While each LHC is likely to have a different
  structure, a fully established community could
  include
• all types of NHS trust
• local authority social services
• independent and voluntary sector providers
• relevant community support groups

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LHC Governance - Structure

• Formal governance of integrated service
  improvement requires an LHC Board
• The board will be chaired by the LHCs Executive
  Sponsor for Integrated Service Improvement and
  will include
• a chief executive
• director or senior clinical leader from each
  organisation in the LHC
• Ideally, this board will be created by adapting
  or extending the role of an existing forum

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LHC Governance - Responsibilities

• The LHC Board provides the business context for
  the ISI teams operations
• The Board provides its judgements about the
  acceptable strategic risks and costs of the
  programme for change
• The Board provides criteria to enable judgements
  to be made about the appropriateness of the
  change programmes
• The Board decides the structure locally

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Communicate the Case for Change
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Communicate Case for Change
?
?
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Communicating Change

• Who - Which stakeholders need to hear the
  message?
• How - What are appropriate channels of
  communication?
• What - What is the key message?
• Responsibility - Who are the messengers?
• Action - What is the plan?

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Potential Barriers to Change

• Fatigue Not again, we changed last week!
• Cynicism Its all talk. Nothing ever changes
• Superficiality Sure, well try to change, but
  the underlying practices will still be the same
• Challenge Theres no need to change, we just
  need more resources
• Vested Interests Im not doing that, it will
  threaten my status/seniority/position
• Uncertainty If we change what will that mean
  for patients/staff/me?

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Checkpoint Conclusion
How do you know whether you have got ISIP started?

• Are senior stakeholders convinced of the value of
  integrated service improvement?
• Have senior stakeholders worked collaboratively
  to create a compelling and shared case for
  change?
• Is there sufficient commitment from senior
  stakeholders to establish and maintain LHC-wide
  governance for a strategic portfolio of
  integrated change?
• Has the case for change been communicated by
  senior stakeholders so that there is commitment
  across the LHC to engage in integrated service
  improvement?

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Conclusion

• Presenters name here
• Presenters contact details here
• Further information
• http//www.isip.nhs.uk/

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Additional Slides
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Transformational Change

• Not reform but transform
• Not an initiative restricted to a particular
  service or organisation but involving all the
  organisations in an LHC
• Encompasses both internal cultural change as well
  as changes to structures, processes and
  technology
• Involves all stakeholders not just patient
  choice but also staff satisfaction

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Integrated Change
How do we exploit and integrate national programs,
to produce
in the context of,
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Possible Approach to Stakeholder Analysis
Power v. Interest Grid
High
Subjects
Players
Interest
Crowd
Context Setters
Low
High
Low
Power
Source Making Strategy (Eden Ackerman)