Seizing the Moment: Transformational Change

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Seizing the MomentTransformational Change

• Peter Bradley
• CEO LAS
• DH National Ambulance Advisor

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The LAS

• 625 square miles within M25
• 32 PCTs and 1 SHA
• Over 4,000 staff at 70 stations
• 400 ambulances, 70 cars, 25 specialist vehicles
• 1.3 million 999 calls annually (20 of ambulance
  call volume in England
• 900,000 ambulance responses annually
• 400,000 patient transport service patients taken
  to and from clinics annually

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What was the LAS like 7 years ago?
Poor operating systems Poor working
practices Management issues Poor reputation Major
IR issues
Increased calls Lower road speeds Static real
funding Higher expectations Misuse of the Service
Poor pay for frontline staff Personal safety
concerns Morale staff turnover issues Outdated
IT and equipment
Poor response time performance
Variable clinical performance Unsafe
utilisation levels
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What was the LAS like 7 years ago?

• Internally focused
• Not meeting key performance targets
• Focus on what we disagreed on, not what we agreed
  on
• Management lacked credibility we werent
  delivering
• Strong union weak management
• Short of resources
• High turnover
• Low morale, no pride, lost identity
• No common vision

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What did we do?

• Brought in new senior management team members and
  Chairman
• Admitted our shortcomings to ourselves and our
  staff
• Undertook some diagnostic work
• Developed shared vision, purpose and values
• Top team commitment
• Built support externally
• Listened internally
• Acted quick wins
• Obtained investment
• Built trust and confidence with the unions
• Developed a 6 year Service Improvement Programme

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Our Vision

• A world class ambulance service for London
  staffed by well trained, enthusiastic and proud
  people who are all recognised for contributing to
  the provision of high quality patient care.

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LAS VALUES (Professional Standards)

• C linical Excellence
• R espect and Courtesy
• I ntegrity
• T eamwork
• I nnovation and flexibility
• C ommunication
• A ccept responsibility
• L eadership and Direction

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Organisational change critical success factors
Clear shared vision and values
Pressure for change
Capability and capacity for change
Actionable next steps
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Making change happen
Source Sarah Fraser
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Service Improvement Programme

• 6 year programme ended in 2006
• Designed by staff, managers, unions and external
  stakeholders
• Programme Manager appointed
• 266 individual initiatives
• 239 completed
• 40 outcomes agreed to measure our success
  people, patients and performance

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Service Improvement Programmekey areas

• Bringing resources in line with demand
• Strengthening management
• Improve support for staff
• Improve staff safety
• Managing demand
• Improve clinical effectiveness
• Improve risk management

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Outcomes

• Patients
• Complaints down 25
• Call to needle times reduced
• Cardiac arrest survival up from 2.5 to 9 (now
  15.8)
• Performance
• Category A performance 36 in 8 mins at the start
  of the Programme 75 for 2006/2007 year
• 999 call answering up from 60 to 90 in 5
  seconds
• People
• Turnover down from 11 to 3
• Staff absence down from 8 to 6.5
• 40 reduction in reported assaults
• Substantial improvements with staff survey
  results

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What have we learnt?
Climate Change
WHAT
Cultural Change
HOW
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What have we learnt?

• Performance obsession can be unhelpful
• Focus on how as much as what
• Middle management engagement
• OD strategy alongside SIP
• Programme management not just project management
• Outcomes before initiatives
• Appropriate support and expertise to deliver
  programme

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What have we learnt ?

• Quick wins/celebrating success
• Regular demonstration of progress
• On-going staff involvement
• Detoxifying cynicism and pessimism (Kotter)
• Remember the history
• The feel good factor needs refreshing
• Multi-layered communication is key

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Communicate again, again and again

• Internet, intranet available to all staff
• 40 meetings with 40 of workforce annually
• In-house monthly magazine and weekly bulletin
• Regular rideouts on ambulances
• Annual management/union conference
• Monthly meetings with CEO, HR and union officials
• 2 day induction course for all new staff
• CEO newsletters to senior managers
• 5 senior managers conferences annually
• 10 conferences with firstline and middle managers
  annually

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What next ?

• OGC Feedback
• Redefining success balanced scorecard
• Building on what we have achieved for the whole
  organisation
• Leveraging efficiency 10 minimum
• Incorporating lessons learnt into new 7 year plan
• Real benefit realisations for LAS and NHS
  support from ISIP

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The 7 Year Plan
Six aspirations

• An accessible service
• That responds appropriately
• Remains focussed on delivery, AND
• Engages its patients and partners
• Provides greater options for patients, and
• Has a culture built on our CRITICAL VALUES

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And five programme strands

• Operational model
• Access and connecting the LAS for health
• OD and People
• Corporate processes and governance
• The Olympic and Paralympic games
• Underpinned by stakeholder engagement strategies
• Using MSP, Programme Managers appointed
• Overarching aim to create an organisation that
  looks, feels, behaves and delivers differently

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The Ambulance Review Strategic Vision

• Mobile healthcare, not just patient transport
• Quality call handling and advice
• A wider range of services, e.g. diagnostics
  and long-term conditions management
• Even better care for patients with
  immediately life-threatening conditions

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Ambulance Review

• 5 key work streams
• 70 recommendations
• DH support
• CEO lead roles
• Director groups

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Five key workstreams for ambulance services

• Supporting the NHS in assessing and improving
  Quality and Consistency of care by improving the
  evidence base, accrediting independent providers
  and developing clinical and outcome indicators.
• Supporting the NHS in improving Efficiency and
  Effectiveness of ambulance trusts through
  facilitating national/ regional capital
  procurements and effective use of technology/ new
  models of service delivery.

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• Developing Organisations that are fit for purpose
  by creating strategic capacity and improving
  leadership, both clinical and managerial, so that
  organisation structure, culture and style matches
  new models of care.
• Supporting Performance Improvement and restoring
  public confidence in reported performance through
  consistent measurement, service re-design and
  progressively tighter focus on response times for
  Category A calls
• Facilitating further development of the Workforce
  so that it is capable of meeting patient needs.

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CEO Lead Roles

• Will Hancock Procurement
• Paul Sutton - Emergency Preparedness
• Ken Wenman Urgent Care
• Paul Phillips - Clinical Effectiveness
• Anthony Marsh Leadership
• Jayne Barnes Performance / Communications
• John Burnside IMT
• Tim Lynch Workforce Development
• Chris Carney Training Education
• Simon Featherstone Foundation Status, PBR
  Commissioning
• Peter Bradley Benefits Realisation

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Implementation of
Recommendations

• 05 Evidence base for call categorisation ?
• 20, 21 improved clinical care ? (but more to
  do)
• 27 lead commissioner for each service ?
• 33 minimum dataset ?
• 40 Reduced number of ambulance services ?
• 43 demand analysis tool ?
• 47 New category A performance ?

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Implementation of
Recommendations

• 48, 50, 52 Modernised performance measures ?
• 53 - Call prioritisation should be reviewed
  annually?
• 56 support performance improvement ? (but more
  to do)
• 65 new careers literature ?
• 70 Five year workforce plans ?

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Other achievements

• Sponsorship to promote research into pre-hospital
  care, and publication of updated clinical
  guidelines to reflect latest evidence base and
  professional consensus
• Updated PTS guidance issued
• Rollout of ambulance radio programme / live in
  Essex region
• Review of non-pay spend to identify areas for
  collaborative procurement

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Other achievements

• Co-ordinated programme of work to develop the
  workforce, led by stakeholders and facilitated by
  DH
• Control room review undertaken
• Emergency preparedness audit completed
• Management capacity and capability audit about to
  start

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Short list of benefits to be measured

• To resolve patients needs without them having to
  leave home
• To take fewer patients to hospital
• To achieve better survival rates for patients who
  are seriously ill and injured
• Myocardial Infarction Cardiac Arrest Stroke
  Serious Trauma Respiratory Arrest
• To achieve even better patient satisfaction
• To achieve high levels of staff satisfaction
• To achieve organisational improvement

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4) To achieve even better patient satisfaction

• Through
• Improved speed of call answering
• Faster response times
• Improved care from independent sector
• Improved triage of calls
• Improved patient assessment
• Improved telephone advice
• Seamless call transfer
• Enablers
• (Ambulance review recommendations) 5,7,18,47,53
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• Trusts own initiatives

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• Emergency Admissions

• Workforce Skills

TIME
TIME

• 999 Call Waiting

• Appropriate Destination for Stroke CHD etc

TIME
TIME
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• Use of WICs, MIUs, other NHS

Clinical Telephone Advice
TIME
TIME

• Costs per Call

Cardiac Arrest Survivors
TIME
TIME
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Final Thoughts

• Whose morale is it anyway ?
• Knowledge skills and attitude behaviour
  competence
• What is world class, is it achievable is good,
  good enough ?
• 20 years ago if you had a vision you got locked
  up. Now you cant get a job without one

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A service that responds appropriately to all our
patients
A service that looks, feels and behaves, and
delivers differently
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Thank You
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SEIZE THE MOMENTSuccessfully Managing Complex
Change