AHP Management Does Structure Matter

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AHP Management Does Structure Matter?
Healthcare Mangement
J J

• Robert Jones and Fiona Jenkins
• Dublin
• December 7th 2005

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Overview

• Why this Topic
• Historical Perspectives - UK
• Health Service Reform - Ireland
• Research- past and current
• Research Findings
• Proposed Assessment Tool
• Traffic Lights
• Your Interpretation

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Why this Topic?

• Research/Evidence Base
• High Interest Response Rate
• Reforms
• Never know where to Put AHPs
• Increasingly Complex Organisations
• Little Guidance when Facing Restructuring
• Interests usand Hopefully you!
• Is it transferable to a different health system?
• Writing a Book

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NHS Historical Perspective - 1

• 1960s Medical Model
• 1974 Districts formed
• 1977 HC(77)33
• 1979 Patients First
• 1982 Reorganisation
• 1983/4 Griffiths and General
• Management
• 1989 Working for Patients

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NHSHistorical Perspective - 2

• 1991 Trusts
• 1992 End of Districts
• 1997 Labour Government
• 2000 NHS Plan,
• Meeting the Challenge
• PCTs, SHAs
• 2004 Foundation Trusts
• 2005 A Patient Led NHS
• PBR, Practice Based
• Commissioning

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Forward Looking

• A4C Implications
• Separation of Commissioning and Providing
• SHA Reorganisation
• Integration/ Partnership working
• Vertical Integration
• Contestability and Plurality
• And Beyond?

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Health Service Reform Programme

• A major rationalisation.
• Consolidation and amalgamation of 32 agencies
• Establishment of a Health Service Executive
• A Primary, Community and Continuing Care
  Directorate with four regional health offices and
  32 local health offices to deliver regional and
  local non-hospital services.
• The reorganisation of the Department of Health
  and Children, to ensure improved policy
  development, oversight and evaluation of service
  delivery.
• The establishment of a Health Information and
  Quality Authority to ensure that quality and
  effectiveness of care is promoted throughout the
  system.
• The devolution of responsibility for budgets to
  the people actually in charge of delivering
  services.
• The complete modernisation of supporting processes

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Health Strategy - 2003

• Health Strategy
• "Ireland will have a single, unified health
  service with devolved and empowered decision
  making at local level. This will deliver the most
  equitable and efficient management of the health
  system in order to achieve improved
  patient/client care, a better working environment
  for staff and enhanced value for money
• Health Service Reform Programme
• Greatest change for 30 years
• 2000 health spend per person
• - Better value for taxpayers money, improved
  health care management

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National Structure

• National Hospital Agency
• Significant increase in Hospital beds
• Improved acute hospital decision making
• Liaise with professional bodies
• Extra 1330 physiotherapists by 2015
• Professional regulation

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Mission Statements

• To support, protect and empower individuals,
  families and their communities to achieve their
  full health potential by putting health at the
  centre of public policy and by leading the
  development of high quality, equitable and
  efficient health and personal social services.

• Mission Statement"The role of the Irish Society
  of Chartered Physiotherapists is to represent
  Chartered Physiotherapists in Ireland and to
  support them in their achievement of the highest
  standards of professional practice. The Society
  is committed to the provision of a health service
  that is accessible, effective and humanitarian."

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Organisational Structure
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Background and Evidence

• Williams 1980s
• Jones 1986 to Date
• Berry early 1990s
• Øvretveit and Brunel 1980s-Early 1990s
• Boyce 1990s
• Jenkins 2002 to Date
• Any One Else?

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Jones Research

• 1985-91
• 1991-2000
• 2000 to Date

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Roles, Responsibilities and Duties of
Physiotherapy Managers

• 8 Domains, 27 Elements
• Strategic Management
• Human Resource Management
• Operational Management
• Budget and Resource Management
• Information Management
• Education Pre and Post Graduate
• Research and Development
• Clinical and Professional Leadership and
  Consultancy

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Jenkins Research Why?

• Interested
• Politics
• Development of Research
• Look at Cross Organisational Working
• AHP Inclusive

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The Research

• AHP Managers
• AHP Advisors
• SHA AHP Leads
• Roles, Responsibilities and Duties
• Relationships
• Views on Organisational Structure

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Findings

• AHP Managers
• AHP Advisors
• SHA AHP Leads

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Communication 1
Is the Mechanism for AHP input to the SHA
Effective?
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Communication 2
AHP Managers Communication with PEC Reps
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Domain Strategic Management
Additional Roles
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AHP Representation at Board and Executive Levels
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Domain Clinical Governance

• More than 80 of AHP Managers have responsibility
  for
• Monitoring HPC Registration/ Fitness to Practice
• Risk and Complaints Management
• Ensuring Evidence Based Practice
• Developing and Monitoring Service Policies
• Patient and Public Involvement for their Service
• Recruitment, Appraisal

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Domain Human Resource Management
WTE Staff Employed
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Domain Clinical
Undertake Regular Clinical Work
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Operational Management Across More Than One
Trust
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Domain Resource Management

• 84 of AHP Managers
• Manage the Budget for
• the Whole Service

!!!!!!!!
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Domain Information Management

• Only 49 have any involvement with Connect for
  Health

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Domain Education

• 70 Involved with Pre- Registration Education
  Commissioning

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Domain Commissioning
Involvement with LDP
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Anecdotal Evidence

• Non Fragmented Services Are Better
• Cross Organisational Working benefits patient
  care
• Maintain Critical Mass
• Lack Good Board and Executive Level
  Representation
• PEC Links Poor
• SHA Links Very Poor

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AHP Advisors - Comparison

• Less Clinical Work
• Less Complex Organisations
• Less Cross Boundary Working
• Narrower Scope, Limited Management Responsibility
• Less Satisfaction with Management Structure

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SHA AHP Leads

• How Many are There?
• Few Full Time AHP Leads
• Not All are AHPs
• Poor Communication
• Differing Jobs
• Significant Scope to Develop these Roles
• Lost Opportunity to Engage AHP Expertise

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Does Structure Matter?
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Our Proposed Assessment Tool

• 10 Domains, with Individual Elements
• Developed from Collaborative Working
• Includes Historical Perspective
• Pooled Research Findings

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Traffic Lights

• Red - Mostly No
• Amber - Not Sure or
• Dont Know
• Green - Mostly Yes

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Confused?
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1Strategic Management

• Does the structure enable
• Engagement in LDP Process and Commissioning for
  your Whole Service
• Fully Integrated non Fragmented Service
• Long and Medium Term Service Development and
  Planning
• Workforce Planning
• Management Accountability
• Authority to Manage your Whole Service
• Responsibility for your Whole Service

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2Clinical Governance

• Does the structure enable
• Patient Centred Services
• Implementation of Evidence Based Practice
• Research and Clinical Audit Activity
• Management of Service Risk
• Education and Training
• Organisational Governance
• Staffing and Staff Management
• Effective Communication

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3 i) Clinical Professions Requirement

• Does the structure enable effective
• Clinical / Professional Leadership and
  Consultancy across Whole Service
• Critical Mass of Staff
• Non-Fragmented Service Provision
• Consistent Access to CPD, PDP
• Access to a Range of Clinical Specialists
• In-service Training
• Implementation of National Guidelines and
  Policies

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3 ii) Clinical Professions Requirement

• Does the structure enable effective
• Input to National Professional fora
• Undergrad Clinical Placements All Core Areas
• Undergrad Clinical Placements in Specialist Areas
• Supervision and Support For all Staff
• Staff Rotations Across Whole Service

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4 Operational / Service Management

• Does the structure enable effective
• Use of Staff Resource
• Day-to-Day Management of Clinical Practice
• Day-to-Day Management of Clinical Staff
• Seamless Patient Care
• Cross Organisational Staff Networking
• Collaborative Inter Agency Working

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5 Resource Management

• Does the structure enable effective
• Economic Use of Resources Across Organisations
• Budget Holding and Management for the Entire
  Service
• Flexibility of Budget and Resource Use
• Involvement in Capital Project Planning and
  Management

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6 Human Resource Management

• Does the structure enable effective Recruitment
  and dismissal of staff
• Ease of recruitment to all grades/specialisms
• Equitable implementation of IWL
• Equitable implementation of grievance and
  discipline policies
• Consistent employment packages for staff
• Staff retention, career opportunities and
  succession planning.

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7 Information Management

• Does the structure enable effective
• Uniform Use of IM T Across Whole Service
• Engagement in the Development of IMT
• Consistent Interpretation of Information
• Use of Information for Clinical Purposes
• Cross Organisational Data Analysis of AHP
  Activity
• Use of IMT for Performance Management

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8 Education

• Does the structure enable effective
• Involvement with SHA in Pre Reg Education
• Engagement in Post Reg Education Demand
  Forecasting
• Training Budget Holding and Management for Whole
  Service
• Staff Engagement in RD
• Single Point of Contact for Universities

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9 Commissioning

• Does the Structure Enable Effective
• Engagement in Service Development and
  Commissioning for AHP Services
• Consistency in SLA Service Specification for AHP
  Services
• Participation in PBR costing and activity
• Ensure AHP Participation in Choice

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10 Service Improvement / Modernisation

• Does the structure enable effective
• Authority to Lead and Implement Service
  Improvement within and across Organisations and
  Agencies
• Active engagement in service improvement beyond
  the professional group

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Does Structure Matter?
Structure
Function
Systems
YES!
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.and Next