What is Clinical Engagement and how can it help with 'Sharing and Caring' and the Darzi Review Actio

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What is Clinical Engagement and how can it help
with 'Sharing and Caring' and the Darzi
ReviewAction Learning, Leadership, Delivery
Senior NetworkingDr Amir HannanFull-time
General PractitionerMember of the Clinical
Leaders NetworkPrimary Care Lead, North-West
Strategic Health AuthorityIndependent Sector
Clinical Assessment Treatment and Support
Services Clinical Lead, Greater Manchester (IS
CATS)Member of the HealthSpace Reference
Panelamir.hannan_at_nhs.net www.cln.nhs.uk
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The constants

• The public
• The patients
• The clinical staff
• Health service managers
• BUT aspirations and expectations of all groups
  change over time

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The opportunity

• Bring together the clinicians across sectors to
  express a more unified view
• Work together with NHS management in a more equal
  partnership
• Have a better understanding of the needs and
  desires of the patients and the public

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• When considering any NHS development programme
  successful transition contains common elements

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Seven key beliefs

• Genuine engagement occurs most effectively
  following debate at a local level
• Place the patient at the centre of a cultural
  move towards a new pathway
• Observability Trialability is compelling
  Rogers Plsek
• Local clinical leaders are essential, they often
  have legitimacy with their colleagues and are
  seen as honest brokers
• When a new system has been applied successfully
  in a local context, this strength of evidence
  is very compelling
• Align roles and responsibilities between clinical
  leaders and managerial directors
• The request for a clinician to change their
  working process will produce dissonance

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Disengagement
Dissonance
Behavioural management And transformational
change
Engagement
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Historical NHS Policy Implementation
DH
Clinical Advisors
SHA
The driver Of line management
GPs Nurses AHPs
PCT
Clinical advise Clinical engagement
Consultants Nurses AHPs
Trust
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New Double Helix Approach
DH CfH
Clinical Advisors
SHA
Value Belief Engagement
GP's
Patients Pathway Driver
PCT
Nurses
Consultants
Trust
AHP's
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Personalities of Lead Clinicians

• Clinical Experts
• Quality and Governance
• Change Leaders

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The National Program enabling healthcare through
enabling clinicians.
Members of Clinical Implementation Support Team
working with Local Service Provider
Clinical Advisor Acute Care
Clinical Advisor Mental Health
Clinical Advisor Primary/Community
Chief Clinical Officer
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Multidisciplinary strategic clinical leaders
Clinical Advisor Acute Care
Clinical Advisor Mental Health
Clinical Advisor Primary/Community
Chief Clinical Officer
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Clinical engagement is most successfully achieved
at a local level That there are clear, simple
goals and they are well-conceived for
accomplishing these Place the patient at the
centre of a cultural move towards improving
safety and quality, and that managing clinical
culture is a primary activity
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Clinical Engagement Escalator
Aligned with Managerial Colleagues Project Plan
Imbedding
Multidisciplinary strategic clinical leaders
Clinical Champion to bring about Clinical
Engagement and imbedding
Acceptance and implementation
Clinicians for Product Testing
Dissemination
Early implementers
Clinicians for Product Development
Clinical volunteers
Clinical Advisor Acute Care
Clinical Advisor Mental Health
Clinical Advisor Primary/Community
Awareness-raising
Chief Clinical Officer
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• What is the CLN?
• A group of at least 60 clinical leaders within
  each SHA who
• Meet monthly to listen, discuss and debate issues
  directly with a key note speaker (local or
  national service / policy lead)
• Participate in focused Action Learning Sets
• Dedicate a further session per month to leading
  service reform within their health area
• Lead the delivery of change and service
  improvement
• Evaluate impact and their affect on service
  improvement
• Aim To address the gap in the engagement of
  senior practicing clinicians (within and outside
  of management positions) in the service reform
  and implementation agenda. Specifically focusing
  on the relationship, process development and
  information requirements to deliver the outcomes
  of Our Health, Our Care, Our Say

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What Is The CLN ?
Inputs
Delivery
Outputs
Structured Action Learning
Structured Delivery
Service Improvement
Priority Focus
Keynote Speaker Plenary
Local Delivery Session
Quality Gain
Capability
Facilitated Action Learning Sets
Participant Evaluated
Specify Information Needs
Recruitment
Reimbursed Session (1/2 Day) (Centrally Resourced)
Reimbursed Session (1xPA / Clinical
Session) (SHA Resourced)
KPI and SLA Delivery
National Standards
Interdependency Coverage
Programme Alignment
SHA Led Steering Group
Leadership Networking
Commitment
Structured Evaluation Feedback
Participants
Stakeholders
Skills Gain
Specialist Resourcing
National Stakeholder Board
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Method of Delivery
Central
SHA
Participants

• Max 180k budget for session reimbursement for
  ALS
• National contract for professional Facilitators
• Max 40k budget for venue and speaker expenses
• Project management and implementation support
• Comms Strategy

• Max 180k budget for session reimbursement for
• delivery sessions
• Clinical chair to deliver the programme
• Steering group, administration and project
• management support to chair
• Local communication plan and responsible officer
• Engagement with local NHS organisations

• Time and participation commitment to ALS and
• delivery sessions
• Prepared personal development objectives
• Clarity of objectives their participation in
  programme
• will achieve (with organisation heads)

Provision

• Provision of resourcing until 2010
• Ongoing scrutiny of delivery and value for money
• Management of performance of facilitators
• Evaluation framework, reporting and feedback
• National roll out
• Ongoing support to SHA Chairs

• Local ongoing evaluation
• SLA and KPI reporting and delivery
• Agenda setting and speaker engagement
• Resource and support the local chair and steering
  
• Group
• Alignment with wider local leadership and
  engagement
• strategies

• Delivery of evaluation processes
• Ensuring case information and reimbursement
• requests are timely managed
• Constructive input
• Engagement of local colleagues
• Succession planning

Responsibilities

• 600 actively engaged leading clinicians
  participating
• on a monthly basis
• Sustainable engagement model for multiple
• improvement and reform programme focus
• Skill transfer to the NHS
• Value for money

• 60 actively engaged leading clinicians
  participating
• on a monthly basis
• Sustainable engagement model for multiple
• improvement and reform programme focus
• Skill transfer to the NHS
• Value for money

• Quantified personal development and peer support
• Direct engagement with policy heads
• Leading position in local service reform
• Integrating quality improvements in local
  services
• Participation in a national network of peers

Benefits
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How does this help with the Darzi review?
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Healthier Horizons for the North West Clinical
Leadership and Clinical Engagement
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Achievements?
Delivered cancer 2 week target
Top performing system for HCC Use of Resources
The NW treats nearly 50 more patients than the
rest of England
More midwives and nurses for population than
nationally
802 million invested in GP premises and
hospitals since 1997
Will deliver 18 week target
1 million people using Walk in Centres and Minor
Injury Units
Maintained 98 4 hour wait in AE
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Highest rates for heart disease and stroke
Nearly a quarter of children live in poverty
16 people on benefits
23 of adults binge drinkers
The Case for Change
Average life expectancy 3 years less than the UK
best
Highest rate for long term mental health problems
60 of adults overweight or obese
2nd highest rates - deaths from cancer and
smoking related illnesses
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• Our vision for the next 10 years - to develop a
  new relationship between the NHS and the people
  of the North West

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Strategic Scenarios
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What are we asking the North West system to
deliver?

• ERSONALISED
• DVANCED
• ARE
• NVIRONMENT

. a recipe for quality and safety
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How will the Clinical Pathway Groups findings
help us to deliver this?
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• Care passports and personal budgets Long Term
  Conditions
• Living wills - Co-ordinated personal advanced
  care planning End of Life

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• The virtual ward / virtual care campus Long Term
  Conditions Urgent Care
• One-stop memory clinic Mental Health
• High street testing and diagnostic enablers
  Urgent Care, Planned Care, Long Term Conditions

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• Social marketing programmes Staying Healthy
• Championing normality Birth
• Risk stratification and targeting Childrens

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• Networked care at the boundaries of specialised
  and general services Childrens
• Hot and cold sites Planned Care, Urgent Care

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The SHA has identified 7 steps to ensure
delivery of these changes

• Getting beyond reconfiguration
• Developing strategic capability
• Listening, understanding and tailoring what we
  offer
• Being innovative
• Developing partnerships with meaning
• Raising our game on safety, quality, governance
  and becoming world class
• Managing the system in the interests of local
  people

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Programmes for delivery
NW Leadership Academy
Advancing Quality
Regional Mental Health Commission
Technology Adoption Hub
RD Programmes
Our LifeNorth West
Fairness in Primary Care Procurement
Accelerated Achievement of World Class
Commissioning
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10 PublicTouchstones
I will be living a healthier lifestyle
I will receive the most informed technologiesas
part of my care
I will receive more personalised care
I will be more involved indecisions madeby the
NHS
I will get more integrated seamlesscare, when I
need helpfrom more than oneorganisation
I will have betterCustomer careand an improved
patient experience
I will receive more of my care closer to my home
My NHS will maintain ahealthy financial
position andperform the best in class
I will be givenhigher qualityclinical care
My family will have a better opportunityto live
a longer andhealthier life
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Qualities of leadership defined by the CPGs

• Commitment drive
• Focus
• Pledging
• Advocating
• Outcomes standards-focussed
• Patient-centred

• Partnership
• Improving
• Embedding
• Streamlining
• Co-ordinating
• Integrating

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The Clinical Leaders Network

• Lots of work to think about and do
• A method to enable and support the wider clinical
  engagement
• Close co-operation between clinicians and
  managers
• Support work locally
• Help to improve services
• Enable better long term outcomes
• Contact your Medical Director at your SHA to ask
  about your local Clinical Leaders Network and how
  they can help you

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• Any questions