1. Transforming quality and costs
at Hinchingbrooke Hospital
Nuffield Trust Summit, Thursday 7th March
Translating evidence into better care: the impact of clinical leadership and culture
Massoud Fouladi, Cofounder of Circle Partnership
Hisham Abdel-Rahman, Hinchingbrooke Clinical Chairman

2. ‘Clinical and financial basket case’
Quality Financial
• ‘Dysfunctional’ colorectal • £10 million deficit
service (RCS report) amounted to 10% of revenue
• A&E services rated • £12 million backlog
poor by commissioners of capital repairs
• ‘Red’ PCT rating for • Agency costs £4 million pa
serious incidents due to inability to fill vacancies
management • £40 million historic debt
• Small district general hospital serving 150,000 population
with 22 GP practices and approximately £100 million budget
• 235 beds, accident and emergency, maternity, intensive
treatment unit and full complement of secondary care services
• Innovative 10-year franchise arrangement in which Circle
operates the Trust and underwrites financial risks

3. Changing culture:
Creating a social movement through our partnership model
1,200 of the 1,700 strong workforce attended a four-hour
‘partnership session’ to agree collectively the business plan

4. Changing culture:
Alignment of everyone to common goals and plans

5. Circle’s operating system
Devolved power structure and
continuous improvement methodology

6. You achieve excellence by…
• Learning, adapting and improving at all levels of the organisation
• Developing four core capabilities
1. System designed for excellence, with the capacity to detect failure built-in
2. Problem solving to build new knowledge and drive improvement
3. Sharing new knowledge throughout the organisation
4. Leading by developing these skills in others

7. Mandated clinical leadership:
Flat structure with majority clinician board

8. Case study:
‘Stop the Line’: Toyota Andon System applied to healthcare
Rapid cycle improvement process

9. Case study:
Colorectal service transformation

10. Early successes
Clinical results
• First of 46 hospitals in A&E
• 60% drop in serious incidents
• Cancer target compliant
for first time
• CQC compliant for first time
since inspections commenced
Patient experience Financial
• Feedback up 852 to 24,000 • 7% annualised savings delivered
per annum • Trust in financial balance
• Top 10 of 46 for patient at zero cost to taxpayer
experience • £3.7 million Circle investment
• Food satisfaction up, parking in transformational change
fines scrapped, bedside
TVs installed

11. Has Circle delivered at Hinchingbrooke?