In this slideshow, Jo Cubbon Chief Executive, Somerset and Taunton NHS Foundation Trust and Andy McGrath, Chief Executive, Alamac Ltd share case studies and results from a project to improve and manage hospital performance. Jo Cubbon and Andy McGrath presented at How can hospitals do more with less? in October 2012.

1. Nuffield Trust & NHS Institute for Innovation Conference
Rapid Hospital Wide Performance Improvement
‘How can hospitals do more with less?
Implementing best practice for efficiency’
Jo Cubbon
Chief Executive, Somerset and Taunton NHS Foundation Trust
Peter Colclough
Chief Executive, Weston Area Healthcare NHS Trust
(and previously, Chief Executive, Royal Cornwall Hospitals NHS Trust)
Andy McGrath
Chief Executive, Alamac Ltd
NHS Performance Improvement Specialists

2. Rapid Hospital Wide Performance Improvement
What we would like to share with you today…
• Introductions
• Sharing case studies and results
• How the results were achieved (intro… performanceKITBAG ™ )
• Questions from the audience

3. Nuffield Trust & NHS Institute for Innovation Conference
Rapid Hospital Wide Performance Improvement
‘How can hospitals do more with less?
Implementing best practice for efficiency’
Peter Colclough
Chief Executive, Weston Area Healthcare NHS Trust
(and previously, Chief Executive, Royal Cornwall Hospitals NHS Trust)

4. Rapid Hospital Wide Performance Improvement
Royal Cornwall Hospitals NHS Trust & Weston Area Health NHS Trust
• History of finance and performance difficulty
• Historic debt
• Poor working relationships
• Difficulty sustaining improvement
• Reputation

5. Rapid Hospital Wide Performance Improvement
Royal Cornwall Hospitals NHS Trust & Weston Area Health NHS Trust
Performance Assurance Framework
• Introduced performanceKITBAG ™
– March 2011 (Royal Cornwall Hospitals NHS Trust)
– October 2011 (Weston Area Health NHS Trust
• Improved operational grip
• Improved performance

6. Rapid Hospital Wide Performance Improvement
Royal Cornwall Hospitals NHS Trust & Weston Area Health NHS Trust
• Prospective view of performance
• Framework tailored and locally agreed
• Combination of tools and coaching
• Skills transfer and capacity building

7. Rapid Hospital Wide Performance Improvement
Royal Cornwall Hospitals NHS Trust - Results
Indicators Threshold Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11
As per April recovery plan
RTT backlog 1434 1279 1335 1088 955 847 678 529
amended in August
As per April recovery plan
RTT overall performance amended in August - national 58.20% 62.60% 70.00% 80.50% 83.10% 90.20% 90.30% 90.10%
target remains 90%
RTT overall activity (admitted) As per recovery plan 2198 2520 2053 2503 2821 2669 2683 2484
RTT activity per working day 109.9 109.6 114.1 125.2 128.2 127.1 122.0 128.0
Theatre activity per working day 89.3 92.6 92.8 95.0 91.4 105.0 102.6 97.1
ED performance 95% 90.98% 93.95% 92.69% 97.43% 96.87% 97.94% 95.30% 96.40%
SHA average position (across basket
out of 17 acute providers 11.1 9.4 10.3 9.4 8.8 10.3 9.9 7.2
of indicators)
Workforce 4726 4705 4725 4687 4672 4662 4650
SIP delivery £600 £1,300 £2,200 £3,100 £4,500 £6,800

8. Nuffield Trust & NHS Institute for Innovation Conference
Rapid Hospital Wide Performance Improvement
‘How can hospitals do more with less?
Implementing best practice for efficiency’
Jo Cubbon
Chief Executive, Somerset and Taunton NHS Foundation Trust

9. Lessons learnt Musgrove Park Hospital
• Past performance is not a prediction of future success
• Know your numbers…and how they connect
• Separate the wheat from the chaff
– Selecting the right indicators
– One size doesn’t fit all
– Get ownership from teams
– Set stretching targets…the easy way is not necessarily the right way
• Brings teams together: one common purpose…
– to be ‘Green’ (‘Performing’) and avoid the need for a performance review

10. The next steps Musgrove Park Hospital
• Separate outcomes from process
• Focus effort at the right level of the organisation
– Directorate team Performance Assurance Framework (PAF)
– Getting clinician buy-in

11. Historic feedback Musgrove Park Hospital
“We have a very historical view of performance, so where something is
performing well you don’t know if it is going off in future” (Director)
“You can’t see individual trends so it can’t tell you which areas are failing,
it just tells you about the Division” (Performance Manager)
Performance Assurance Framework feedback
“It focusses the mind and we agree actions as part of the PAF process”
(Director)
“The PAF gives far greater visibility for Trust leaders to see where
performance is waning” (Divisional Director)
“The PAF has certainly added rigour and focus to performance
management” (Director)

12. Initial PAF Musgrove Park Hospital

13. Refined and tailored PAF Musgrove Park Hospital

14. PAF is a tool for improvement Musgrove Park Hospital
A real example of
an action log and
PAF measure
• The PAF increases visibility across a multitude of measures in all performance disciplines
• It is the one performance reference for Directorates and Divisions, ‘one currency’
• The Trust is currently in the process of rolling out a Directorate level PAF
• This will help operational teams manage the Hospital more effectively

15. Nuffield Trust & NHS Institute for Innovation Conference
Rapid Hospital Wide Performance Improvement
‘How can hospitals do more with less?
Implementing best practice for efficiency’
Andy McGrath
Chief Executive, Alamac Ltd
NHS Performance Improvement Specialists

16. Our 3 main points...
1. Tailored, Predict, Connected, Consistent, Relentless
2. Doing things differently by seeing things differently
3. ‘Front windscreen’

17. You will have read almost everything
there is to know…
…about performance improvement
and management…
…but sometimes we still do not get
the results we want...

18. The definition of insanity…
…is to do the same thing
over and over again
and expect the same result…!
Albert Einstein
So we must do some different things...

19. But we all know the pressures
we face in the real world...

20. …and we have a complex day job to do...

21. …and not forgetting the daily miracles
our teams perform...

22. …so we need to use what we already know...
Here is Edward Bear, coming
“… Here is Edward Bear, coming
downstairs… bump, bump,
downstairs now, bump, bump,
bump…
bump, on the back of his head,
It behindfar as he knows the
is as Christopher Robin. It is,
as only he knows, the only way
far as way of coming
of coming downstairs, but
downstairs…
sometimes
But sometimes he feels another
he feels that there really is there
way, if only he could stop bumping
really must be a better way…
for a moment and think of it .… “
…but apply it in a If only he could stop for a
different way…! moment to think of it…!

23. So how do we do this...?
performanceKITBAG ™
Patient Safety &
Operations
Quality
Finance Workforce

24. But the performanceKITBAG ™
is not rocket science...
...we use your data...
…turn it into information...
& show your teams how to use it

25. … in a relentless way…!

26. The performanceKITBAG ™ has 3 areas of focus...
Performance…
Management Improvement
Culture

27. The main ethos behind the
performanceKITBAG ™ approach is...
Know your business...
Measure... Do... Measure...
Gain control...
Predict and anticipate performance...
Better, quicker decisions...
Establish stability and assurance...
‘Stickier’ efficiency / cost improvement...
Reduce waste, better patient care...

28. This all helps us manage the ‘business’ of
health through the ‘front windscreen’...

29. And most importantly the performanceKITBAG ™
creates a performance culture...

30. Own up to what is not working
to develop a ‘cross hospital’ team...

31. Do what you say you will do...
What we think, or what we know,
or what we believe…
is in the end of little
consequence…
John Ruskin
(1819 - 1900) it is what we do that counts
Poet

32. Action = Benefit...
E=MC2
Albert Einstein

33. Set small incremental goals to ensure we
are always improving...

34. Be positive, be brave...

35. ...be innovative and fail fast (!)...

36. But, we will always have bad days...

37. Balance ‘challenge’ with ‘motivation’...
Encumbered by low self-image,
Bob takes a job as a speed bump... !

38. Through support and
encouragement...

39. …To ensure our people can be the
‘best’ they can be...

40. To ultimately
create a
freedom to
perform...

41. Our 3 main points...
1. Tailored, Predict, Connected, Consistent, Relentless
2. Doing things differently by seeing things differently
3. ‘Front windscreen’

42. Many thanks
& Q’s...?