1

Transforming Care for the Future 2016-2017 Quarter 2 Progress Report

Vanessa Gardener, Director of Transformation

September 2016

1. Overview and transformation objectives

2. Review of quarter 2

3. Divisional Updates

4. Our priorities 16/17

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Contents

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Contents Overview Review of

Quarter 2

Our Priorities

2016/17

Divisional

Updates

Overview The Transformation Strategy was approved by the Trust Board in September 2014 and a 3 year plan produced. Year 2 2016/17 Plan and

Commitments was approved in May 2016 setting out how we will organise and deliver our transformation programme and management

capability, in the context of delivering “Transforming Care for the Future”.

The aim of our transformation strategy is to ensure we go from ‘Good’ to ‘Great’ by reaching top decile for quality in 3 years.

The Transforming Care for the Future Programme objectives for the next 2 years are:

Culture for change Create the culture to deliver the change through embedding values and

behaviours and distributed leadership

Build Capability Clear methodology and build skills to deliver transformational change and

continuous improvement

Delivery through CMFT

standards

Transform outpatients, maximise elective activity and optimise the non

elective pathway contributing circa £15m efficiency savings

Governance Implement a PMO to ensure that the ideas of clinical leaders and their

teams are delivered and ensure linkages with other external major

transformational work

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Review of Quarter 2 – Delivery against commitments

Contents Overview Review of

Quarter 2

Our Priorities

2016/17

Divisional

Updates

Workstream Commitment Progress

Culture

change &

Capability

Building

• Agree roll out plans for skills assessment

• Transform Together event

• Leadership conference with OD

• A&C conference with HR

Skills assessment rolled out to staff who are going on change courses

Transform Together took place on 9 July 2016, winner was Professor Body with Pathway to Accelerate Chest

Pain decision making

Agreement to replace the idea of a leadership conference with using NHS Change Day on 19 October to combine

Transform Together shared learning with staff taking collective action to change by committing pledges

Questions regarding change have formed part of the Q1 pulse check

Successful A&C conference took place on 4 July 2016

Outpatients • Implement findings from the text reminder exercise

• Design new patient letter template and amendment process with

Applications

• Outpatient standard re-assessment

Text reminder contract reviewed and renegotiated with plans to roll out everywhere during Q3 as part of an

Outpatient Turnaround project

New letter template co-designed with patients and staff and pilot undertaken in neurophysiology. Patient

information booklet designed and informatics reviewing solutions to implement the templated letter

CMFT Outpatient Standards data collection tool has been reviewed and updated, reassessment to be undertaken

in Q3

Elective • Full implementation of surgical pre-op process / model in

Division of Surgery

• Implement phase 1 and 2 of the Surgery bed reconfiguration

plan

• Evaluate progress against general surgical service reviews

• Work with Eye and Dental to become exemplar sites

• RMCH Rapid Improvement Event (RIE)

Proof of concept tested in urology, roll out plan in place for implementing across the Division through out Q3 and

Q4

Phase 1 and 2 of surgery bed reconfiguration plan implemented, urology relocated to ETC short stay and ward 14

closed

General surgery plan updated to focus on scheduling and optimising theatre time

Work ongoing to implement changes to deliver against all the elective standards in eye and dental

Rapid improvement conducted over 2 weeks w/c 27 June 2016

Non-Elective • Agree an approach for managing patients in sick frail category

with complex discharge services

• Support CSS in reduction of diagnostic waits

• Full implementation of bronze dashboards and wall of analytics

with Informatics

• Evaluate Heading Home

Complete

The Performance Team have worked with the Divisions to reduce diagnostic waits in line with the trajectory

x Not implemented due to re-prioritisation of Informatics work programme

Evaluation completed and roll out plan for the MRI agreed

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5

July September August

• RMCH ENT rapid improvement 2 weeks

• Transform Together shared learning

• New surgical pre-op pathway piloted in

General Surgery & Urology

• NHSi Faculty of Improvement Launched

• Theatre scheduling tool introduced in

Surgery

• Outpatient ‘back to basics’ project

launched in partnership with Informatics

• WAVE project management tool

introduced

• Supported SHINE celebration day and

AGM

• Hosted 5th Shelford Transformation

Network at CMFT

• Medical model and management of outliers

workshop

• Planning for NHS change day

• Healthier together workshop between

surgeons and anaesthetists

• Review of CathLab undertaken

• Development of single ideas portal for

transformation, innovation, turnaround and

change one thing ideas

• Pilot of heading home discharge bundle on

AM1

• New performance framework for complex

discharges and standardised approach to

LoS monitoring implemented across MRI

• Outpatient Communication workshop held

to develop set of standard for new

outpatient letter template

Contents Overview Review of

Quarter 2 Our Priorities

2016/17

Divisional

Updates

Flow across the MRI – medical models workshop A&E Conference 4 July 2016 AGM 27 September 2016

2016/17

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Outpatients

Elective

Non-Elective

7 Day

Services

It is really important that we create and sustain the

conditions for our staff to change and innovate.

We were 1 of 3 Trusts taking part of the NHS

Improvement cultural pilot testing 6 practical tools out

across CMFT, including a culture and outcomes

dashboard, board interviews, leadership behaviours

survey, focus groups, leadership workforce analysis,

patient experience. Next steps are to use the data to

refresh and inform our leadership strategy. UHSM and

PAT are also now taking part.

A deep dive project has commenced into results for REH

to ascertain the conditions and drivers for high

performance; which can be translated into other Divisions.

We now have 11 projects supported by charitable funds

to improve care for our projects and progress is being

reported to the Charitable Funds Committee.

The Transformation/OD teams undertook 9 events in Q2

engaging with over 412 staff:

⁄ A&C Launch Conference – 197 staff

⁄ Transform Together Shared Learning – 50 staff

⁄ Outpatient Letter Workshop – 13 Staff

⁄ Heading Home Engagement Session – 32 staff

⁄ Healthier Together Workshop with Surgery– 10

⁄ Annual Members Meetings – 50

⁄ Medical Outlier Follow-up Workshop – 10

⁄ Change Activist Training – 25

⁄ Newly Appointed Consultants Induction - 25

To date over 2062 staff have been part of workshops,

learning events and engagement sessions. A mentoring

scheme is in place for staff involved in change projects.

Creating the Culture for Change Creating Culture

for Change

Building

Capability

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

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Outpatients

Elective

Non-Elective

7 Day

Services

It is not only key to engage staff, we need to develop our

staff and ensure they are equipped with the right skills to

continually improve the quality of services.

We have invested in leadership programmes and each

participant is required to undertake a change project and

demonstrate learning into practice.

300 staff have taken part in leadership programmes,

which has generated over 100 projects across the Trust.

These projects have been aligned with the transformation

strategy and are presented at Transform Together Shared

Learning events every quarter. The winner of the last

event was Professor a Body for his work on developing a

Manchester chest pain algorithm to identify and treat

cardiac patients more rapidly.

We have partnered with AQuA and now offer 3 different

change courses to support continuous improvements:

⁄ Quality improvement basics – 1 day awareness of

change for all staff – 35 staff attended, extra courses

being arranged

⁄ Introduction to improvement – 3 days for staff

involved in change – 30 staff attended

⁄ Improvement practitioner – 3 core and 2 optional

days for staff leading change – 19 staff participating

OD have developed an online tool/library and are

working to provide a project management online tool to

support the turnaround process.

Building Capability for Continuous Improvement Creating

Culture for

Change

Building

Capability

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

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Outpatients

Elective

Non-Elective

7 Day

Services

Creating

Culture for

Change

Building

Capability

Progress on Setting the CMFT Outpatient Standards

The CMFT outpatient standards were ratified in

March 2015 following consultation with staff,

patients and Governors. The 12 standards cover

areas important to our patients including

communication of waiting times, cleanliness of

areas, information given prior to and after clinic,

friendly welcoming at reception areas.

Divisions carried out a baseline assessment and

presented their results and improvement plans to a

panel in June 2015. In January 2016 each Division

undertook a reassessment against the outpatient

standards and presented in February to a panel the

improvements. Since then the Divisions have

presented back to the Clinical Effectiveness

Committee in June 2016.

The transformation team are continuing to work

with REH and therapies to become Exemplar Sites.

Divisions are continuing to implement their

improvement plans and will repeat their self

assessment in Autumn 2016 in order to

demonstrate continual improvement. Next year this

will be replaced by the outpatient accreditation

process.

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

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Outpatients

Elective

Non-Elective

7 Day

Services

Creating

Culture for

Change

Building

Capability

Progress on Setting the CMFT Outpatient Standards

As well as the Divisional improvement plans, there were 6

cross cutting themes that corporate teams have been working

on together to improve experience.

Progress has been presented to Governors in August:

⁄ Values based recruitment for outpatient staff

⁄ Admin and clerical guides and directory of staff

⁄ Mentoring for new A&C starters

⁄ New Appointment letter developed with accessibility

statement

⁄ New template in use at pilot site area,

Neurophysiology department

⁄ Informatics reviewing current printing arrangements

to enable new design

⁄ Control and escalation process to keep letter

template up to date

⁄ Standard Operating Policy in place and being used

⁄ Bookwise in place in REH, RMCH and MRI

⁄ Outpatient dashboard developed and on central

Intelligence to track performance.

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

10

Outpatients

Elective

Non-Elective

7 Day

Services

Creating

Culture for

Change

Building

Capability

Progress on Maximising Elective Activity

The aim of this work stream is to optimise theatre lists

through implementing the CMFT elective standards.

Overall the number of cases going through theatres is

beginning to increase across the Trust.

Progress to date in surgery:

⁄ Cancelled operations reduced by 20%

⁄ Elective length of stay reduced from 4.3 to 4 days overall

⁄ Surgery elective LoS has reduced from 5.4 to 4.1 days

⁄ LoS reduction and excellent CPE management allowed

for ward 14 to close

⁄ Opening of additional 7 daycase beds in surgery

⁄ Opening of Elective Surgical Critical Care Unit (4 HDU

beds protected for surgery)

⁄ £3.1m delivered against financial plans

Focus is on optimising theatre lists to recover activity in surgery:

⁄ improved scheduling from September (daycase on start

of each list).

⁄ Focus on the transplant programme

⁄ Review of waiting list demand by procedure to

redistribute theatre time eg vascular session to general

surgery

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

The transformation team continues to provide support

to Surgery and RMCH to assist in improved scheduling

and performance management using Foureyes

dashboard.

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Our Priorities

2016/17 Divisional

Updates

Our Year Ahead

Outpatients

Elective

Non-Elective

7 Day

Services

Our Priorities

2016/17

Divisional

Updates

Creating

Culture for

Change

Building

Capability

Progress on Maximising Elective Activity

For two weeks in July the transformation team ran a rapid

improvement initiative in RMCH with the managers and

clinical teams in ENT and theatres. Key changes during the

two weeks were:

⁄ Earlier start time of 8.30am

⁄ Theatre waiting area staffed

⁄ Run through for the 2 or 3 session days – more cases

through existing lists

⁄ Use of theatre Scheduling tool

⁄ Identifying and preparing golden patients – first on list

Results for ENT were:

⁄ Lists lock down

⁄ Use of theatre waiting area

⁄ Improvement in start time

⁄ Increased communication

⁄ WHO checklist performed earlier

⁄ Theatre prepped in advance

⁄ New admissions process implemented

“Exceptional team today :

- All trays prepared for surgery ahead of time

- Friendly, motivational environment”

“2 patients brought to

waiting area @ 08.50. Both

patients and families happy

in the play area

“Good team interaction. Good

communication from ward to team in

theatre”

Next steps are:

⁄ Agree roll-out plan to all other paediatric surgical

specialties

⁄ FourEyes continued support with

⁄ Designer lists in spinal surgery

⁄ Super listing in Paediatric Surgery and Urology

⁄ Paediatric surgery timetabling

⁄ Development of specialty implementation plans to move

from 3.5 – 4hr sessions

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

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Outpatients

Elective

Non-Elective

7 Day

Services

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

Creating

Culture for

Change

Building

Capability

Progress on Optimising the Non Elective Pathway

During Q2 constant focus remained on improving flow to

meet increased demand and support delivery of the

elective programme.

Progress includes:

⁄ Non elective length of stay reduced from 4.5 to

4.2 days overall

⁄ Daily senior ward rounds / afternoon wrap up

round (for sick general / sick specialty patients)

⁄ Increased use of Discharge Lounge

⁄ Continued focus on complex discharge meetings

- new performance framework around 100+ day

patients is having positive effect

⁄ Ambulatory Care: capacity planning for now and

the future

⁄ Pilot of “heading home” campaign on AM1

Focus remains on:

⁄ Implementing Urgent Care centre (Nurse led

Service) at Trafford General Hospital with effect

from 3rd October

⁄ Roll out of the “heading home” discharge bundle

across the MRI & Trafford Hospitals

⁄ New escalation procedures with Manchester

council and social care providers agreed on 21st

September

⁄ Implementation of MFFD Ward, from December

2016

⁄ We are part of the NHS Improvement Programme

on A&E

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Outpatients

Elective

Non-Elective

7 Day Services

Creating

Culture for

Change

Building

Capability

Supporting 7 Day Services

The Trust remains an ‘Early Deliverer’ of 7 Day Services by NHSI (along with

UHSM, Pennine Acute, Macclesfield, Lancaster and Preston). The aim for Early

Deliverers is that 25% of the local population will have access to 7 day services

as per the 4 key priority standards by 2017 for Urgent and Emergency Care.

Divisions continue to focus on the themes where we have gaps in service as

outlined below. CMFT is taking part in the second national 7 day services audit

during September 2016. The key areas that remain a focus are:

⁄ Radiology Capacity – particularly for MRI

⁄ Emergency theatre/endoscopy suite availability

⁄ AHP shortfall: physiotherapy, occupational therapy, dietetics

⁄ Recruitment issues e.g. Endoscopy staff, care of elderly consultants

The Steering and Implementation Groups are focusing on tracking progress to

implementing changes to meet the priority standards.

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

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Divisional Progress

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates

DIVISION Outpatients Elective Non-Elective

DMAC

Plans in progress for introduction of text reminders across the Division

expected to be implemented by October 16.

Ambulatory Care Unit operational and embedded - SOP

finalised

9 Ambulatory Care Clinical Pathways developed

Heading Home pilot completed on AM1

Complex Discharge – Roles & Responsibilities, SLAs and

LOS meeting TORs approved and revised operating

procedures implemented

Revised Patient Choice/Reluctant Leavers letters

approved Divisionally and submitted for Corporate

approval

EGRESS training delivered to key ward staff to support

revised complex discharge procedures

Complex Discharge dashboard developed

SMS

Paperless renal clinics to go live on 17-10-16

Secure of charities money for integration of diabetes/endocrinology

Integration and TUPE transfer of Tameside/Stockport and Trafford Sexual

Health Services – 16th Sept.

Divisional process for clinic attendance & disposal monitoring

Review of divisional multi-professional clinics and outpatient procedures to

ensure accurate coding in place.

Monitoring process implemented of uncoded specialist outpatient

diagnostics in place.

Process implemented for RTT open pathway tracking from clinic outcomes.

Implementation of divisional clinic utilisation report to monitor outpatient

capacity

Review of outpatient booking processes across division for patient

choice/partial booking linking with patient access policy & reasonable notice

criteria to reduce DNA rate & cost efficiency

Reconfiguration of beds with 4 additional beds on HDU and

8 beds on ward 14 to support catheter lab productivity/HDU

Business case for Renal interventional consultant post

completed, to increase day case biopsy procedures/fistula

rates.

Cath Lab review undertaken with support from

Transformation & FourEyes

Significant improvements in LoS for Renal due to daily board

rounds lead by Directorate Manager

Weekly monitoring of pre-admission outcomes on PAS to

ensure all elective activity is captured

Weekly divisional cancelled ops KPI implemented to monitor

cancelled on the day patients

Continue ‘team MRI’ work programme

Daily clinic introduced in ward areas to support the

ambulatory care model.

Home/Shared care dialysis

Communication sessions daily with Consultants on renal

wards for patients/family

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Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview

Review of

Quarter 2

Our Priorities

2016/17

Divisional

Updates

DIVISION Outpatients Elective Non-Elective

SURGERY

Outpatient prescribing data collected and changes in place.

Reduction across most areas in regard to FP10 prescribing.

Project now in monitoring phase.

Provision of clinic information to Bookwise underway, to

allow population of clinical activity.

Roadshows with pharmacy input to assist clinicians with

alternative prescribing options carried out.

New SoP implemented for cashing up/outcoming and Trust

form used. Significant improvement in outcoming and

associated income. Updated form to go live in Oct with

outpatient procedures also captured to further improve the

process.

Completion of staff engagement sessions to share vision

and standards within MRI.

All level 3 ERAS+ pathways defined.

COTW pilot rolled out and formal audit presentation at Oct ACE day by

Urology. Most specialties now have a form of COTW and further

enhancements to be rolled out post the ACE day presentation.

Roll-out of new ward configuration completed

Theatre scheduling tool implemented in two pilot specialties and now

being rolled out across all areas.

6-4-2 model introduced and new weekly monitoring meeting in place.

Planning work underway to move from 3.5 hour to 4 hour theatres

sessions.

W14 successfully closed and staff allocated to key areas to help with

flow. New SAL/DC coordinator in place to ‘trouble-shoot’ daily issues

and improve flow.

Pre-operative assessment model piloted in General Surgery & Urology.

Plans are now in progress to roll-out out to all specialties.

Daily 8am brief and 4pm de-brief implemented in theatres

Abscess pathway complete and ready to roll out once ICE

updates complete (this has been a delay for a few weeks

now).

NSAP same as above.

Additional emergency capacity at weekend implemented.

Project started to look at emergency theatre utilisation with

MDT input.

Hot clinic transferred to ACU

Implemented new performance framework across Surgery

& Trafford sites for monitoring LoS and escalation of

complex discharge issues.

TRAFFORD

Implementation of enhanced anaesthetic pre-assessment clinics in

progress.

Implementation of escort role to reduce inter-case delays in progress.

EYE

Successful introduction of KanBan system in Macular clinic

and plans to roll-out

Four Eyes theatre dashboard and scheduling tool trialled.

Theo installed for use by admissions team. Training completed.

Revised scheduling protocol shared with clinical staff.

Divisional Progress

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Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview

Review of

Quarter 2

Our Priorities

2016/17

Divisional

Updates

DIVISION Outpatients Elective Non-Elective

SMH

Partial book SOP developed for gynaecology.

Final sign off due before trial commences.

Roll out of appointment reminder service

progressing in Obstetrics.

Band 7 team leader for admissions lounge and pre-op has been appointed.

Due to start in December.

⁄ Process for accessing emergency theatre for urgent

gynaecology cases has been clarified with MRI.

⁄ New electronic system implemented in Obstetric triage to

capture and follow up calls to the unit.

RMCH

Implemented new processes in two CSUs, full roll

out of these practices to all CSU teams who use

OPD.

Implementation of business rule to accurately

code all multi-professional activity.

Started outpatient review to highlight

differences in processes and procedures.

Implementation of improvement project actions has started.

Started to implement effective use of 6:4:2 process ⁄ Appointment of Band 7 lead for non-elective care to

ensure continuity.

⁄ Process to be adopted to ensure any child waiting over 24

hours for access to CEPOD list is highlighted

⁄ Review of burns area to try to accommodate urgent

plastic cases.

Divisional Progress

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Priorities for 2016/17

Our priorities for 2016/17 are summarised below and are published in detail in the 16/17 Business Plan. The priorities going

forward align to the Turnaround plans and process to ensure that the impact on quality of care is measured alongside the

financial impact.

Outpatients Elective Non-Elective

Culture Change

&

Capability Building

Q3

• Implement quick wins for outpatient turnaround across

all outpatients areas:

• Clinic templates

• Clinic codes

• Text reminders

• Printing and sending letters

• Letter templates

• Consultant master file index

• Clinic outcomes and cashing up

• MREH EBD – evaluate successes

• Roll out text reminder to all areas

• Implement new processes to track and monitor,

cases, case mix and theatre optimisation on a

weekly basis to ensure delivery of plans in

surgery, RMCH and cath labs

• Cath Lab Perfect Week

• Develop super listing in paediatric urology

• Review bespoke lists for paediatric spines

• Develop plans to move from 3.5 hour to 4 hour

operating

• Work with the nursing team to roll out theatre

accreditation

• Specialty implementation plans for

the new outliers process

• Roll out Heading Home process

across the MRI

• Q3 progress report against the

MRI/TGH Urgent Care strategy

• Pilot Capacity Utilisation Review

system on 3 wards and assess how it

measures the SAFER standards

• Implementation and roll-out of

Clinical Frailty Scale Screening tool

• Host the Shelford network

meeting

• Transform Together celebration

event

• Atrium road shows

Q4

• Embed the quick win changes implemented in Q3 and

track impact

• Roll out Outpatient accreditation – standards to

become BAU (with quality service improvement)

• OP standard self-assessment (final)

• Evaluate impact of new pre-op assessment

model and ERAS+

• Shared learning event

• Implement new model for non acute

patients

• Q4 progress report against the

MRI/TGH Urgent Care strategy

• Develop 17/18 Capacity Plan

• Publish 16/17 case studies

• Transform Together event

Throughout

2016/17 we

will have

• Worked with MREH and AHPs to become exemplar

sites for the standards

• Received Divisions Bi-annual self-assessment

results

• Worked with the nursing team to implement the

Outpatient accreditation scheme

• Improved patient experience, reduced DNAs and

complaints

• Theatre Utilisation at 84% by Oct 2016 and

89% by March 2017 through embedding

CMFT elective standards

• Achieved LoS of 3.7

• Delivered year 2 of the

MRI/Trafford Urgent Care Strategy

• Agreed a rehabilitation strategy

• Achieved LoS target of 4.4

• Improved staff engagement

score

• Demonstrated positive changes

on cultural survey

• Carried out quarterly Transform

Together events

Our Priorities

2016/17 Divisional

Updates

Our Year Ahead Contents Overview Review of

Quarter 2

Our Priorities

2016/17 Divisional

Updates