Chief Nursing Officer for England’sSummit 2015

Creating Value Through Transforming Care

Peering into the future of NHS ProvidersDavid Dalton

The Challenge – better care @ lower cost

Succeeding in a competitive environment with less money

Safeguarding high quality services

with less money

Safer Care

Improving Health

Reducing Inequalities

Prevention

Improving Outcomes

Access

Creating Value

Supporting Staff

Dalton Review #DaltonReview2014

New Models and Shapes Emerging

Individual LocalityCity/County

Area

Region

TertiaryComplex Secondary

DGH/Secondary

Home Care

Single SharedServices (JV)

Merger

Intermed.Care

JV

AccountableCare

OrganisationsIntermediate Group/

Chain

Federated Back Offices

Dalton Review #DaltonReview2014

What is the Dalton Review about?• Variation in care is significant and its extent should not be tolerated

• Reliability is crucial – clinical and financial viability

• Successful systems and methods should be spread

• Encourage new entrepreneurial spirit

• Remove barriers + create incentives

Aims of the Dalton Review

System leaders understand their own populations and therefore need to be enabled to implement the best clinical models for their patients.

Successful organisations should determine evidence of best practice, develop a standard operating model and support staff to reliably implement and replicate this so that patients can benefit from reliable care pathways

• How will we know if this has worked?

How will we know if this has worked?So what might a typical general hospital look like in five years time?

Federated Back OfficeWith 10 other Providers Management

Contract, orOrganisational Chain?

Single Shared Surgical Service with 2 other Providers serving 1m population

Service Line Contract for Specialist Services with Specialist Providers

Integrated Care Models for Long term conditions

and Urgent Care

The Diagnosis

The variation in clinical practice and operations that exists today causes significant inefficiency

There are too many decision makers; too little shared information and not enough engagement of the front line

The prevailing leadership style ,and the culture it develops, inhibits achievement of reliability and excellence

Fragmented provider landscape prevents investment in new solutions as economies of scale are not realised;

Our SolutionA group that delivers ACO types of operating at locality level with a single service model for acute clinical care covering a 2m population

A standard operating model that provides digitised information from patient onwards; hardwires decision support systems into workflow and optimises capacity utilisation

Leadership and governance that will instil a culture to fully exploit opportunities provided by the standard operating model and SRFT’s QI capability

Back office and corporate functions operated at scale

Partner with global leaders to bring expertise, investment and leverage

New Integrated Care Organisation

THE PATIENT

Hospital

Community

Domiciliary

Primary Care

SocialServices

Mental Health

Identify, Stratify and EngageUsing digitisation as a care service

Analytics that enable proactively management of patients across the continuum of care

Overdue for healthcheck Type II diabetes

Early stage heart failure COPD

HCP dashboard and task list:Directing outreach into patients homes to prevent admissions

The Group’s Vision – Standardisation at ScaleOur bold vision is to establish a healthcare group that will deliver accelerated improvements in patient outcomes and productivity = Better care at lower cost

We will achieve this by:Building on the assets to develop a standard operating model that will:

Developing standardised care models, which are capable of replication into other localities of the Group, to include:

Use information repositories to remove unwarranted variation and address fragmentation of patient pathways, by:

• Standardising the patient pathways

• Standardising operational system and processes

• Developing a groundbreaking proof of concept that utilises standardised care pathways and predictive modelling to dynamically match resource deployment to demand

(including workforce & consumables)

• A vertically integrated health and social care service in each locality in the Group

• Single-shared clinical services across operating entities of the Group

• A single set of corporate services operating across the Group

Evidence Based Care StandardsAnd Digitised Workflow

InnovationMoving Knowledge into practice; systematically and reliably; hard-wiring evidence into clinical workflow; making the right thing to do, the

easy thing to do; embedding SOPs.

SRFT has reduced cardiac arrests, saving £700k p.a. on the rapid response team alone

SRFTs current performance on pressure ulcers is saving £637k p.a. on a base line of 2011/12.

Dynamic Matching of Resources to Demand New Zealand nurse staffing model

Enterprise-wide Capacity OptimisationPredictive demand modelling and dynamic resource allocation

Variation: We go looking for it

SCAPE Ward and Community StatusJanuary 2010 November 2014

SCAPE Wards & Areas 0 + 0 29 + 0

Green Wards & Areas 32 + 0 15 + 34

Amber Wards & Areas 15 + 0 2 + 2

Red Wards & Areas 1 + 0 0 + 0

Delivering Standardisation @ Scale- Leadership ModelLeaders at all levels are crucial in creating the culture which can deliver the change they wish to see. Effective leaders in a Group will demonstrate their leadership by:

Clarity of Purpose • Aims & Values• Standards Based• What, how much, when• Assess & Measure

Mindset• Reliability• Deep staff engagement• Openness & Transparency• Teamwork trumps hierarchy

Behaviours• Hear Patient voice & listen to Staff• Visibility and Authenticity

– Signal Generator• Defer to expertise• Encourage collective solutions • Build relationships• Challenge inappropriate behaviour