What We Did - We have developed a programme of work with a focus on achieving savings in a clinically led, joined up, inclusive way that is being embedded into the DNA of the organisation to balance and complement patient experience and quality delivery. This is allowing us to move towards sustainability in an aligned, driven and transparent way.
Why We Did It - Incorporating clinical and executive leadership to deliver lasting change to the Trust’s relationship with money.
Most Significant Achievement - The programme has demonstrated a step change in Cost Improvement. For year 2017 savings forecast to be greater than £12m, compared to £8-10m per annum.
Challenges
* A Trust emerging from Special Measures in December 2015.
* The challenge of delivering sustainable, quality services for the future.
* Morecambe Bay - An expansive geographical footprint.
* Requirement to deliver £20m of operational efficiency savings in excess of the norm over three years 2016/17-2019/20
* Engagement of staff to contribute innovative ideas towards achieving Sustainability Programme objectives.
Actions
* Set up dedicated Clinical and Nursing supplies group with deliverables aligned to Carter procurement focus.
* Weekly Cost Control Board established providing tone, oversight, scrutiny, challenge & decision-making around tactical actions, and including clinical and executive leadership.
* Investment in Project Management Office to support Divisional Teams in their plans to develop and deliver savings.
* Long-term view - investment in initiatives such as Electronic Patient Records, pharmacy and PACS that have high ‘up-front’ investment but longer term payback in efficiency and effectiveness of care delivery.
* Co-ordinated Communications Strategy to support cultural change from Board to Ward and celebrating staff innovation around Sustainability Programme.
Results
Transformational Procurement:
* Established two key groups aimed at engaging clinical leaders in purchasing decisions - putting senior clinicians at the heart of decision making processes to effect operational change and release efficiency potential.
* Output from these groups include changes to operating times and practices in Ophthalmology Services allowing higher volumes through theatres and reducing outsource costs - £104k financial benefit via increased throughput and £150k alternative agency source.
* Pharmacy Stock - sold excess stock to Pharmacy Partner - financial benefit £240k. Further stock reductions with a Year End benefit of £220k.
* New Dementia Care Therapies introduced for patients at Royal Lancaster Infirmary led to reduction in security costs of £40k
Value
To date the programme has demonstrated a step change in Cost Improvement Programme delivery. The Trust is on target to deliver £12.5m of cost improvements, which is 4.3% of revenue and £6m more than the 2% ‘stand still’ requirement in tariff. Oversight includes tracking of the ‘balanced scorecard’ dashboard incorporating quality and experience metrics. This, alongside efficiency measures to ensure this has been achieved, has been delivered whilst maintaining focus on ‘triple aim’. The Trust is also in a more advanced position in developing plans for future years than it has ever been:
* The service review process is now owned by front-line staff which allows clear continuity in to next year.
* The enhanced PMO, is bringing increased rigor and clarity of direction with front-line ownership.
* Governance structures are firmly in place with regularity of action-focused, executive-led discussion of programme work through the CCB. This creates alignment with organisational timelines for annual plan submissions.
* External support has been provided from PwC and Blue Sky to apply learning from elsewhere in the NHS, apply best practice and be an independent ‘critical friend’ in support of making change happen.
In detail
Ambition
Over the past few years UHMBT has begun building afresh. Many things have contributed to the immense progress that has been made, including significant performance and quality improvements, investing in systems and processes from Board to Ward, ensuring leaders have the right values and qualities, greater partnership working and the development of a Bay-wide clinical strategy called Better Care Together (BCT). Through the BCT programme, and across the health economy footprint the Trust aims to deliver £20m of operational efficiency savings in excess of the norm over the three years 2016/17-2019/20.
Outcome
Alongside back office challenge and application, dedicated Clinical and Nursing supplies groups have been established to deliver initiatives aligned to Carter recommendations.
- Weekly Cost Control Board (CCB) meetings provide tone, oversight, scrutiny, challenge and decision making around tactical actions encompassing senior clinical and executive leadership maintaining a pace and consistency to implementation. The CCB also provides a ‘clearing house’ for best practice and alignment with Trust sub-committees and governance. CCB also supports levels of spending plans, break glass limits, timely decisions and focus on reducing underlying need and spend in a balanced and connected way.
- Service reviews focused on ‘triple aim’ of quality, patent experience and finances to develop sustainable and repeatable approaches to efficiency identification. This process is owned within Divisions with corporate support for analysis and delivery.
- On-going engagement with senior clinicians and management through leadership Congress on approach and behavioural change requirements.
- Investment in the Project Management Office (PMO) function to work across quality improvement and efficiency initiatives, applying best practice project support, action focus, and assurance through governance structures. In addition, the PMO is supporting the Divisional teams across the Bay in both their operational plans and delivery- standing ‘shoulder to shoulder’ in both inception, transparency and delivery of transactional savings.
- Taking a long-term view
- Investment in initiatives such as Electronic Patient Records (EPR), pharmacy and Picture Archiving and Communication System (PACS). These have high up-front investment costs, however, longer term, there is a return on investment through efficiency gains and effectiveness of care delivery.
- Discipline in divisional/service accountability to executive for execution of plans with support to turn around underperformance.
- Strong and robust governance structures from ‘front line’ to ‘Board’, with Non-Executive Director involvement as chair of Sustainability Programme Steering Board.
- Alignment of people and initiatives at organisational, wider health and care system and Sustainability and Transformational Programme (STP) levels.
- Co-ordinated communications strategy to effect cultural change from board to ward, ensuring consistency of messages and celebration of success throughout the organisation.
- Established culture of ‘learning’ combining Listening into Action, team development and management congress. In addition to clinical and nursing forums, these are all wrapped around the shared goal of sustainable services.
- Direct linkage to Sustainability and Transformational Programme as well as an Accountable Care System that ensures alignment to more integrated health and care services.
Spread
We have developed a programme that gives a clear focus on achieving savings in a clinically led, joined up, inclusive way. It is being embedded into the DNA of the organisation to balance and complement patient experience and quality delivery, as we move towards sustainability in an aligned, driven and transparent way. The Trust’s programme has incorporated clinical and executive leadership in order to deliver lasting and scalable change to the Trust’s relationship with money. Moving towards an Accountable Care Organisation and working closely alongside partners through our BCT programme, our sharing of work we are doing as part of the Sustainability Programme with our 11 partner agencies, will ensure that the Programme is replicable throughout the wider health and care system.
Value
To date the programme has demonstrated a step change in Cost Improvement Programme delivery. The Trust is on target to deliver £12.5m of cost improvements, which is 4.3% of revenue and £6m more than the 2% ‘stand still’ requirement in tariff. Oversight includes tracking of the ‘balanced scorecard’ dashboard incorporating quality and experience metrics. This, alongside efficiency measures to ensure this has been achieved, has been delivered whilst maintaining focus on ‘triple aim’. The Trust is also in a more advanced position in developing plans for future years than it has ever been:
* The service review process is now owned by front-line staff which allows clear continuity in to next year.
* The enhanced PMO, is bringing increased rigor and clarity of direction with front-line ownership.
* Governance structures are firmly in place with regularity of action-focused, executive-led discussion of programme work through the CCB. This creates alignment with organisational timelines for annual plan submissions.
* External support has been provided from PwC and Blue Sky to apply learning from elsewhere in the NHS, apply best practice and be an independent ‘critical friend’ in support of making change happen.
Involvement
-360 degree multi-stakeholder input and oversight included in senior leadership team/NHS Improvement and governance, with strong Non-Executive Director focus.
- Consultative and collaborative approach within the enabling mechanisms established and connected through board leadership supporting sustainability.
- Using heading of ‘Clinically Led, Efficiency Driven’ the use of filmed case studies, highlighting the innovative work done by staff to increase standards of quality and safety and, as a by-product, significantly reducing costs
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