Operational Strategy Hospital by iip15531

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									          The NBT ‘Big 5’ - 2010/11

1. Improve patient experience and safety
a) Complete the current Safer Patients’ Initiative (SPI) and then expand
coverage of the processes and methodologies to ensure they become part of
everyday practice, including the setting of clear clinical standards which are
achieved through such processes
b) Continue to reduce hospital acquired infections
c) Implement and use information and technology systems to improve the
patient experience
d) Redesign services to ensure highest quality and value to patients
e) Reduce over-reliance on temporary staff to ensure continuity of care and
service provision

2. Progress significantly towards no waits/no
delays
a) Reduce patient waiting times for emergency services
b) Reduce patient waiting times for elective services
c) Reduce patient waiting times for cancer services
d) Redesign services and ways of working to reduce patients’ waits and delays
at all stages of their diagnostic and treatment pathway

3. Prepare for the opening of the new hospital
at Southmead
a) Complete site-work/liaise with Carillion to ensure the new hospital is
constructed to timetable
b) Develop the clinical strategy/operational policy for the new hospital-the
‘Building for the Future’ blueprint
c) Establish the ‘Building for the Future’ programme and begin the
implementation of change projects
d) Play a leading and influential role in pan- Bristol Health services planning
e) Make progress on a number of key service developments
4. Be a great place to work
a) Improve staff survey results by doubling those in the Top 20% of all NHS
organisations, and halving those in the bottom 20% - as a stepping stone
towards to becoming one of the 5 best places to work in NHS South West
b) Ensure that staff in every directorate are aware of and engaged with the
‘Building our Future’ programme
c) Good practice in equality and diversity to be given a higher priority across
NBT
d) Reduce sickness absence to 3.8% across the Trust
e) Ensure the Trust and its staff are meeting obligations under the NHS
Constitution
f) All NBT Staff to receive a 1-1 appraisal with their line manager and to keep
Mandatory Training ‘Staff Passports’ up-to-date
g) Promote staff achievements and successes throughout the year

5. Build a strong, viable organisation
a) Take forward service strategies to achieve our vision to become a leading
provider of healthcare
b) Improve the NBT ‘brand’ & reputation
c) Build the Trust’s research & development capability & capacity
d) Improve performance & productivity in all areas
e) ‘Bust’ bureaucracy to ensure staff have more time to do the things that
matter
f) Improve the creation, supply and usefulness of information needed to work
more effectively
g) Ensure that we remain a financially secure organisation
h) Be an environmentally responsible and sustainable organisation
i) Improve the way that the purchasing and use of supplies is managed
j) Improve Trust Board performance
k) Preparation for application for Foundation Trust status
        The Big 5 – Sub-Objectives 2010/11

1. Improve patient experience and safety
a) Complete the current Safer Patients’ Initiative (SPI) and then expand coverage of the
processes and methodologies to ensure they become part of everyday practice,
including the setting of clear clinical standards which are achieved through such
processes

   1. NBT to have SPI safety programme rolled out to all clinical areas and reporting on all
      SPI measures on a monthly basis by Apr 2011. This will include new work around
      reducing pressure ulcers and piloting the prevention of acute kidney injury
   2. In line with SPI work measures will inform the CQUIN and Quality account indicators
      providing a regular monitoring and reporting process. Patient experience reporting
      will be introduced by:
            Regular reports on complaint numbers, themes and learning
            Triangulation of complaints, incident, litigation and GTT themes
            E surveying for each clinical area (to supplement yearly national in-patient
                survey)
   3. Reorganise clinical governance structures and processes to incorporate clinical
      service improvement, patient safety and patient experience issues in addition to
      regulatory assurance. The Quality committee will oversee the effective delivery of
      current and future quality initiatives reporting to the Governance and risk
      management committee
   4. Ensure that effective treatment pathways are the norm and NICE compliance is
      assured.
   5. Develop a co-ordinated approach to the safeguarding agenda to incorporate
      safeguarding adults and children, domestic violence agenda and safeguarding other
      vulnerable groups e.g. learning disability

b) Continue to reduce hospital acquired infections

   6.   Reduce C Diff rate to127 in 2010/11.
   7.   Reduce MRSA cases to 8 hospital acquired bacteraemia in 2010/11
   8.   Ensure decontamination processes meet all required standards.
   9.   Ensure good practices in domestic services to support infection reductions

c) Implement and use information and technology systems to improve the patient
experience

   10. Implement Cerner Millennium Phase 1 – The first part of our electronic patient record.
       Scrutinise all clinical practice areas for appropriate changes that can be improved by
       use of Cerner Millennium and drive requisite change programmes.
   11. Optimise the support of information systems and reporting to support areas such as
       SPI spread, monitoring quality and operational standards and pathway management
       (e.g.: map of medicine).
   12. Roll-out the value added elements of the telecommunications transformation –
       including video conferencing, audio services, speak your name dialling, etc – to
       enhance staff working and patient experience.
   13. Scrutinise all clinical practice areas for appropriate changes that can be improved by
       use of Cerner Millennium and drive requisite change programmes.
   14. Develop the health and social care record – “Connecting Care” project – across the
       community, working with partners – aiming to switch on in 2011 for 2012 go live, and
       move the CCHP service to a position where it can go “electronic” with children‟s
       records from 2011.
d) Redesign services to ensure highest quality and value to patients

   15. Each directorate to develop a plan for streamlining pathways and ways of working
       aimed at adding value to the patient‟s experience.
   16. Achieve redesign of two pathways per directorate, using lean principles and bearing
       in mind the need to add value to patient experience.
   17. Achieve year on year improvement against national patient survey metrics.
   18. Introduce greater and more varied patient surveys, with faster if not instant, turn
       around times on results, supporting patient experience and CQUINs achievement.
   19. Ensure all major service redesign projects include patient input and an equality
       impact assessment.
   20. Stop cancelling patients on the day of surgery.
   21. Ensure appropriate budget and planning for under £5K replacement equipment items
       in frontline clinical areas.
   22. Implement the Liverpool Care of the Dying pathway across all relevant clinical areas,
       and the South West end of life care system to support the patients choice of where to
       die.
   23. Contribute to the public health agenda by improving health outcomes relating to
       measures of smoking, obesity, alcohol and other substance misuse, and physical
       activity.
   24. Continue to audit and improve fundamental aspects of care by defining and
       publishing the standards of nursing care that reflect the CNO high impact changes,
       “essence of care” benchmarks and the RCN standards of care.
   25. Systematically embed PW full programme in all wards with aim to increase direct
       nursing care from 40% to over 60%

e) Reduce over-reliance on temporary staff to ensure continuity of care and service
provision

   26. Review budgeted staffing establishments in line with:
            National Benchmark audit results
            Move to graduate workforce
            Implement e-rostering across the Trust, initially focussing on nursing and ahp
               staffing but with the scalability for all rostered groups in future years.
            Roll out of Productive Ward project
   27. Monitor and minimise bank usage in clinical and non-clinical areas
   28. Review and optimise the role of admin and clerical staff
   29. Eliminate agency usage across clinical and non-clinical areas
2. Progress significantly towards no waits/no
delays
a) Reduce patient waiting times for emergency services

   1. 98% of all Emergency Department patients to be seen, treated and discharged within
                                                           st
      4 hours, progressing to 3 and a half hours from the 1 June 2010
   2. All patients attending the Emergency Department to receive a full clinical assessment
      by a doctor or Emergency Nurse Practitioner within 30 minutes of arrival.
   3. Emergency Department to establish an interim target for 2 hour initiation of treatment,
      with progression to 95% by March 2011.
   4. Handover ambulance times <15 minutes to Emergency Department

b) Reduce patient waiting times for elective services
               st
   5. From 1 April 2010 100% of all admitted and non-admitted patients referred to the
      Trust, by speciality, will be treated within 18 weeks, with the exception of pre-agreed
      complex clinical pathways and patient choice.

c) Reduce patient waiting times for cancer services

   6. Meet all access targets within the Cancer Reform Strategy within the stated
      timescales, and set appropriate stretch targets.

d) Redesign services and ways of working to reduce patients’ waits and delays at all
stages of their diagnostic and treatment pathway

   7. Redesign services to sustain 18 week delivery, in every speciality.
   8. Identify hidden delays which are not currently subject to national or local targets and
       set baseline standards for 2010/2011
   9. Review all operational systems and processes to ensure that they support and enable
       the service improvement plan. Clear stages to 2013 to be set out.
   10. Ensure that the simple surgery pathway is implemented effectively, ensuring that
       structures, process and people are in place to deliver the service to a high standard.
   11. Implement routine and “central” pre-op assessment processes.
   12. Ensure preoperative assessment and same day admission is the norm.
   13. Clinical Directorates to continue to align activity following the transfer of activity to the
       UKSH independent sector treatment centre.
   14. Capacity plans to address potential impact of independent sector treatment centres
       and other alternative providers.
   15. Reduce length of stay in accordance with the operational plan through focus on
       eliminating unnecessary waits and efficient discharge processes.
   16. Continue to embed „Hospital at Night‟ as a team approach to care out-of-hours.
   17. Focus on discharge processes and reduce long stay tail of length of stay.
   18. Provide trauma surgery within NICE timescales.
3. Prepare for the opening of the new hospital
at Southmead
a) Complete site-work/liaise with Carillion to ensure the new hospital is constructed to
timetable

    1.    Complete residual design work
    2.    Complete year1 reviewable design and maintain exemplary quality of design.
    3.    Complete room elevations and ensure optimum clinical efficiency
    4.    Avoid major variation.
    5.    Maintain clear and effective communication and engagement
    6.    Develop comprehensive communication plan.
    7.    Reach high level of staff engagement and knowledge of service plans.
    8.    Ensure patients, public and other stakeholders are kept informed of progress.
    9.    Complete 10/11 enabling projects
    10.   Commence construction of cellular pathology building.
    11.   Complete design stage C for Learning and Research building.
    12.   Complete design stage C for corporate office building.
    13.   Clear utilities from PFI site.
    14.   Clear other buildings from development site.
    15.   Clear utilities from construction site
    16.   Develop a detailed Estate Strategy for the retained estate, identifying target
          standards of accommodation, lifecycle costs and investment requirements

b) Develop the clinical strategy/operational policy for the new hospital-the ‘Building for
the Future’ blueprint

    17. Secure agreement of Trust vision and organisational strategy.
    18. Review and update clinical strategy
    19. Develop operational policy for new hospital
    20. Achieve sign-up to the strategy, clinical strategy and operational policy across the
        organisation.
    21. Construct clear and coherent organisation development, workforce, finance and IM&T
        frameworks to support the operational policy.

c) Establish the ‘Building for the Future’ programme and begin the implementation of
change projects

    22.   Agree structure and method for programme
    23.   Implement structure for delivering change
    24.   Launch range of projects
    25.   Develop organisational competence in redesign and improvement methodologies.

d) Play a leading and influential role in pan- Bristol Health services planning

    26. Contribute significantly to the „Healthy Futures‟ Programme, working closely with NHS
        partners.
    27. Secure agreement to formation of a major trauma and stroke centre.
    28. Progress Darzi review recommendations.

e) Make progress on a number of key service developments

Sites:

    29. Cossham – commence refurbishment of hospital.
    30. Thornbury Hospital –review future plans with PCT.
    31. Frenchay Community Hospital – prepare plan and strategic Outline Case for
        development of Frenchay Community Hospital with the PCT (South Glos).
Services:

   32. Specialist Paediatrics – complete work with UHB on development of FBC.
   33. Rehabilitation Services –implementation of integrated service.
   34. Community Children‟s Services, Health Visiting & CAMHS – complete successful
       implementation of new service across Bristol and South Gloucestershire.
   35. Deep Brain Stimulation –implement scheme.
   36. Cardiology – maximise cardiology capacity, including focusing on groups that were
       previously under-targeted, and achieve FBC targets.
   37. Re-provide Wheelchair Service on the Frenchay site and draw up a business case for
       the long term re-provision of the Prosthetics and Wheelchair Service.
   38. IVF Services – consolidate and meet FBC targets and accommodate growth
       demands.
   39. CSSD – make progress in re-provision/centralisation of CSSD services
   40. Residencies – formulate clear residences‟ strategy.
   41. Workplace Nursery – implement clear and coherent strategy and produce business
       case for scheme.
4. Be a Great Place to Work
a) Improve staff survey results by doubling those in the Top 20% of all NHS
organisations, and halving those in the bottom 20% - as a stepping stone towards to
becoming one of the 5 best places to work in NHS South West

   1.   Each directorate to identify, prioritise and implement actions in the staff survey
   2.   NBT to take forward a strong, effective and long-term staff engagement strategy
   3.   Staff to volunteer and implement ideas on how staff survey results can be improved
   4.   Each member of staff to do one new thing to make their ward/department a „great
        place to work‟

b) Ensure that staff in every directorate are aware of and engaged with the ‘Building
our Future’ Programme

   5. Align NBT workforce & development plans to deliver the „Building our Future‟
      programme
   6. Review and streamline employment policies and procedures to ensure rapid and
      good practice implementation of organisational change
   7. Deliver the leadership development programme for the top 180 leaders at NBT
   8. Contribute to an Avon-wide organisational change protocol, ensuring effective joint
      working with NHS partners

c) Good practice in equality and diversity to be given a higher priority across NBT

   9. Ensuring that equality impact assessments are carried out for all major service
       developments.
   10. Specific actions to be taken where performance is deficient under the NBT equality
       scheme

d) Reduce sickness absence to 3.8% across the Trust

   11. All Directorates to focus on reducing sickness absence by applying effective
       management of the Trust‟s sickness absence management processes
   12. Improve health and well-being in the workplace

e) Ensure the Trust and its staff are meeting obligations under the NHS Constitution

f) All NBT Staff to receive a 1-1 appraisal with their line manager and to keep
Mandatory Training ‘Staff Passports’ up-to-date

   13. All staff and managers to regularly review progress in personal objectives, personal
       development plans and staff passports

g) Promote staff achievements and successes throughout the year

Managers to actively recognise and promote staff achievements and success.
5. Build a strong, viable organisation
a) Take forward service strategies to achieve our vision to become a leading provider
of healthcare

   1. Agree the NBT „vision‟ and develop the organisational strategy to achieve this vision,
      incorporating clinical, quality, workforce, finance, IM&T and estates strategies
   2. Maximise our opportunities, including gains from specialist commissioning, to develop
      the Trust‟s leading tertiary services. Maintain designation for all existing specialist
      services.
   3. Achieve the deliverables of year 2 of the fundraising strategy.
   4. Explore and secure new business opportunities, within existing and new markets.

b) Improve the NBT ‘brand’ & reputation

   5. Grow stronger relationships with PCTs and the SHA to promote NBT services in the
      SHA in the context of PCT plans for world class commissioning and transforming
      community services.
   6. Build the reputation of NBT and promote the NBT „brand‟ amongst the public,
      patients, staff, stakeholders, commissioners, local authorities, MPs, etc. through
      effective marketing and communication of the Trust's strategic plans, ambitions and
      achievements.
   7. Execution of a wide-ranging and co-ordinated patient, public and workforce
      communication programme describing NBT‟s range of major services and their
      developments in a clear and coherent way
   8. Establish effective mechanisms for communicating with/learning from referring GPs.
   9. Maintain and develop strong relationships with local authority stakeholders.

c) Build the Trust’s research & development capability & capacity

   10. Deliver on the new Research and Innovation strategy for NBT.
   11. Formulate a clear action plan to enable NBT to achieve its goal of becoming a world-
       class organisation for research and development.
   12. Develop and report on improved financial information to assist the improvement of the
       financial performance of R&D activities
   13. Improve interactions and appropriate structures with the Universities of Bristol and
       West of England – and maximise benefits arising out of collaboration within Bristol
       region and NHS South West.

d) Improve performance & productivity in all areas

   14. Ensure continued registration with the CQC (without conditions), achieving all
       performance and quality standards
   15. Successfully launch the “Building our Future Together” Programme, achieve the
       goals of year 1 of the programme, and further develop medium term plans.
   16. Meet all operational contract terms, all CQUINS gateways and at least 75% of the
       maximum CQUINS rewards within the SLA with commissioners.
   17. Ensure individual and team objectives link to „Big 5‟
   18. Develop clear and coherent mechanisms for rewarding success, addressing failure
       and enabling „earned autonomy‟.
   19. Develop coherent and actionable plans to properly resource the hospital for winter
       peaks, working with partners to ensure the whole system is properly resourced.

e) ‘Bust’ bureaucracy to ensure staff have more time to do the things that matter

   20. All corporate management functions to make demonstrable change to streamline
       processes and reduce bureaucracy
   21. Implement E rostering and electronic expenses on programme.
f) Improve the creation, supply and usefulness of information needed to work more
effectively

   22. Implement and successfully utilise the full warehouse Patient Level Costing and
       billing solution
   23. Improve the relevance and presentation of other financial information for staff, clinical
       decision makers, budget holders, managers and the Board. This to include
       information on current service viability and triggers for improved viability, costs of
       products and services, greater relating of costs and income to activity, benchmarking
       and other comparative information.
   24. Further integrate performance reporting to clinical teams, directorates and the Board
       towards full balanced scorecard reporting
   25. Develop and evolve information provision to GPs and PCTs to meet their needs,
       including in particular around the QIPP agenda.
   26. Improve information content in internal and external communication (e.g. service
       directories, newsletters, etc).
   27. Improve information quality, matching the national SUS database, further improved
       coding quality/NHS number.
   28. Improved discharge and correspondence for GPs, achieving clinical and contracted
       goals.

g) Ensure that we remain a financially secure organisation

   29. Achieve a £7.88m surplus in 2010/11, meet our debt repayment obligations for the
       year, and improve out liquidity in line with the budget.
   30. Achieve a “good” rating for the use of resources within the CQC regulatory regime,
       largely driven by progress on the Auditors Local Evaluation (ALE)
   31. Provide clearer guidance for managers on their financial and contract management
       responsibilities, delegated powers and processes for obtaining approvals where they
       do not have delegated power.
   32. Use the new patient level costing system to report on the profitability of individual
       service lines, and to support clinical leaders in improving their services.
   33. Put in place stronger embedded controls over pay and non-pay expenditure.
   34. Plan preparation for the 2011/12 contracting round, including:-
            Early updating of the forward financial plan for specific use and relevance to
                2011/12
            Detailed review of non-PBR tariffs and contract values in comparison with
                current costs and national indicative tariffs.
   35. Earlier setting of CRES targets and development of CRES plans (plans in place by
       end December 2010), closely linked to Building our Future.
   36. Overall commissioning strategy agreed corporately and with directorates before the
       commissioning round begins in earnest.
   37. Continued development of RUM/QIPP plans with commissioners

h) Be an environmentally responsible and sustainable organisation

   38. Quantify all aspect of the Trust‟s carbon footprint and implement systems and
       practices to meet the NHS 2015 target. (10% reduction on 2007 baseline)
   39. Develop sustainable procurement and purchasing policies and practices with whole
       lifecycle, carbon and environmental impacts considered.
   40. Ensure that all staff are aware of their environmental responsibilities.
   41. Embed the principles of good corporate citizenship into everything we do.
   42. Ensure that we implement the necessary measures to support the NHS Carbon
       Strategy.
   43. Incorporate sustainable development into every aspect of our services.
   44. Ensure every job description/Terms & Conditions incorporates a commitment to
       supporting the Trust in its sustainable development.
   45. Sustainability objectives for all Executive and Non Executive members.
   46. Assign a Carbon Champion role (recommended by Carbon Strategy)
   47. Develop better information and communication to keep staff updated on
       environmental requirements, targets, successes and progress

i) Improve the way that the purchasing and use of supplies is managed

   48. Embed the use of MEDTRAC inventory system in orthopaedics and achieve
       measurable benefits from the system. Draw up a business case for the optimal use of
       inventory systems across the Trust, and implement if approved.

j) Improve Trust Board performance

   49. Achieve and sustain strong performance of the Trust Board to ensure the
       achievement of organisation‟s short, medium and long-term objectives and ongoing
       development.
   50. Develop effective organisational strategies to enable the Trust to achieve its vision as
       a leading healthcare provider
   51. Improve the tracking and performance management of the timely achievement of the
       Trust‟s objectives through the year.

k) Preparation for application for Foundation Trust status

   52. Develop an action plan for a potential Foundation Trust application
   53. Prepare a Integrated Business Plan and associated Long Term Financial Model.

								
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