ACHIEVING HIGH QUALITY, FINANCIALLY
SUSTAINABLE HEALTHCARE
Why are you here?
• Achieving financially sustainable healthcare now and in future
is likely to change how and where peopl...
Who will you hear from?
• Chair: Simon Belfer, Director of Finance,
NHS National Services Scotland
• Session Lead: Profess...
Three session aims
•Explore the links between quality and efficiency
•Opportunity to share innovative ideas and suggestion...
2020 Vision for Health and Care in Scotland
• Our vision is that by 2020 everyone is able to live longer healthier
lives a...
The challenge inside the 2020 vision
•Over the next few years, demand and the
circumstances for delivery will be radically...
Examples of the challenges
• Healthcare inflation
• Reducing health inequality:
• Despite efforts to address, we have made...
Public Service Reform – Christie response
•decisively shifting towards prevention
•integrating more public services locall...
Professor Cam Donaldson
Yunus Chair in Social Business & Health
Glasgow Caledonian University
Collaborating for Quality
Achieving high-quality, financially-sustainable
health care
Cam Donaldson
Scottish Exhibition an...
Celebrating the NHS, London Olympics opening
ceremony
Otherwise known as ‘leftie...crap’!
Two main directions follow
• Health care reform to enhance incentives for efficiency:
• user charges
• ‘internal markets’
...
Two main directions follow
• Health care reform to enhance incentives for efficiency:
• user charges
• ‘internal markets’
...
The focus of ‘Triple Aim’
• Patient experience (quality)
• Population health
• Cost (Value and financial responsibility)
Important antecedents
• Rational collective action
• Integration
My triple aim at Triple Aim
• Is integration sufficient?
Platitudes of health care reform
• Reforms all over the world state that the ‘new’ system will:
• adopt ‘a balance of care...
My triple aim at Triple Aim
• Is integration sufficient?
• Are we recognising and managing scarcity?
Managing scarcity: the clinical challenge
• Any decision to change the way care is delivered will impact on
HEALTH OUTCOME...
Managing scarcity: the clinical challenge
• Any decision to change the way care is delivered will impact on COST.
This wil...
“Allocation of funds and facilities are nearly always based on the opinion of
consultants but, more and more, requests for...
• “Allocation of funds and facilities are nearly always based on the opinion of
consultants but, more and more, requests f...
Deciding whether it’s worth it:
A challenge to clinicians
2  = ×
3 × ×
A B C
1  
HEALTH OUTCOMES
C
O
S
T
 = recommend ...
An economics-based framework for needs
assessment: the management challenge
An economic approach addresses need from the p...
Shameless promotion: part II
But it’s not new
Who said this?
“If I had a plan, it would be simply to take the poorest and least organised
hospital in L...
A novel idea!
“If I had a plan, it would be simply to take the poorest and least organised
hospital in London and, putting...
My triple aim at Triple Aim
• Is integration sufficient?
• Are we recognising and managing scarcity?
• Where does ‘populat...
Lessons
We need to work towards:
• maintaining publicly financed systems
• thinking more about explicit evaluation and pri...
Sally Campbell
Managing Director of Cheshire HR Service
Developing a new model of HR Services
Cheshire HR Service - Overview
• Established in 2006, experienced in supporting NHS organisations in various sectors of
he...
Cheshire HR Service - Timeline
Pre 2006
Separate HR Teams
– Acute,
Community, PCT
2007 - 2011
NHS HR Shared
Service
5 Orga...
The HR Challenge
• Safety & Effectiveness
• Value for Money
• Quality
• Increased Patient & Staff
Satisfaction
NHS Outputs...
• Small shared HR Service already existed
• Changes to commissioning structure – new organisations forming
• Introduction ...
• Separate HR Departments
• Multiple sites
• Multiple Processes and Procedures
• Multiple contact points
• Disparate, outd...
Our vision for a model service
Future
proofing
Strategic health
of organisation
Policy & Process
Administration
Process im...
Systems
Support
Service
Recruitment
Service
Learning &
Development
Service
HR
Consultancy
Service
Wellbeing
Service
Busine...
Business Partnering
Inefficient case mix, lots of ER activity, chasing of information,
limited business skills
Analytical ...
Tier 1:
HR Direct
24/7 Online Advice and Tools
Tier 2:
Advice Line/Administrators
Case Handlers/HR Advisors,
recruitment/g...
Multiple Systems
Non-Standard Complex
Processes
Multiple Locations
Transactional
Efficiencies
Baseline
Remove
Complexity
R...
• Diversity of cultures from multiple organisations and ownership of HR
• Allocation of resources
• Geography/location
• M...
• Supported organisations in making savings year on year
• Increased customer satisfaction – organisation, manager, staff
...
Internal HR
The Organisation New Capabilities
Self Diagnose their current state on maturity map
Set realistic expectations...
Discussion and audience participation
So Just How Effective Are We?
Question 1
Who are the greatest band of all time?
1. Pink Floyd
2. Beatles
3. Abba
4. Chas & Dave
Question 2
How easy or difficult would it be for your organisation
to introduce ‘an economics-based framework for
needs as...
Question 3
How would you assess the culture of transparent
measurement and learning and wider application of
quality impro...
Question 4
How ready is Scotland to deliver the scale and speed of
change required?
1. Lost cause
2. Behind
3. Ahead
4. We...
Question 5
The theme of this year's conference has been collaborating for
quality. Which of the following statements best ...
Question 6
How engaged are you personally in collaborative work
between Health & Social Care partners?
1. Not at all
2. Ve...
Question 7
What is the most important area for collaborative work over
the coming years?
1. Primary Care
2. Secondary Care...
Question 8
What would be the biggest help/support to you as
individuals/organisations with your change agenda?
1. Informat...
Question 9
To what extent has today given you new information or fresh
ideas and impetus to engage?
1. Not at all
2. Not m...
Question 10….(Chairman’s Special
Question)
How much UK tax should Google pay? Enough for:
1.Billy Connolly to get a haircu...
Wrap-up
Parallel Session: Achieving High Quality, Financially Sustainable Healthcare
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Parallel Session: Achieving High Quality, Financially Sustainable Healthcare

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Achieving financially sustainable healthcare now and in the future is likely to mean changes to how and where people access services. This means that NHSScotland needs to consistently deliver high-quality care at a lower cost and against rising expectations and demand. This session investigates the current thinking and practice around the critical links between improving quality and delivering on efficiency. Professor Cam Donaldson, author of ‘Credit Crunch Healthcare’, challenges delegates on their thinking around ‘traditional’ delivery of efficiencies and how this can impact on improving quality. Sally Campbell from NHS North West England also describes the journey to delivering best value in HR services.

See more on the 2013 NHSScotland Event website http://www.nhsscotlandevent.com/resources/resources2013/resources

Published in: Health & Medicine, Business
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  • Again, scarcity still exists.
  • Again, scarcity still exists.
  • Parallel Session: Achieving High Quality, Financially Sustainable Healthcare

    1. 1. ACHIEVING HIGH QUALITY, FINANCIALLY SUSTAINABLE HEALTHCARE
    2. 2. Why are you here? • Achieving financially sustainable healthcare now and in future is likely to change how and where people access services • This means that NHSScotland needs to consistently deliver: • high quality care • at a lower cost • against rising expectations and demand. • This session will investigate and develop current thinking and practice around the critical links between improving quality and delivering on efficiency
    3. 3. Who will you hear from? • Chair: Simon Belfer, Director of Finance, NHS National Services Scotland • Session Lead: Professor Cam Donaldson Yunus Professor of Social Business & Health, Glasgow Caledonian University, author of ‘Credit Crunch Healthcare’ • Sally Campbell - Managing Director of Cheshire HR Service • Discussion and audience voting • Wrap up • Introduction • Challenge delegates on their thinking around ‘traditional’ delivery of efficiencies and how this can impact on improving quality. • Describe the journey to delivering best value in HR services.
    4. 4. Three session aims •Explore the links between quality and efficiency •Opportunity to share innovative ideas and suggestions to influence this work •Able to contribute to the national work being undertaken to support NHS Boards in this area
    5. 5. 2020 Vision for Health and Care in Scotland • Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. • We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. • When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. • Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. • There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.
    6. 6. The challenge inside the 2020 vision •Over the next few years, demand and the circumstances for delivery will be radically different •We will need to continue to provide high quality health and care services, meeting what the people of Scotland expect •We will be measured by securing the best possible outcomes for people from the care and support they receive.
    7. 7. Examples of the challenges • Healthcare inflation • Reducing health inequality: • Despite efforts to address, we have made very little progress. • Ageing population: • By 2033 the number of over 75 is likely to have increased by almost 60% • Continuing shift towards long-term and multiple conditions, with complex needs • By 2033, demography could grow spend on health and social care by over 70% • Dementia: • Estimates will rise from 71,000 to 127,000 sufferers in the next 20 years • Tremendous financial costs to the NHS and social services • Health and cost impact on carers - more likely to take prescribed medication, visit GP with higher levels of stress and physical symptoms
    8. 8. Public Service Reform – Christie response •decisively shifting towards prevention •integrating more public services locally, driven by better partnership, collaboration and effective local delivery •investing in the people who deliver services through enhanced workforce development and effective leadership •focussing on better performance, through more transparency, innovation and use of digital technology.
    9. 9. Professor Cam Donaldson Yunus Chair in Social Business & Health Glasgow Caledonian University
    10. 10. Collaborating for Quality Achieving high-quality, financially-sustainable health care Cam Donaldson Scottish Exhibition and Conference Centre, Glasgow 11-12th June 2013
    11. 11. Celebrating the NHS, London Olympics opening ceremony
    12. 12. Otherwise known as ‘leftie...crap’!
    13. 13. Two main directions follow • Health care reform to enhance incentives for efficiency: • user charges • ‘internal markets’ • remuneration • integration • The need for economic evaluation of health care: • assessments of cost effectiveness and cost benefit (a challenge to physicians) • systematising evaluation thinking (a challenge to managers)
    14. 14. Two main directions follow • Health care reform to enhance incentives for efficiency: • user charges • ‘internal markets’ • remuneration • integration • The need for economic evaluation of health care: • assessments of cost effectiveness and cost benefit (a challenge to physicians) • systematising evaluation thinking (a challenge to managers)
    15. 15. The focus of ‘Triple Aim’ • Patient experience (quality) • Population health • Cost (Value and financial responsibility)
    16. 16. Important antecedents • Rational collective action • Integration
    17. 17. My triple aim at Triple Aim • Is integration sufficient?
    18. 18. Platitudes of health care reform • Reforms all over the world state that the ‘new’ system will: • adopt ‘a balance of care’ approach • be about ‘effectiveness and efficiency’ • adopt ‘an evidence-based approach’ • ‘involve communities and other stakeholders’. • But no-one ever says how!!! i.e. what’s the process?
    19. 19. My triple aim at Triple Aim • Is integration sufficient? • Are we recognising and managing scarcity?
    20. 20. Managing scarcity: the clinical challenge • Any decision to change the way care is delivered will impact on HEALTH OUTCOMES. This will: • improve A • remain unchanged B • decrease C
    21. 21. Managing scarcity: the clinical challenge • Any decision to change the way care is delivered will impact on COST. This will: • decrease 1 • remain unchanged 2 • increase 3
    22. 22. “Allocation of funds and facilities are nearly always based on the opinion of consultants but, more and more, requests for additional facilities will have to be based on detailed arguments with ‘hard evidence’ as to the gain to be expected from the patient’s angle and the cost. Few could possibly object to this.” Who said this?
    23. 23. • “Allocation of funds and facilities are nearly always based on the opinion of consultants but, more and more, requests for additional facilities will have to be based on detailed arguments with ‘hard evidence’ as to the gain to be expected from the patient’s angle and the cost. Few could possibly object to this.” Cochrane AL. Effectiveness and Efficiency: random reflections on health services. Nuffield Provincial Hospitals Trust, London, 1972.
    24. 24. Deciding whether it’s worth it: A challenge to clinicians 2  = × 3 × × A B C 1   HEALTH OUTCOMES C O S T  = recommend change to new treatment X = recommend status quo = judgement required
    25. 25. An economics-based framework for needs assessment: the management challenge An economic approach addresses need from the perspective of resources: 1. What resources are available in total? 2. In what ways are these resources currently spent? 3. What are the main candidates for more resources and what would be their effectiveness and cost? 4. Are there any areas of care which could be provided to the same level of effectiveness but with less resources, so releasing those resources to fund candidates from (3)? 5. Are there areas of care which, despite being effective, should have less resources because a proposal from 3. is more effective (for £s spent)? Can be applied at ‘micro’ or ‘macro’ levels
    26. 26. Shameless promotion: part II
    27. 27. But it’s not new Who said this? “If I had a plan, it would be simply to take the poorest and least organised hospital in London and, putting myself there, to see what I could do – not touching the Fund for years, until experience had shown how the Fund might best be available.”
    28. 28. A novel idea! “If I had a plan, it would be simply to take the poorest and least organised hospital in London and, putting myself there, to see what I could do – not touching the Fund for years, until experience had shown how the Fund might best be available.” Florence Nightingale (1857)
    29. 29. My triple aim at Triple Aim • Is integration sufficient? • Are we recognising and managing scarcity? • Where does ‘population health’ fit?
    30. 30. Lessons We need to work towards: • maintaining publicly financed systems • thinking more about explicit evaluation and priority setting at all levels of the system • dealing with chronic disease management:  integration plus priority setting? • working ‘with’ rather than ‘on’:  people as well as systems • engaging the public:  what is socially relevant? • rethinking the notion of the ‘clinician-scientist’.
    31. 31. Sally Campbell Managing Director of Cheshire HR Service
    32. 32. Developing a new model of HR Services
    33. 33. Cheshire HR Service - Overview • Established in 2006, experienced in supporting NHS organisations in various sectors of healthcare • Hosted by East Cheshire NHS Trust as an ‘arms-length’ division with an operating framework to provide increased autonomy • Provider of a full range of business focused HR and L&D services • We offer customers a wealth of experience and knowledge of working with the complexities of the changing healthcare environment • Our mission ‘to deliver excellence in people management’
    34. 34. Cheshire HR Service - Timeline Pre 2006 Separate HR Teams – Acute, Community, PCT 2007 - 2011 NHS HR Shared Service 5 Organisations 2011 - 2013 NHS HR Service Provider – 50+ customers 2013+ NHS Service Provider with Commercial Partner 2006 2013
    35. 35. The HR Challenge • Safety & Effectiveness • Value for Money • Quality • Increased Patient & Staff Satisfaction NHS Outputs • Potential to save £616m-£1bn nationally • 56% of HR function could be provided as a shared service • 20-50% operational savings • Best practice approaches DoH Back Office Report 2010 • People and skills taking centre stage • Risk management and governance giving HR pivotal role • OD and change capability high demand Drivers
    36. 36. • Small shared HR Service already existed • Changes to commissioning structure – new organisations forming • Introduction of Electronic Staff Record (ESR) across NHS • Different payroll arrangements • Absence of coherent HR strategy/lack of strategic HR input • Cumbersome and outdated HR processes, inadequate technology • Poor levels of satisfaction with HR • Increased measurement and monitoring of HR indicators Our Key Drivers
    37. 37. • Separate HR Departments • Multiple sites • Multiple Processes and Procedures • Multiple contact points • Disparate, outdated technology platforms • Manual and duplicate data entry • Strategic staff performing administrative tasks • Results • Costly, disparate HR functions. • No performance metrics • No customer service focus • Shared HR Service – Harmonised and centralised HR services – Single point of contact for HR customers – Single employee access portal and data entry – Enhanced Technology platforms – Enhanced HR reporting • Results – Cost reduction – Customer focused HR delivery – Strategic staff re-focused on strategic delivery Transforming HR Services
    38. 38. Our vision for a model service Future proofing Strategic health of organisation Policy & Process Administration Process improvement automisation, Self-service /HR Service Centre Centres of expertise Customer retained HR activities
    39. 39. Systems Support Service Recruitment Service Learning & Development Service HR Consultancy Service Wellbeing Service Business Partnering Our Services
    40. 40. Business Partnering Inefficient case mix, lots of ER activity, chasing of information, limited business skills Analytical skills, strategic consultancy, workforce planning skills, psychometric testing, service improvement training OD, workforce planning, productivity, service change, governance and compliance, business strategy 2009-2011
    41. 41. Tier 1: HR Direct 24/7 Online Advice and Tools Tier 2: Advice Line/Administrators Case Handlers/HR Advisors, recruitment/general administration, online system management, MI Reports Tier 3: Specialist Advisors Case Managers, specialist advisors, people coaching, mediation, people development, policy development Services underpinned by Systems Support
    42. 42. Multiple Systems Non-Standard Complex Processes Multiple Locations Transactional Efficiencies Baseline Remove Complexity Remove complexity Standardise Processes Remove complexity Standardise Processes Implement Common System Establish new organisation Remove complexity Standardise Processes Implement Common System Centralise transaction processing Establish new organisation Remove complexity Standardise Processes Implement Common System Centralise transaction processing Implement e-enabled common system Migrate to Virtual transaction processing Multiple Systems Non-Standard Simple Processes Multiple Locations Transactional Efficiencies 20% Multiple Systems Standard Simple Processes Multiple Locations Transactional Efficiencies 40% Common Systems Standard Simple Processes Multiple Locations Transactional Efficiencies 50% Common Systems Single/ Few Locations Transactional Efficiencies 60% e-enabled system Virtual Locations Transactional Efficiencies 75% Increasing process maturity Standard Simple Processes Standard Simple Processes Multiple Systems Multiple Locations Transactional Efficiencies Baseline Multiple Systems Non-Standard Simple Processes Multiple Locations Transactional Efficiencies 20%
    43. 43. • Diversity of cultures from multiple organisations and ownership of HR • Allocation of resources • Geography/location • Managing Change • Business Continuity • Developing technology against competing demands • Achieving change in behaviours – customer/business focus • Developing internally – capability to “let go” and become commissioning partners Challenges
    44. 44. • Supported organisations in making savings year on year • Increased customer satisfaction – organisation, manager, staff • Technology benefits for HR and customers – modern, fast, efficient, compliant • Improved job satisfaction in HR (above the best national average score) • Skill Mix/Career Development - Right people undertaking right tasks • Increased confidence and capability of managers Was it worth it?
    45. 45. Internal HR The Organisation New Capabilities Self Diagnose their current state on maturity map Set realistic expectations aligned to culture and practice Identify quick wins Make sure leaders are a partner on the journey HR Business Partnering and Strategy Managing SLA’s/outsourced services Business Case Development Demonstrating value through information Renegotiating “the deal” between HR and managers Absolutes Internal HR Investment in technology Commitment to concept of new mode of control Clear governance arrangements Simplify customer facing end An OD/Change Programme which focuses on: Defining roles/mind the gaps Developing capability to let go and take on the new Change in behaviours/ taking a customer perspective HR Business Partners as commissioners of HR services Don’t put off dealing with capability issues What did we learn?
    46. 46. Discussion and audience participation
    47. 47. So Just How Effective Are We?
    48. 48. Question 1 Who are the greatest band of all time? 1. Pink Floyd 2. Beatles 3. Abba 4. Chas & Dave
    49. 49. Question 2 How easy or difficult would it be for your organisation to introduce ‘an economics-based framework for needs assessment’ into its management processes? (please enter a number from 1-4, where 1=very easy and 4=very difficult)
    50. 50. Question 3 How would you assess the culture of transparent measurement and learning and wider application of quality improvement techniques throughout your organisation? (please enter a number from 1-4, where 1=very easy and 4=very difficult)
    51. 51. Question 4 How ready is Scotland to deliver the scale and speed of change required? 1. Lost cause 2. Behind 3. Ahead 4. Well ahead
    52. 52. Question 5 The theme of this year's conference has been collaborating for quality. Which of the following statements best describes your view on the level of collaboration that currently exists across Health & Social Care? 1. There is no collaboration 2. We collaborate across our organisation, but collaboration with social care partners could be better 3. We have good collaboration across health & social care 4. We collaborate actively with a range of partners in public, third and private sectors
    53. 53. Question 6 How engaged are you personally in collaborative work between Health & Social Care partners? 1. Not at all 2. Very occasionally 3. A reasonable amount 4. Almost all the time
    54. 54. Question 7 What is the most important area for collaborative work over the coming years? 1. Primary Care 2. Secondary Care 3. Care at home and in the community 4. Support Services (IT, Finance etc)
    55. 55. Question 8 What would be the biggest help/support to you as individuals/organisations with your change agenda? 1. Information from other health systems/different sectors 2. Time with peers/colleagues to discuss opportunities 3. Supported development programmes 4. Internal consultancy support to the assessment of options for change
    56. 56. Question 9 To what extent has today given you new information or fresh ideas and impetus to engage? 1. Not at all 2. Not much 3. Quite a lot 4. Huge
    57. 57. Question 10….(Chairman’s Special Question) How much UK tax should Google pay? Enough for: 1.Billy Connolly to get a haircut 2.A chocolate bar for everyone in this room 3.A Google chrome laptop for every P1 child in Scotland 4.Cam Donaldson to get a new Ferrari each year
    58. 58. Wrap-up
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