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Eliminating the top 5 challenges for STPs

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A White Paper for Healthcare Executives, PMO Leads and Project Managers

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Eliminating the top 5 challenges for STPs

  1. 1. Eliminating the top 5 challenges for STPs A White Paper for Healthcare Executives, PMO Leads and Project Managers
  2. 2. © QOREX Ltd 2017 Contents The Five Challenges For STPs A partnership approach to whole-system planning and healthcare delivery across a local area is a radical shift from the previous commissioner/provider split approach and leads to a number of challenges. 1. Coherence How do you design a plan that is logical, coherent and addresses national priorities while meeting the needs of your local population? 2. Clarity How do you ensure that your plans are easily understood, focused and prioritised, with a clear line of sight from your objectives to how they will be accomplished and by whom? 3. Consistency How do you ensure a consistent approach to delivering your plans across a diverse range of organisations that makes the best use of finite resources? 4. Collaboration How do you create an environment in which people can collaborate, cooperate and trust each other so that you leverage the capability and expertise across the partnership giving your plans the greatest chance of success? 5. Control How do you control delivery of your plans across a diverse and dispersed range of stakeholders in your local health and care system, supported by a simple, effective and affordable governance structure where accountability and responsibility for achieving your plans are understood?
  3. 3. © QOREX Ltd 2017 There are 44 Sustainability and Transformation Partnerships (STPs) establishing themselves across the NHS in England. This is a radical shift from the existing commissioner/provider approach, to partnership working for whole-system healthcare planning and delivery, across a local area. The intricacy of partnership-working and the inherent complexity of these plans virtually guarantees delivery challenges for STPs. This whitepaper sets out our assessment of the top 5 challenges facing STP delivery and seeks to offer some insight into how they may be eliminated. Causes of the top five STP Challenges There are fundamentally two causes of the top five STP challenges: 1. Complexity – over the years the NHS has added layers of unnecessary complexity to an already inherently complex system. 2. Silos – the NHS has an organisational-centred approach to strategy, planning and delivery rather than working in partnerships centred around the patient and public. Simplifying this complexity and creating a partnership across multiple organisations leads to some significant challenges. ▶▶ Coherence How do you design a plan that is logical, coherent and addresses national priorities while meeting the needs of your local population? There is so much national guidance. It is difficult to integrate this with your own local needs to construct a coherent plan. ▶▶ Clarity How do you ensure that your plans are easily understood, focused, and prioritised? How do you establish a clear line of sight from your STP objectives to how they will be accomplished, and by whom? The interconnected nature of the health and care system makes it challenging to have a clear line of sight and shared understanding of how best to deliver your plans. “ ““ “ QOREX has skillfully demystified the complexity that was our STP portfolio, and revealed a hidden beauty in a simplified and ordered governance. Pure brilliance! Adele Yemm, SW London STP Introduction
  4. 4. © QOREX Ltd 2017 ▶▶ Consistency How do you ensure a consistent approach to delivering your plans? How do you ensure consistency across a diverse range of organisations? How do you make the best use of finite resources? Even if you’ve trained people in a consistent approach to management and delivery you will face challenges. Without a mechanism to embed that approach across the partnership, you will experience significant variation. This results in waste, duplication, and inefficiency. ▶▶ Collaboration How do you create an environment in which people can collaborate, co-operate, and trust each other? How do you leverage the capability and expertise across the partnership? How do you give your plans the greatest chance of success? Geographically dispersed teams, with isolated systems of work, struggle to achieve a single point of truth. How do you collaborate to drive successful, joined up delivery? ▶▶ Control How do you control delivery of your plans? You have a diverse and dispersed range of stakeholders in your local health and care system. How do you establish a simple, effective, and affordable governance structure? How well is accountability and responsibility for achieving your plans understood? You can’t take control of whole-system transformation without a whole system view. A system-wide view of investment plans, delivery plans and benefit plans is needed. Accountability and responsibility throughout the system needs to be understood.
  5. 5. © QOREX Ltd 2017© QOREX Ltd 2017 Implications of the top five challenges for STPs Failing to address these challenges leads to a highly stretched, stressed environment within which it is impossible to achieve your plans. Asking a newly formed partnership to deliver a complex set of requirements within an already complex environment can be likened to asking a team of new drivers to navigate spaghetti junction without a map. Using a helicopter view, you can see that whilst all the drivers are on the road, they are not necessarily heading in the same direction. They have no line of sight to see where the others are. It is unlikely that they will successfully reach the required destination on time (some may even run out of fuel before they get there). Let’s have a look at how we can eliminate each of these challenges. Better Health & Care 4.Fin ance 3.Capab ility 2. Health and C are Services1. Patien tsandPublic Maximising Income In-year financial performance In-yearfinancial performance Financial plan Financial plan Digital Acute Care Provider Community Care Provider Primary Care Urgent & Em ergency C are Provider Mental Health ProviderServiceIntegration (PatientPathways) CCGs Autism Learning Disabilities M aternity M ental Health Dementia Diabete Can Obesity R in Funding G ap Improvement Expenditure Public and Patient Engagement CQC inpatient / MH and community survey IAP tim beg treatm e w ithin 6... Patient Access Experience Optimise Expenditure
  6. 6. © QOREX Ltd 2017 A coherent plan first requires a structured approach to creating that plan which is agreed and shared across the STP. It should create a framework that: 1. Identifies those things internally and externally to the STP that are driving direction and strategy (such as the Government’s mandate for the NHS) 2. Articulates the STP’s strategic intent as a set of SMART Objectives. The Objectives are made measurable through Key Performance Indicators (KPI) that quantify the operational improvements that you are looking to achieve (e.g. health outcomes, financial savings, patient satisfaction etc.) 3. Enables a portfolio of work to be defined and managed that transforms the health system to achieve the Objectives 4. Defines: a. the required programmes of work, accountable for delivering the expected Results b. the associated projects to deliver the capabilities to enable the expected Results to be realised and so deliver the transformation Coherence Strategic Intent Formulate strategy as a set of SMART Objectives based on internal and external Drivers Enterprise Portfolio Establish and manage a Portfolio that invests in transforming Operations to accomplish the Strategic Intent Business Manage and deliver Business Results (KPIs) Operations Manage day-to-day Operations Programmes Manage and deliver Programme Results Projects Manage and deliver Project Outputs DesigntheBusiness,definetheOperations DesigntheTransformation,definethechange ChangetheBusiness,Governthechange RuntheBusiness,governtheOperations Drivers Why and how the Business is driven to deliver and behave as it does Objectives The purpose of the Business - what it is trying to accomplish Results (Value) Measurable Results (Benefits and Outcomes) that demon- strate progress towards the Objectives and quantify value to the Business Enablers (Investment) The capability and capacity, systems and processes required for the Business to achieve its Outcomes and deliver the associated value 1
  7. 7. © QOREX Ltd 2017 5. Allows the business cases for the investment in transformation to be continually managed and prioritised to ensure maximum return on investment. There are many Key Performance Indicators (KPI) that enable you to measure the performance of your STP. It is improvement in these KPIs that you are looking to achieve. These KPIs are articulated in many different documents including: NHS Outcomes Framework, CCG Improvement and Assessment Framework, NHS Single Oversight Framework, NHS England’s Transformation Programme Management Office Indicators, STP local indicators. There is significant overlap across these KPIs leading to a substantial piece of work for STPs to enable them to align and prioritise their programmes of work with these KPIs as well as measuring and reporting on progress against them. Alignment and reporting can be automated through Business Management Software such as QOREX PATH. Action steps First make sense of the demands on your STP to determine your strategic intent. Then establish and manage a portfolio of work that invests in transforming operations to achieve your Key Performance Indicators and deliver your strategy. Use appropriate Business Management Software to help make sense of national and local STP requirements and consolidate them in one place enabling you to construct a coherent plan that translates strategy into action and results. This will enable you to design a plan that is logical, coherent and addresses national priorities while meeting the needs of your local population.
  8. 8. © QOREX Ltd 2017 It is important to adopt a structured approach that establishes a “golden thread” from your Objectives, through Results to enabling activities, giving a clear line of sight from STP strategy to delivery. As an organisation becomes larger and more complex the clarity it may have once had often becomes obscured. This lack of clarity can impact across everything that it does; from its Vision and Objectives, through to individual roles and responsibilities. This can also be compounded by the absence of a common and agreed business language across the organisation. The usual outcome is that the organisation becomes increasingly ineffective. Clarity is concerned with answering the question, ‘Why?’ Why does this organisation exist? Why do we have the Vision and Objectives that we have? Why am I working on my current task? A lack of clarity will manifest itself as confusion across an organisation. A lack of clarity means that the Purpose, Vision and Objectives of the organisation are not clear, nor are they aligned with each other. Furthermore, it is not clear how what you are working on contributes to the Vision and Objectives of the business. Clarity “ ““ “ It’s a lack of clarity that creates chaos and frustration. Those emotions are poison to any living goal. Steve Maraboli 2
  9. 9. © QOREX Ltd 2017 We must ensure that we are clear on what we are trying to achieve and why. It is fundamentally important that there is clarity across the STP; from a clear Vision and an agreed set of Aims and Objectives, to clarity of overall outcome and our contribution at an individual level. As individuals, it is important that we understand how what we are doing contributes to delivering what the STP wants to achieve. The structured approach set out in the Coherence section, provides a framework that enables you to create the golden thread from your Objectives through to delivery, and everyone’s contribution to that delivery. Once you have identified the STP’s Objectives and how they will be measured (often through making the connection between each Objective and the relevant KPIs that measure operational performance) you can then associate your transformational projects with the relevant KPIs. Every project in which an STP invests should have a consequence; either enabling another project to deliver or contributing to the positive improvement in an operational KPI. By connecting individuals to each of the activities and deliverables within the projects you create the golden thread that shows how each individual is contributing to the Objectives of the STP. Creating these “Business Maps” is a way of setting out your strategy for achieving your Objectives. You can also start to better understand the contribution that each project is making to your transformation and the impact of late or non-delivery. NHS England has set out many KPIs for STPs, all of which should be considered in your business mapping process. After all, transformation is always about improving your operational business. If any of the NHSE KPIs do not map to one or more of your Objectives then you have either missed an Objective, or you believe that there is no operational value in that KPI (in which case you could link it to an Objective such as “Meet NHSE Requirements”).
  10. 10. © QOREX Ltd 2017 Action Steps First understand the STP’s Objectives and make them measurable by linking them to your operational KPIs. Align all your transformational projects with these KPIs and ensure that the projects have roles and responsibilities for delivery assigned. This then provides the golden thread from individuals’ delivery through to STP Objectives. Relational Business Management Software is essential in helping you to complete this task and to manage the ongoing delivery of your strategy and plans, after all it is impossible to hold this level of detail and complexity in your head. This will ensure your plans are easily understood, focused, and prioritised; establishing a clear line of sight from your STP objectives to how they will be accomplished, and by whom.
  11. 11. © QOREX Ltd 2017 Any organisation needs to have a consistent approach to delivery and standard ways of working if it is to be successful. This becomes even more critical when working in partnership across multiple organisations, such as an STP. In the absence of a consistent approach, your teams will do the next best thing – improvise. Typically, they will work individually, or in small groups, which results in lots of well-intentioned misdirection. Varying and unpredictable processes invariably lead to people working at crossed purposes and in an extremely inefficient manner. Consistency is about answering the question ‘How?’ How do I go about achieving this? How am I meant to deliver this task? How can I work collaboratively across the partnership? How do I work in a way that adds most value to the STP? How people work effectively, efficiently and collaboratively across an organisation or partnership is embodied informally within its culture and formally within its documented and active business processes. Formal business processes are only useful if they enable people to work efficiently, effectively and collaboratively and if they are adhered to. Defining and adopting a consistent approach to delivering your plans requires clear, simple, logical and shared processes that are communicated and adopted across the partnership. Consistency helps to ensure that everyone knows what they need to work on and provides a mechanism for monitoring and managing the performance of the applied processes. Adhering strictly to a well-defined business language in everything that you do helps enormously. Consistency reduces inefficiency, duplication and redundancy and enables you to introduce integrity and cohesion across the partnership. Most people don’t like change, they like stability and to remain in their comfort zone. They like to come to work and know what they need to do, how they are going to do it and how it contributes to the bigger picture. It is consistency that provides this stability for people. Consistency 3
  12. 12. © QOREX Ltd 2017 Everything that we deliver has four aspects to it: 1. Objective - what am I trying to accomplish and why? 2. Outcome - what am I expecting the measurable outcome to be? 3. Output - what physical things am I going to deliver? 4. Process - how am I going to create the output? This structure is in priority order. If you address what you are trying to accomplish, and why, followed by the outcome that you are trying to deliver, then the quality (conformance to requirement) of your output will be driven up naturally. The process is the controlled activity that you undertake to deliver the output and should be clearly defined and understood by the partnership. For example, providing a consistent approach to project management can have an enormously positive impact on the productivity and success of the STP. Providing a standard template that sets out all the required phases, project management milestones and deliverables along with the key project deliverables enables all projects to deliver, report and be governed consistently, efficiently and effectively. Productivity increases and the adopted project management methodology (e.g. PRINCE2) is deployed and adhered to across the whole partnership just by way of adopting your standard project management template.
  13. 13. © QOREX Ltd 2017 This approach has many benefits, not least of all it can be used to ensure that all projects have an agreed set of deliverables and an associated business case. Action steps Once you’ve understood why you are doing something (clarity) you then need to understand how to do it (consistency) through rigorous adoption of simple, standard and shared processes across your partnership. Appropriate Business Management Software can help you to define and adopt a consistent way of working and to share this across the multiple organisations that make up your STP. STP plan consistency maximises productivity and quality and enables your partnership to operate as efficiently and effectively as possible to maximise the return on your investment and deliver you shared STP Objectives.
  14. 14. © QOREX Ltd 2017 Having developed an agreed set of Objectives and Results that you plan to achieve, it is important that these are shared across your STP. You need to work together across your partnership to reach consensus rather than compromise and create an environment within which you can take shared responsibility for collective decision making. I have already talked about the importance of defining an agreed set of measurable Objectives that are shared across the STP. For effective collaboration, the focus is on making sure that relevant stakeholders have directly participated in the setting of these Objectives and they must believe in both the Objectives and the partnership enough to agree to take ‘cabinet responsibility’ for their achievement. This means that they must publicly support all the STP decisions made for the benefit of the STP. It is critical that the right people turn up, participate in finding the optimum solutions to the challenges being faced and help the partnership reach a consensus on the way ahead. Unfortunately, the agreed solutions might not always align fully with our personal preferences - however, when a consensus is reached the direction is set and should be followed by everyone. The best way - possibly the only way - to achieve the requisite level of collaboration is to, at least initially, work together, face to face, to agree the Objectives. Once agreed, capture them in a single repository where all can share access to them and update them with progress being made along with useful notes that add additional intelligence as their accomplishment progresses. In the spirit of complete transparency, all stakeholders across the partnership must have visibility of the portfolio of programmes and projects that will deliver the required health and care system transformation, and understand how this delivers the agreed plans and Objectives. All stakeholders across the STP must be clear on: ▶▶ Why they are doing what they are doing, ▶▶ The interdependencies between their work and the work of others, and ▶▶ How it contributes overall to the Objectives of the STP. This is one area in which being risk-averse pays dividends. Take no chances. Know who is accountable for what, know the interdependencies between different activities and different results, actively manage them, record and report against them so that all interested parties know what part they must play. Collaboration 4
  15. 15. © QOREX Ltd 2017 You must design your portfolio of programmes and projects so that there is an easy logic between what you do, what you measure and how those measures realise the targeted Objectives. ‘Keep it simple’ is the rule to follow here, as any unnecessary complexity will add both cost and confusion. It is important that you are prepared and able to share knowledge, expertise and best practice and leverage this across the whole STP for the best outcome for all. Just like when travelling in a thick fog, it is extremely difficult to drive forward with confidence if you cannot see clearly where the other vehicles on the road are. You need to be able to see what work your colleagues are assigned to, what they are actively doing, whether your trajectories remain aligned or whether you are now working at crossed purposes. In circumstances where this information is not clear, and teams revert to working in silos, time is either wasted because they are moving more slowly whilst trying to avoid collisions, or when time pressures are exerted, the risk is overlooked, and the team presses on regardless trying to optimise what they are doing locally, just hoping it will all work out in the end. The negative impacts arising from both sets of actions are often discovered late in the delivery process when the cost of recovery (if recovery is even possible) is usually much greater. Don’t put off understanding and establishing the joined-up nature of the whole and sharing that knowledge with all participants. The return on the investment you make will pay dividends across the whole portfolio and the partnership for years to come. Be as open as is possible with your information because great ideas can come from anywhere and the more people understand the whole solution, the more likely you are to achieve it. If your plans depend on the performance across multiple local delivery teams, make sure you are centrally capturing intelligence on what each team is doing and whether it is working well or not. Actively share your experiences and when you find something that works well, share it both locally and across other STPs that could benefit from it. Action Steps Collaboration isn’t just about working together but about co- operating to achieve the best results for the STP as efficiently and effectively as possible. It is about taking cabinet responsibility for accomplishing your shared STP Objectives and understanding how what you are doing relates to what others are doing to achieve the desired outcomes. This maximises productivity and quality and enables your partnership to operate as efficiently and effectively as possible to take full advantage of the return on your investment and deliver you shared STP Objectives.
  16. 16. © QOREX Ltd 2017 You can’t take control of whole system transformation without a whole system view of investment plans, delivery plans and benefit plans, where accountability and responsibility throughout is understood. Do you have an efficient, effective and affordable governance structure in place across your STP that ensures ultimate accountability for project delivery and benefit realisation and the decision-making process across the STP is clear? Governance is about decision making, as well as ensuring that things are controlled well enough for you to know that you can say, with confidence, that you are doing the right things, in the right way, for the right reasons. Governance processes often become unwieldy because people try to control absolutely everything. A good starting point would be to ask yourself what is most important for you to control and why, and then determine what information you need to be able to do that. It is likely that different amounts and types of information are needed at different levels within the partnership. So, whilst at a project level, you are likely to want to discuss how you ensure that day to day progress is being made at the right pace and delivering the right results, at a portfolio level you are more likely to need to know what is blocking you from doing what you need to and how to remove those blockages so that you can continue. At board level you may be more concerned with whether the strategy that you are following is the right one and whether the level of investment is appropriate. By keeping it simple, it should be easy to understand, as well as being effective and affordable. Make sure that you have suitable portfolio, programme and project boards in place that are fit for purpose. This means that they have a clear mandate, scope, budget and resource and that they are clear on what they are accountable for. It is also important that membership of your various boards is appropriate in terms of roles, experience and number of attendees. I have attended programme made, accountability and responsibility were unclear, and they just became talking shops for people to air their points of view. This is a very expensive and ineffectual way to govern. Do you have a mechanism for providing all STP stakeholders with access to a Single Point of Truth (SPOT) of holistic, high integrity, information and knowledge of your Objectives, Results, Performance and plans for delivery, presented in a way that is easy to understand? In a way, not having a single source of holistic, high integrity, performance information and recognising that what you have is not presented in a way that is easy to understand may be a blessing in disguise. Yes - it means you have a significant piece of work to do - but this brings you the opportunity to design your performance information so that it is fit for purpose for your partnership. The key Control 5
  17. 17. © QOREX Ltd 2017 here is to remember that sometimes less is more. There is a large amount of statutory information that you need to report on, however, when designing your measures, focus on the most important outcomes of your processes (e.g. patient centred, improving quality and timeliness of care for all patients) as the measures typically reinforce the behaviour you want to encourage. When you are clear about what you want to measure, you then need to think about three more things: 1. Make sure that the hierarchy of measurements makes sense. In other words, think about your audiences at the different levels in the governance structure and how the measures build from bottom to top. Ideally, the STP Board should be reviewing no more than 7-10 measures and those measures should be aggregated versions of the measures that sit beneath them. For example, the STP Board would be interested in indicators that measure progress towards closing any projected financial gap across the STP; the Medicines Optimisation Programme Board would be interested in measuring progress in delivering its contribution to that financial gap target; and individual projects within that programme would be interested in measuring the success of delivery of their project outcomes that enable those cost savings to be realised. 2. Think about how your measures associated with transformation are impacting the operational measures that you need to report on - linking these together will help in two ways, it confirms that what you are doing will (by design) impact the outcomes you need to achieve and publicly report against as well as helping you to profile and then explain the changes in performance you achieve as you progress. 3. You need to think about how you can present the information in a way that is easy for everyone to understand. Special skills should not be required to understand the picture you are painting when feeding back on your performance - so keep it simple, label things well and make the approach to reporting consistent across the whole transformation portfolio so that once you have understood it for one programme or project, you can understand it for them all. Do you have an objective view of your portfolio and its progress so that you can prioritise your resources on the things that are most urgent and most important to you? Prioritising your investments in programmes and projects is almost always difficult. There are a couple of reasons for this. People are invariably passionate about the programmes and projects that they are sponsoring. This is important as it is one of the things that really helps make sure they deliver. There is
  18. 18. © QOREX Ltd 2017 sometimes a downside…. In some organisations, it is not unknown for senior executives to sponsor what might be referred to as vanity or pet projects. Deprioritising these, due to the sponsor’s emotional commitment and positional power, can be very challenging. To explain the second reason let’s assume you are clear about the financial investment you are making and the value that each project or programme is expected to return. When the value is not presented in financial terms it is often believed that you therefore cannot compare it with another project or programme delivering a different value category. We all know that comparing ‘apples and pears’ doesn’t really work. However, it can be done if you use a method to ‘normalise’ the Results. This technique is often used in six sigma and lean engineering and can be applied in any industry. There are also business management systems that will do this for you. Whichever solution you opt for, make sure that the return on investment can be objectively measured so that you can rank everything within your portfolio to determine which gives you the best return and which gives you the worst. When this is understood objectively you can re-evaluate your portfolio based on value and then bring in other influencing factors (e.g. proximity and risk) into the dialogue when making decisions about what work you should start, stop or continue. When starting this journey keep it simple. Try to relate things back to financial Results where possible. If it isn’t possible – limit yourself to the same 7 -10 measures that the executives on the Board consider. If you don’t have the ability to normalise your Results across all value categories, at least aim to prioritise within each value category. You can do this using a simple calculation of what does it cost and how many units of value will that investment get you by the end of the project. Action Steps Keep your governance clear, simple and fit for purpose. Ensure you have a Single Point of Truth of holistic, high integrity, information and knowledge of your Objectives, Results, Performance and plans for delivery, presented in a way that is easy to understand. And ensure you have an objective view of your portfolio and its progress so that you can prioritise your resources on the things that are most urgent and most important to you. This enables you to take and retain control of delivering your STP plan across the diverse range of organisations and stakeholders in your partnership. OBJECTIVE 1 KPI 1 PROJECT 1 PROJECT 2 PROJECT 3 KPI 2 PROJECT 4 PROJECT 5 KPI 3 PROJECT 6 PROJECT 7
  19. 19. © QOREX Ltd 2017 The intricacy of partnership-working, inherent complexity and silo-working of the NHS virtually guarantees planning and delivery challenges for STPs. Coherence How do you design a plan that is logical, coherent and addresses national priorities while meeting the needs of your local population? Make sense of the demands on your STP to determine your strategic intent. Establish and manage a portfolio of work that invests in transforming operations to achieve your Key Performance Indicators and deliver your strategy. Use appropriate Business Management Software to help make sense of national and local STP requirements and consolidate them in one place, enabling you to construct a coherent plan that translates strategy into action and results. Clarity How do you ensure that your plans are easily understood, focused, and prioritised across the partnership? Understand the STP’s Objectives and make them measurable by linking them to your operational KPIs. Align all your transformational projects with these KPIs and ensure that the projects have roles and responsibilities for delivery assigned. This then provides the golden thread from individuals’ delivery through to STP Objectives. Use relational Business Management Software to complete this task and to manage the ongoing delivery of your strategy and plans. Consistency How do you ensure a consistent approach to delivering your plans across the STP? Adopt simple, standard and shared processes across your partnership. Use appropriate Business Management Software to define and adopt a consistent way of working and to share this across the multiple organisations that make up your STP. Summary
  20. 20. © QOREX Ltd 2017 Collaboration How do you create an environment in which people can collaborate, co-operate, and trust each other? Take cabinet responsibility for accomplishing your shared STP Objectives and understanding how what you are doing relates to what others are doing to achieve the desired outcomes. Control How do you control delivery of your plans when you have a diverse and dispersed range of stakeholders in your local health and care system? Keep your governance clear, simple and fit for purpose. Ensure you have a Single Point of Truth of holistic, high integrity, information and knowledge of your Objectives, Results, Performance and plans for delivery, presented in a way that is easy to understand. Have an objective view of your portfolio and its progress so that you can prioritise your resources on the things that are most urgent and most important to you. It is vital to eliminate these challenges to achieve the health and social care transformation you are tasked with delivering. Failing to address these challenges leads to an overly-complex, disjointed environment within which it is impossible to achieve your plans.
  21. 21. qorex.co.uk © QOREX Ltd web: qorex.co.uk email: info@qorex.co.uk Riverbridge House, Guildford Road Leatherhead, Surrey KT22 9AD Crown Commercial Service Supplier Phil Trickey 07834 800416 phil.trickey@qorex.co.uk Anna Byrne 07776 136913 anna.byrne@qorex.co.uk

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