The document summarizes the transformation of quality and costs at Hinchingbrooke Hospital under a new partnership with Circle. It describes how the hospital was previously rated as a "clinical and financial basket case" with dysfunctional services, poor quality ratings, and large deficits. Circle implemented its operating system focused on clinical leadership, culture change, and continuous improvement. Early successes included becoming one of the top hospitals for A&E wait times, reducing serious incidents by 60%, achieving cancer targets, positive CQC inspections, improved patient experience ratings and feedback, and eliminating the trust's deficit while delivering 7% annual savings.

1. Transforming quality and costs
at Hinchingbrooke Hospital
Nuffield Trust Summit, Thursday 7th March
Translating evidence into better care: the impact of clinical leadership and culture
Massoud Fouladi, Cofounder of Circle Partnership
Hisham Abdel-Rahman, Hinchingbrooke Clinical Chairman

2. ‘Clinical and financial basket case’
Quality Financial
• ‘Dysfunctional’ colorectal • £10 million deficit
service (RCS report) amounted to 10% of revenue
• A&E services rated • £12 million backlog
poor by commissioners of capital repairs
• ‘Red’ PCT rating for • Agency costs £4 million pa
serious incidents due to inability to fill vacancies
management • £40 million historic debt
• Small district general hospital serving 150,000 population
with 22 GP practices and approximately £100 million budget
• 235 beds, accident and emergency, maternity, intensive
treatment unit and full complement of secondary care services
• Innovative 10-year franchise arrangement in which Circle
operates the Trust and underwrites financial risks

3. Changing culture:
Creating a social movement through our partnership model
1,200 of the 1,700 strong workforce attended a four-hour
‘partnership session’ to agree collectively the business plan

4. Changing culture:
Alignment of everyone to common goals and plans

5. Circle’s operating system
Devolved power structure and
continuous improvement methodology

6. You achieve excellence by…
• Learning, adapting and improving at all levels of the organisation
• Developing four core capabilities
1. System designed for excellence, with the capacity to detect failure built-in
2. Problem solving to build new knowledge and drive improvement
3. Sharing new knowledge throughout the organisation
4. Leading by developing these skills in others

7. Mandated clinical leadership:
Flat structure with majority clinician board

8. Case study:
‘Stop the Line’: Toyota Andon System applied to healthcare
Rapid cycle improvement process

9. Case study:
Colorectal service transformation

10. Early successes
Clinical results
• First of 46 hospitals in A&E
• 60% drop in serious incidents
• Cancer target compliant
for first time
• CQC compliant for first time
since inspections commenced
Patient experience Financial
• Feedback up 852 to 24,000 • 7% annualised savings delivered
per annum • Trust in financial balance
• Top 10 of 46 for patient at zero cost to taxpayer
experience • £3.7 million Circle investment
• Food satisfaction up, parking in transformational change
fines scrapped, bedside
TVs installed

11. Has Circle delivered at Hinchingbrooke?