Transcript Developing the Performance Management Framework

Developing the Gloucestershire Hospitals NHS
Foundation Trust
Strategic Performance Management Framework
Dr Sally Pearson
Helen Munro
Andrew Abbott, Courtyard Group
Background
At Project Initiation in July 2008, the Trust
had already made progress in developing
its strategy
•
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October 2007- Endorsement of an approach to Organisational Development (OD)
November to January 2008 - The ‘People First’ programme, representing the first
stage of the OD approach engaging a wide range of staff in the generation of the
Trust’s values
February 2008 – Board Seminar to :
• Review outcomes of ‘People First’ Programme
• Develop draft Values, Mission and Vision statements
• Identification of the key strategic challenges for the Trust
Mission
improving health by putting patients at the centre of excellent specialist care
Values
Listening to patients, putting their needs at the centre of everything we do, by
Working together to deliver excellent, safe health care in a clean environment, with
Valued staff who are motivated, well trained and have a helpful attitude.
The Trust had also defined a strategic
framework for developing the Vision and
Mission into Strategic Objectives
The Strategic Framework
Situational
Analysis;
External changes;
-National
-Local
Analyse
impact on;
Mission
Why we’re
here
Vision
Where are
we trying to
get to
Internal issues;
- how we
are performing
Strategic
Objectives
What we need
to achieve
‘In Year’
Priorities
What we’re doing to
achieve the strategic
objectives
Values
Our Style
This had resulted in a draft
performance management framework
Patient Experience
• to increase the proportion of
patients who can express high
satisfaction as a result of a positive
experience
-Planned care convenient for patients
-Privacy Dignity & Responsiveness
-Eliminating un-necessary waits &
duplication
-Communication
- Environmental improvements
Staff
•To increase the proportion of
staff who feel positive about the
Trust and their Job
•Leadership & teamwork
-Training, development
- Valuing and recognising good
performance
-internal Communication
-Staff engagement
-Job design and role clarity
Development of Our Services
•To increase the proportion of our
services viewed as specialist
Clinical Excellence
• To achieve the highest rating for
the quality of our services from
external bodies
-Rapid adoption and consistent
compliance with national guidelines,
standards and targets
-Maximising clinical safety
-Competent teams
-24/7 for emergency care
-Information systems to monitor clinical
outcomes
-Research and Innovation
Working in partnership
•To be regarded as excellent
corporate partners by our
Commissioners, other agencies
& providers and Customers
Finance and Efficiency
•To achieve the highest rating of for
the management of resources from
external bodies
-Generating surpluses to reinvest for
improvement
-Trust wide approach to quality
improvement and process redesign
-Service Line Reporting & Patient
Level costing
-Simplification of internal systems
- Service delivery responsive to
commissioners
-Corporate social responsibility
-Communication
-Reconfiguration
-Repatriation
-Dispersal
-Balancing demand & capacity
It became clear that existing systems
and processes for measuring
performance were not sufficient
Upon reviewing this framework, at its Feb 2008 meeting the Board stated:
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“The Board will wish to be assured of progress towards the strategic objectives and
achievement of the in year priorities, across the 6 domains identified…...”
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“This will require the current approach to performance monitoring and management at Board
level to be reviewed, including the contribution of the existing Board sub committees.”
This provided the mandate for developing a refined approach to performance management:
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•
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To review existing performance measurement and reporting processes and systems as to their
ability to assure the Board of progress towards the Strategic Objectives, and to set out an options
appraisal to address any gaps in existing systems
To introduce into the Trust appropriate best practice to better enable the organisation to manage its
performance, with the implementation of the preferred option in line with developing needs and
aspirations of the Trust
To assist in knowledge transfer from Courtyard Group to Trust staff, to ensure the Trust is selfsufficient as soon as possible and can carry forwards this work as appropriate within the Trust,
without the need to engage external consultancy support
Project Approach
Project Approach
Courtyard Group was engaged to define, implement and manage a project to develop the PMF.
Project Organisation is detailed in Appendix A
The approach for this project was to break it down into 2 main phases, progress against which was
governed by the Project Board:
Phase 1 – Discovery (July and August ‘08)
1.1 Project Initiation
1.2 Stakeholder Interviews
1.3 Feedback of key themes
1.4 Phase 2 proposal
Authorisation to Proceed
Phase 2 – Design and development (September – November ‘08)
2.1 Definition and Preparation
Authorisation to Proceed
2.2 Implementation and Refinement
Authorisation to Proceed
2.3 Business as Usual usage
Phase 1 outcome
Refinement of the existing performance framework was recommended to the Project Board.
This discovery work supported Courtyard’s initial recommendation, that before investing in any
Performance Management IT systems, the basics of a PMF needed to be in place.
From staff feedback about the current framework, it was acknowledged by the Project Board that:
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The domains were not yet fully defined and the purpose of the scorecard and its
development had not yet been communicated effectively across the Trust
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The objectives within each domain were not clear enough - a mixture of strategic and
operational objectives, measures, targets and initiatives
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The critical success factors (CSFs) describing the essential elements that need to be in
place to ensure achievement of the strategic objectives had not been defined
•
Therefore, appropriate measures could not be defined for all of the current objectives and
necessary CSFs
•
Governance mechanisms within the Trust for the strategic objectives were not clear
In response to this feedback, a tiered options
appraisal was requested to enable the Project
Board to commission an appropriate solution
PMF feature
Silver
Gold
Platinum
Comments
6 domains defined
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
CSFs for each domain along with statement of
purpose
Objectives and initiatives
defined
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
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SMART objectives and contributing initiatives
documented
Accountabilities agreed



Who is responsible and who is accountable for
the objectives and initiatives
Mandatory reporting
aligned
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
S4BH, NHSLA, Monitor, Management reporting,
aligned to framework
KPIs and PIs defined



Measures, targets, thresholds, data sources and
reporting agreed
Key Corporate projects
aligned
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
Aims of UTOPIA, IM&T, OD, NSFI, Service Line
Mgt etc. aligned to objectives
MS Excel based
Scorecard with RAG
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Performance measurement scorecard produced
with RAG indicators
Reporting sophistication
enhanced
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Online delivery, online measurement capture,
Dashboard reporting etc
Balanced Score Card
cascaded


Divisional and Speciality levels cascade, or
across programmes and projects
IT enabled process
automation

Process automation through IT solutions –
portfolio and Performance Management
Portfolio Management

A process for managing investments such that
you know that you are working on the right
things, in the right way, getting them done well
and getting the benefits
The agreed approach to developing the PMF
during Phase 2 involved 3 key stages
Definition and
preparation
Implementation
and refinement
Vision and mission
Collect data
Define Strategic
Objectives
Develop reporting
Business as usual
usage
Review reports
Agree remedial action
Agree Critical
Success Factors
Implement
Governance
Define Measures
and KPIs
Review processes
Review effectiveness
Agree Governance
Refine processes
Refine remedial action
Cascade
Manage actions
Courtyard Group resources were focused on
supporting these stages
Definition and
preparation
Implementation
and refinement
Vision and mission
Collect data
Define Strategic
Objectives
Develop reporting
Business as usual
usage
Review reports
Agree remedial action
Agree Critical
Success Factors
Implement
Governance
Define Measures
and KPIs
Review processes
Review effectiveness
Agree Governance
Refine processes
Refine remedial action
Cascade
Manage actions
Internal Trust resources were best placed
to support these stages
Definition and
preparation
Implementation
and refinement
Vision and mission
Collect data
Define Strategic
Objectives
Develop reporting
Business as usual
usage
Review reports
Agree remedial action
Agree Critical
Success Factors
Implement
Governance
Define Measures
and KPIs
Review processes
Review effectiveness
Agree Governance
Refine processes
Refine remedial action
Cascade
Manage actions
The project is currently at this stage, requesting
Authorisation to Proceed with KPI development
Definition and
preparation
Implementation
and refinement
Vision and mission
Collect data
Define Strategic
Objectives
Develop reporting
Business as usual
usage
Review reports
Agree remedial action
Agree Critical
Success Factors
Implement
Governance
Define Measures
and KPIs
Review processes
Review effectiveness
Agree Governance
Refine processes
Refine remedial action
Cascade
Manage actions
The Performance
Management
Framework
Strategic Objectives
In order to fulfil the mission, the following Strategic Objectives have been drafted, based upon the
previous iteration of the PMF, input from the stakeholder workshop held on 30 September ’08, and
ongoing development by the Project Board :
1.
2.
3.
4.
5.
6.
7.
Increase the proportion of patients who describe our services as excellent
Reduce harm to patients, staff, and visitors
Increase proportion of staff who describe us as excellent
Be regarded as an excellent partner organisation
Achieve the highest ratings for the quality of our Clinical Services
Optimise the use of our resources and ensure value for money
Develop our portfolio of services to meet the needs of the population
The Board is asked to endorse this description of the 7 Strategic Objectives
Performance Perspectives
In order to promote a balanced perspective of Trust performance, the approach and principles devised
by Kaplan & Norton in developing the Balanced Scorecard were adopted, but adapted for use in the
NHS
The Board is asked to endorse the proposed performance perspectives, through which Trust
performance in realising the Strategic Objectives is to be assessed
CLINICAL
EXCELLENCE
STAFF
PATIENT
EXPERIENCE
PARTNERSHIPS
FINANCE
&
EFFICIENCY
Critical Success Factors
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These can be described as what we must do well in order to achieve the
strategic objectives
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In addition, what behaviours do we want this CSF to engender (linking into
Trust values)
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The CSFs are placed in each performance perspective to ensure that a balanced
view of ‘must do well objectives’ is promoted and all perspectives are considered
•
The Board is asked to endorse the proposed Critical Success Factors and
Trust leads, which have been previously approved by the PMF Project on 11
November ’08
Improving health by putting patients at the centre
of excellent specialist care
STRATEGIC OBJECTIVES
1. Increase the proportion of
patients who describe our
services as excellent
2. Reduce harm to patients, staff,
and visitors
3. Increase proportion of staff who
describe us as excellent
PATIENT EXPERIENCE
1. Measure and exceed patient expectations, improving the patient experience
2. Ensure Patients experience no unnecessary delays
3. Involve patients and their carers in decisions about their care
4. Provide an environment that exceeds patient expectations
5. Ensure patients are treated with dignity and respect
6. Improve the quality, availability and communication of Information to patients, carers and the public
CLINICAL EXCELLENCE
7. Deliver an improvement in defined and measureable clinical outcomes
8. Deliver a comprehensive strategic clinical audit programme
9. Ensure a culture which supports and promotes high quality research and innovation
10. Be compliant with national standards for clinical care
11. Clinical Safety
STAFF
4. Be regarded as an excellent
partner organisation
5. Achieve the highest ratings for the
quality of our Clinical Services
6. Optimise the use of our resources
and ensure value for money
12. Enhance and extend the range and uptake of pay and benefits available to staff
13. Recognise and celebrate success
14. Enable staff to meet agreed individual and team objectives and deadlines
15. Develop high performing leaders and managers
16. Ensure personal competence is optimised through effective learning and development
PARTNERSHIPS
17. Be perceived as an excellent corporate partner
18. Communicate effectively with a wide range of stakeholders
19. Be responsive to Commissioner intentions
FINANCE & EFFICIENCY
7. Develop our portfolio of services
to meet the needs of the
population
20. Generate a ‘surplus’ to reinvest
21. Understand and optimise the use of resources, developing an approach to continuous systems
improvement – right first time, every time
22. Develop and maintain governance arrangements that are fit for purpose
23. Achieve the highest rating by external bodies
What next?
Key Performance Indicators
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The Critical Success Factors need measures to quantify performance progression
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These are called the Key Performance Indicators (KPIs), and are being developed to capture a
snap shot of Trust performance
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Key principles applied here are:
• We must have a balance of ‘input’, ‘process’, and ‘output’ measures
• We must consider both qualitative and quantitative measures
• We must agree what good performance is, with thresholds for Red, Amber, Green status
and timescales for achievement of targets
• We must make optimal use of existing performance measures, systems, processes and
people, to limit the burden of inspection
• We must ensure mandatory reporting is satisfied
• We must be prepared to stop reporting which is not mandatory or providing value
•
The Board is asked to support the PMF Project Board in developing the construction of the
KPIs
Example KPI construction
Perspective
Critical Success
Factor
Patient Experience
2. Ensure Patients experience no unnecessary delays (Steve Peak)
Key
Performance
Indicator
No delays index (Helen Munro)
KPI
construction
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Operational Delays
Patient Survey feedback
18 week RTT
A&E 4 hr waits
Patients waiting over the standard
Cancellations
No Delays run through
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Embed Excel file for no delays here
RAG status for ease of completion
Green =Routinely collect existing measure
Amber = collect, not routinely reported
Red =new or difficult to measure
Patient Experience
1. Measure and exceed patient expectations, improving the patient experience - Amber
2. Ensure Patients experience no unnecessary delays - Green
3. Involve patients and their carers in decisions about their care - Red
4. Provide an environment that exceeds patient expectations - Amber
5. Ensure patients are treated with dignity and respect - Amber
6. Improve the quality, availability and communication of Information to patients, carers and the public - Red
Clinical Excellence
7. Deliver an improvement in defined and measureable clinical outcomes - Red
8. Deliver a comprehensive strategic clinical audit programme - Amber
9. Ensure a culture which supports and promotes high quality research and innovation - Amber
10. Be compliant with national standards for clinical care - Amber
11. Clinical Safety - Amber
Staff
12. Enhance and extend the range and uptake of pay and benefits available to staff - Amber
13. Recognise and celebrate success - Red
14. Enable staff to meet agreed individual and team objectives and deadlines - Amber
15. Develop high performing leaders and managers - Amber
16. Ensure personal competence is optimised through effective learning and development - Red
Partnerships
17. Be perceived as an excellent corporate partner - Red
18. Communicate effectively with a wide range of stakeholders - Red
19. Be responsive to Commissioner intentions - Red
Finance & Efficiency
20. Generate a ‘surplus’ to reinvest - Green
21. Understand and optimise the use of resources, developing an approach to continuous systems
improvement – right first time, every time - Amber
22. Develop and maintain governance arrangements that are fit for purpose - Amber
23. Achieve the highest rating by external bodies - Green
Recommendations
Gloucestershire Hospitals NHS Foundation Trust Board is recommended to endorse:
1. The 7 Strategic Objectives
2. The 5 perspectives through which performance in achieving the Strategic Objectives
will be assessed
3. The 27 Critical Success Factors required to achieve the Strategic Objectives
4. The Executive leads acting as responsible owner for each CSF
5. Authorisation to proceed with completing the KPI constructions for each CSF
Appendix B – The Balanced Scorecard