The NHS is facing the biggest challenge in its history because of the squeeze on its budget, says its new boss.
In a speech on his first day as NHS England’s chief executive, Simon Stevens, will say the health service is enduring the most sustained “budget crunch in its 66-year history”.
He will warn navigating the next few years will require a huge effort.
And he will say only by “radically transforming services” will the NHS continue to thrive
It’s virtually impossible to like everyone you meet. It’s even more unlikely that you will get along with everyone at work. People have different personalities, biases, values, ambitions, and interests, all of which affect the chemistry of their relationships. And if you throw in the pressures of the workplace, it’s hardly surprising that tensions arise between colleagues and co-workers. But when members of a senior management team don’t get along, the negative impacts can cascade through an organization. Those conflicts have the potential to reduce productivity and morale for dozens or hundreds of people.
We are faced with the need to make decisions every day. Should we bring product A or B to market? Which marketing strategy should we use? Of the choices that we have available, who is the best person to hire or who would make the best partner? In each case, we try to rely on as many facts as we can so that we can make a reasonable estimation of the best path to follow. At first glance, the approach of weighing the evidence rationally seems perfectly reasonable. Yet, in so many instances, rational predictions fail. Why is that? And what can we do about it?
Do you often feel reactive instead of proactive? Do people complain that decisions at the top take too long to percolate down to the frontlines? If so, you probably manage your organization and your direct reports through weekly meetings and email. You should instead consider “leader standard work.”
The article discusses research on quality-improvement actions and strategies that employers use to encourage employees to care about quality outcomes and to make quality a cultural value in the organization. The researchers found that leadership emphasis, message credibility, peer involvement, and employee ownership are attributes which predict a corporate culture focused on quality. The discussion topics include making quality a leadership priority, delivering communications that appeal to workers, holding peers responsible for quality, and empowering workers to make quality decisions and to challenge directives that do not maintain or improve quality. INSET: THE FOUR ESSENTIALS OF QUALITY
This resource requires an OpenAthens account you can register here from an NHS connected computer (you can email us to request one) or call Evidence Services on 0151 285 4493.
As we move into 2014/15, the leadership challenge for NHS providers remains significant. Improving quality for patients at a time of growing financial constraint is an increasingly demanding goal for NHS trusts, one which we must take on at a time when the scrutiny applied to the NHS is rightly more intense than ever before. This Accountability Framework sets out how the TDA will work alongside NHS trusts to meet this challenge.
Additonal Information
Documents containing supporting guidance which provide further detail to help trusts understand the processes set out in the Accountability Framework.
http://www.ntda.nhs.uk/blog/2014/03/31/af2014/
“Local processes and professional and microsystem considerations played a significant role in adoption and implementation.”
Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in health care
Y Kyratsis, R Ahmad, K Hatzaras, M Iwami, A Holmes
HS&DR, 2014, 6(2)
“Part of the reason why quality improvement is so hard to achieve may be that those involved in leading QI programmes need to deploy three different but interrelated types of improvement skills: technical, soft and learning skills.”
Skilled for improvement?
The Health Foundation
March 2014
“Recognising these different patterns should help identify at-risk diagnoses where quality of care can be improved in order to minimise the excess mortality associated with weekend admission.”
Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study
O Perez Concha, B Gallego, K Hillman, GP Delaney, E Coiera,
BMJ Quality & Safety, 2014, 23:215-222
This paper sets out the Government’s response to the five recommendations directed to the Department of Health. The response can be divided into two sections:
The article presents the author’s perspective on transformational management, noting that the transformation truths discovered by Liz Clairborne apparel company’s business teams include the idea that transformation is an era and not a short-lived moment or event in a company’s history. The management topics include sustaining a vision, building a brand, and reorganizing teams.
This resource requires an OpenAthens account you can register here from an NHS connected computer (you can email us to request one) or call Evidence Services on 0151 285 4493.
The Learning Communities Initiative aimed to explore the use of organisational techniques such as learning communities and communities of practice. It set out to work with selected improvement groups in the NHS to help them learn collectively about proven improvement methods (‘improvement science’) and to examine how the learning process – and hence the enhancement of quality – could be better deployed in future improvement initiatives.
The four improvement groups proved very different in terms of their characteristics, cultures and processes, and the extent to which they achieved their improvement tasks. This report presents a detailed picture of the four contrasting improvement stories – which, in effect, proved to be a natural experiment – and analyses the reasons why there were such significant differences in what they achieved and how.
Aims to provide a toolkit that will enable a consistent approach, to be adopted across the NHS, for combating inflationary pressures.
NHS Providers are being advised by the Department of Health to resist blanket inflationary price increases from suppliers; an approach supported by both the Trust Development Authority (TDA) and Monitor. The NHS has been facing inflationary pressures well above the norm and increasingly NHS Providers are not receiving uplifts in budgets to cover such price increases. Our goal, as a minimum, is to ensure non-pay expenditure is inflation-free until at least the end of 2015-16, to keep a balanced budget and to continue to provide a quality service for patients by protecting the front-line.
This guidance has been developed with the support of a number of NHS Providers and includes some examples of best practice they have implemented to tackle these financial pressures. It is not intended to be a comprehensive guide to supplier management, but does provide some basic processes and templates to support
those NHS Providers who are embarking on implementing supplier management in their organisation.
Across the country, hospitals and primary and community care organisations are working together to look at ways of delivering safe and effective care over seven days a week. This helps address the link between poorer outcomes for patients and the reduced levels of service provision at the weekend.
This new publication summarises service improvement achievements and potential challenges. While significant progress has been made we need to strive to find new and innovative solutions that are both clinically and financially sustainable to change delivery of diagnostic and scientific services to meet the needs of service users.
A new coalition of people and organisations across the health, social care and voluntary sectors has been launched to make person-centred coordinated care for people with long term conditions a reality.
The Coalition for Collaborative Care is using an approach called the House of Care to improve care and support planning for the 15 million people in England who have a long term condition. That means improving the relationship that people have in their day-to-day interaction with the NHS and social care so their care and support is organised around what matters to them.
There are many social enterprises throughout the North West, with several being set up during the NHS transition, when Primary Care Trusts (PCTs) were closed down and services transferred to other organisations.They helped to ensure that the provision of certain services were sustained and even extended. This overview is intended to give a snapshot of such organisations, including Bolton Community Practice Community Interest Company (CIC), Spiral Health CIC, Future Directions CIC and One to One Midwives.
Guidance from the Whistleblowing Helpline containing a number of recommendations, aiming to help make whistleblowing an important part of improving the quality of service user support and patient safety.
Report from Dr Foster Intelligence that calls on NHS England and the Health and Social Care Information Centre to improve the consistency and accuracy of data recording to improve monitoring of patient care.
The report note that calculating adjusted mortality ratios that take account of whether or not patients were admitted for palliation or treatment at the end of life are extremely useful to clinicians and managers of health services.
The ability to provide such information has been undermined in recent years by growing variation in clinical coding practices and a lack of rigour in the coding definitions. This report summarises the changes in coding practices in recent years.
British Journal of Nursing, Vol. 23, Iss. 6, 27 Mar 2014, pp 338
This series explores what reflection is and how it can be applied to your clinical practice. It examines some of the techniques that you can use to aid reflection and looks at portfolios, reflective learning and helping others to reflect.
Reflection: from staff nurse to nurse consultant. Part 4: Reflective feedback – (BJN Article request full text from Trust Library Services or call 01942 822508)
Whistleblowing Helpline –
This guidance contains a number of recommendations, aiming to help make whistleblowing an important part of improving the quality of service user support and patient safety.
If you were asked to identify the most strategic and valued unit in your corporation, the procurement department would probably not come to mind. The term procurement itself has a very administrative connotation: It’s associated with buying ‘stuff’ for the lowest prices possible.
Today’s corporations are directing more and more of their budgets toward a complex web of global specialist providers and suppliers to help deliver on their businesses’ core strategies. A recently released global study of nearly 2,000 publicly traded companies found that 69.9% of corporate revenue is directed toward externalized, supplier-driven costs. In the last three years alone, companies have increased their external spend as a percentage of revenue by nearly 4%.
As a result, the role of procurement is magnified. Or, at least, it should be magnified. Suppliers must now be viewed as an extension of the company. Like the internal workforce, they must be incentivized, coached, sanctioned, and rewarded to help achieve corporate objectives.
However, procurement doesn’t register on the C-suite’s radar in a manner proportionate to its growing importance within the organization, and most procurement departments are neither ready nor empowered to take on their new responsibilities. This post gives some of the reasons for this.
With the exception of “dyed-in-the-wool” unforgiving types (you know, the people who seem to delight in ruining family holiday dinners), one of the things nearly all of us are defenseless against is a sincere, earnest, unsolicited apology.
Despite its power, there are not a small number of people in this world who have never received one — and an equally sizable number of people who have never felt they owed one to someone. And yet for the majority of people, it’s disarming and intriguing enough to lower their guard to hear what the apologizer has to say.
If you’re unsure of the value in delivering a sincere, earnest, unsolicited apology, you need go no further than the neurology of mirror neurons. Mirror neurons appear to help us with learning and empathy. But they can also have a negative impact, such as when criticism triggers defensiveness (i.e. a reciprocal criticism from the criticized) and bared teeth trigger reciprocally bared teeth. In the case of a sincere, earnest, unsolicited apology, receptiveness begets more openness. Still too soft? You need look no further than conflicts you have successfully resolved at home with your spouses, children or parents… unless of course you truly believe that your “my way or the highway” approach to life has served you well.
So, I can’t guarantee that it will work, but if there is someone you work with that is not cooperating and with whom you would like to improve cooperation, it might be worth your trying. The sincere, earnest, unsolicited apology consists of five steps:
More than 65 years ago in Massachusetts, doctors began a longitudinal study that would transform our understanding of heart disease. The Framingham Heart Study, which started with more than 5,000 people and continues to this day, has become a data source for not just heart disease, but also for insights about weight loss (adjusting your social network helps people lose weight), genetics (inheritance patterns), and even happiness (living within a mile of a happy friend has a 25% chance of making you happier).
Upon reading about the study, I wondered if the idea of such long-term research could be attempted in another field that touches all of us: work. After more than a decade in People Operations, I believe that the experience of work can be — should be — so much better. We all have our opinions and case studies, but there is precious little scientific certainty around how to build great work environments, cultivate high performing teams, maximize productivity, or enhance happiness.
Inspired by the Framingham research, our People Innovation Lab developed gDNA, Google’s first major long-term study aimed at understanding work. Under the leadership of PhD Googlers Brian Welle and Jennifer Kurkoski, we’re two years into what we hope will be a century-long study. We’re already getting glimpses of the smart decisions today that can have profound impact on our future selves, and the future of work overall.
Podcast by Harvard’s Robert Kegan on companies that do really personal development.
This briefing from the King’s Fund describes the different types of accountable care organisations (ACOs) – a group of providers that take responsibility for providing all the care for a given population for a specified period of time, emerging in the United States; presents some early evidence on their performance; assesses the future for ACOs; and discusses the implication of these developments for integrated care initiatives in England. They have emerged in the US to provide a more integrated approach to care.
Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort.
Implementation Science 2014, 9:39 doi:10.1186/1748-5908-9-39
Department of Health –
The duty of candour will require all health and adult social care providers registered with the Care Quality Commission to be open with people when things go wrong. The regulations would impose a specific and detailed duty of candour on all providers where any harm to a service user from their care or treatment is above a certain harm-threshold. This consultation sets out what the Department of Health are proposing, includes a draft of the regulations that will introduce the duty of candour and asks about the impact of our proposals and the impact of the new regulations on providers. The consultation closes on 25th April 2014.
Carers UK –
With our ageing population and workforce, dementia is becoming an increasingly significant issue in the workplace, with more and more people combining work with caring for a loved one. In recognition of this, Carers UK and Employers for Carers carried out an employer and employee survey between October 2013 and January 2014 to find out the impact of working while also caring for someone with dementia. This report sets out the key findings and emerging issues from these surveys. It concludes by making 10 recommendations for employers, health and social care services and government to take to facilitate better support for employees who are caring for loved ones with dementia.
Acute services in the NHS in England are facing a year of particular financial pressure in 2015-16, when changes to funding arrangements will see £2bn transferred to community health and social care provision, a parliamentary report has warned.
MPs: Monitor ‘must not be an obstacle to change’ – (HSJ Article request full text from Trust Library Services or call 01942 822508)
NHS Trust Development Authority chief executive David Flory has warned “a significant proportion” of the trust sector has no “clear plan for sustainability”.
Flory: ‘Significant proportion of trusts have no clear plan for sustainability’ – (HSJ Article request full text from Trust Library Services or call 01942 822508)
Executives who combine work and family emphasize the importance of defining success for themselves. In our last blog post, we talked about objective versus subjective success — the difference between your quantifiable, Wikipediable list of accomplishments and your day-to-day emotional and intellectual pursuits. Like everyone else on the planet, you have only 168 hours per week to spend. So it’s important to strategically allocate your time to the objective goals that will bring you the most subjective satisfaction.
But what brings satisfaction? It’s different for different people — even at the same workplace, even in the same role. If you’re trying to answer that question about yourself or your employees, here’s a helpful framework from Managing the New Careerists, by former BYU management professor C. Brooklyn Derr. Though the careerists aren’t so new anymore (the book came out more than 25 years ago), Derr offers an interesting historical perspective on the rapidly changing world of work — and keen insights about human nature, which evolves much more slowly. He outlines five “career orientations,” which tend to shift over time, depending on life circumstances.
The second rounds of the NHS’ two technology funds are due to be “promoted and launched” over the next two months and will focus on integration.
The first round of funding has been approved and awarded for both the ‘Safer Hospitals Safer Wards: Technology Fund’ (known as the ‘tech fund ’) and the Nursing Technology Fund, and second rounds will soon follow.
An update of the NHS terms and conditions of Service Handbook and published a new record of amends, following the publication of Pay and Conditions Circular (AfC) 1/2014.
The new pay circular contains details of a non-consolidated increase of one per cent, payable in monthly instalments, with effect from 1 April 2014 and ending on 31 March 2015 for staff who, on 31 March 2014, are on the top pay point in their pay band.
These new arrangements for pay for Agenda for Change staff, are incorporated into Amendment number 30 to the NHS terms and conditions of Service Handbook.
A new ambition to reduce avoidable harm in the NHS by half over the next three years, cut costs and save up to 6,000 lives has been outlined by Jeremy Hunt. In a speech at Virginia Mason Hospital in Seattle, the Secretary of State has announced details of how NHS organisations can work together to improve patient safety and save money.
Each NHS organisation will be invited to ‘Sign up to Safety’ and set out publicly their ambitious plans for reducing avoidable harm, such as medication errors, blood clots and bed sores over the next three years. The NHS Litigation Authority, which indemnifies trusts against law suits, has agreed to review the plans and, when approved, reduce the premiums paid by all hospitals successfully implementing them. Every year the NHS spends as much as £1.3 billion on litigation claims.
Additional Item
Hunt to launch patient safety ‘movement’ to halve harm -(HSJ Article request full text from Trust Library Services or call 01942 822508)
A colleague has just sent you an email relating to a meeting you’re having in one hour’s time.
The email is supposed to contain key information that you need to present, as part of the business case for an important project.
But there’s a problem: the email is so badly written that you can’t find the data you need.
There are misspellings and incomplete sentences, and the paragraphs are so long and confusing that it takes you three times more than it should to find the information you want.
As a result, you’re under-prepared for the meeting, and it doesn’t go as well as you want it to.
Have you ever faced a situation similar to this? In today’s information overload world, it’s vital to communicate clearly, concisely and effectively. People don’t have time to read book-length emails, and they don’t have the patience to scour badly-constructed emails for “buried” points.
The better your writing skills are, the better the impression you’ll make on the people around you – including your boss, your colleagues, and your clients. You never know how far these good impressions will take you!
In this article, we’ll look at how you can improve your writing skills and avoid common mistakes.
Short quiz to help judge your listening skills. Provides basic overview on three different levels of listening and tips and links to additional resources on how to improve.
Providing compassionate care is not only a concern for nurses, it is relevant throught the health service. “Compassion” was undoubtedly one of the healthcare buzzwords of 2013. A year of negative headlines, chief among them those arising from the scandal in Mid Staffordshire, spoke of a system in which production-line attitudes and procedure-driven philosophies have condemned the fundamental notion of humanity to shell shocked afterthought. It’s perhaps revealing that the vast majority of discussions concerning compassion in the NHS continue to champion it as essential to the nursing profession while neglecting to contemplate its relevance anywhere else.
Compassion and cost-effectiveness can work together – (HSJ Article request full text from Trust Library Services or call 01942 822508)
Alongside midwifery units (AMUs) were identified as a novel hybrid organisational form in the Birthplace in England Research Programme, to which this is a follow-on study. The number of such units (also known as hospital birth centres) has increased greatly in the UK since 2007. They provide midwife-led care to low-risk women adjacent to maternity units run by obstetricians, aiming to provide a homely environment to support normal childbirth. Women are transferred to the obstetric unit (OU) if they want an epidural or if complications occur.
This study aimed to investigate the ways that AMUs in England are organised, staffed and managed. It also aimed to look at the experiences of women receiving maternity care in an AMU and the views and experiences of maternity staff, including both those who work in an AMU and those in the adjacent OU.
An organisational ethnography approach was used, incorporating case studies of four AMUs, selected for maximum variation on the basis of geographical context, length of establishment of an AMU, size of unit, management, leadership and physical design. Interviews were conducted between December 2011 and October 2012 with service managers and key stakeholders (n = 35), with professionals working within and in relation to AMUs (n = 54) and with postnatal women and birth partners (n = 47). Observations were conducted of key decision-making points in the service (n = 20) and relevant service documents and guidelines were collected and reviewed.
Women and their families valued AMU care highly for its relaxed and comfortable environment, in which they felt cared for and valued, and for its support for normal birth. However, key points of transition for women could pose threats to equity of access and quality of their care, such as information and preparation for AMU care, and gaining admission in labour and transfer out of the unit. Midwives working in AMUs highly valued the environment, approach and the opportunity to exercise greater professional autonomy, but relations between units could also be experienced as problematic and as threats to professional autonomy as well as to quality and safety of care. We identified key themes that pose potential challenges for the quality, safety and sustainability of AMU care: boundary work and management, professional issues, staffing models and relationships, skills and confidence, and information and access for women.
AMUs have a role to play in contributing to service quality and safety. They provide care that is satisfying for women, their partners and families and for health professionals, and they facilitate appropriate care pathways and professional roles and skills. There is a potential for AMUs to provide equitable access to midwife-led care when midwifery unit care is the default option (opt-out) for all healthy women. The Birthplace in England study indicated that AMUs provide safe and cost-effective care. However, the opportunity to plan to birth in an AMU is not yet available to all eligible women, and is often an opt-in service, which may limit access. The alignment of physical, philosophical and professional boundaries is inherent in the rationale for AMU provision, but poses challenges for managing the service to ensure key safety features of quality and safety are maintained. We discuss some key issues that may be relevant to managers in seeking to respond to such challenges, including professional education, inter- and intraprofessional communication, relationships and teamwork, integrated models of midwifery and women’s care pathways. Further work is recommended to examine approaches to scaling up of midwifery unit provision, including staffing and support models. Research is also recommended on how to support women effectively in early labour and on provision of evidence-based and supportive information for women.
The National Institute for Health Research Health Services and Delivery Research programme.
Donna Willis
Senior Consultant, Leadership Development
Shortly after joining The King’s Fund, I facilitated a commissioned leadership programme for newly appointed consultants. A general surgeon, challenged by the issues the programme raised for him, asked me: ‘Would you perform your own appendectomy, Donna?’
The possibility had never crossed my mind: ‘I wouldn’t know where to start,’ I replied, rather meekly. ‘Quite!’ he exclaimed. ‘That’s how I feel about all this leadership stuff!’
There are times when all of us feel anxiety around our competence. It’s common and a part of being human. Clinicians are experts in their specialties and we, as patients, rely upon their competence to aid recovery from illness. However, the skill-set clinicians need to lead effectively is quite different, and learning to confidently and competently deploy leadership skills, attitudes and behaviours is paramount. Diverse teams of health care professionals who have shared collective leadership are absolutely crucial to the leadership of today’s health service.
Emergent clinical leaders are the leaders of the future. It is they who will increasingly provide care across organisational and health and social care boundaries. It is they who will establish fit-for-purpose multidisciplinary care that leads to better patient outcomes, centred on the needs of patients and service users.
This set of multi-media resources share valuable learning and insight from HWBs across England on their development as system leaders and explore three key themes: facilitating shared ownership; working across boundaries; and the future of system leadership.
We all have good ideas. The hard part is making them happen.
HR departments love handing out worksheets on how to plan your time. Management gurus have written hundreds of pages of advice on how to better manage your week, your day, and your hour.
But what happens when you try and apply that advice to your team or organization? How do you deliver complex, multi-level, multi-year programs of work across teams and business units that may be, quite honestly, in chaos?
I sat down with three senior executives leading major projects at complex, fast-moving organizations and asked them what they do to be effective. They had all worked across multiple industries in their careers, run successful projects (and also some that had failed), and extracted lessons that made sense at every organizational level.
Here are the three tips they said had the biggest impact.
The potential benefits of workplace variability are numerous — increased morale, motivation, and the ability to attract and retain talent — yet many managers don’t know where to start. Others are afraid that performance could suffer or something important could fall through the cracks.
Even the most employee-oriented managers have concerns about having employees work outside of normal work hours or at places other than the office. However, by taking a job design approach to workplace flexibility, managers can get the benefits of offering more flexibility while minimizing the downside. Here’s what you need to know.
Are you working endlessly but not accomplishing all you want? Mystified that continuous attention to work is not resulting in satisfactory progress toward your goals? So focused on work that you’re not thinking about or doing much else? If so, you may not be giving your brain the benefit of adequate downtime. A recent article in Scientific American, Why Your Brain Needs More Downtime, summarizes the evidence that “mental breaks increase productivity, replenish attention, solidify memories, and encourage creativity.”
How can hard-working business leaders get the downtime they need? In my executive coaching practice, I help clients reach peak performance by actually doing less work at key times—and by engaging in downtime activities that cutting-edge research shows to be effective in boosting productivity.
Here are five tips for getting downtime so that you can perform better than ever.
How many times have you been in a brainstorming session this week? Chances are the answer is, “More than I can count.” But no study has proven that brainstorming works well, even though it has been the go-to method for idea generation since 1953.
But there is an alternative. After researching why brainstorming inhibits creativity and innovation, my colleagues and I came up with a new process we call Brainswarming. Watch the video on the website for more information on what it is and how you can implement it.
The National Information Board will release a new informatics strategy for consultation in May, to be used to inform commissioning decisions from September this year.
Plans for the 2-5 year strategy are outlined in a paper presented to a NIB working group meeting today.
Successful Nursing Technology Fund trusts will spend millions on mobile devices such as tablet computers before the end of this month.
According to analysis done by EHI Intelligence, 31 of the 85 projects that have been awarded funding from the £30m first round of the Nursing Technology Fund involve deployments of mobile devices or systems.
Dympna Cunnane, Organisation Development Consultant and Programme Director at London Business School, discusses her views on how healthcare leaders respond to the pressures of the job and their role in ensuring high quality, compassionate care for patients.
Slide deck detailing the following:
The key findings from discussions with HWB members about enabling and encouraging cross-HWB working:
Research briefing that explores local charities and voluntary organisations attitudes and experiences of local health organisations. This report explores the extent to which they feel able to influence Joint Strategic Needs Assessments (JSNA). Finds a mixed picture in terms of voluntary organisations feel their views and those of their beneficiaries influenced and impacted upon local priorities. Some local relationships are in their early stages of development, although others report feeling excluded from the development of JSNA or that involvement has been largely symbolic and so has little impact.