Health Management Institute Institute of Healthcare Management

1
Health Management InstituteInstitute of
Healthcare Management

• Leadership for Service Modernisation
• Building New Organisations in Northern Ireland
• william.mckee_at_belfasttrust.hscni.net
• Dublin 15 May 2009

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The Iron Triangle of Health and Social Care
Safety and Quality
Access Responsiveness Expectations
Cost control Productivity
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Presentation format

• Opening comments
• Political timeline
• Some theory about mergers
• The merger process and our approach
• What worked well
• Further development needed

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Political timeline

• Devolution 98 to 02 and the Review of Public
  Administration (RPA) Bonfire of the Quangos
• Direct rule ministerial decisions Nov 05
• 18 trusts merged into 5 and operational April
  07
• 4 Boards replaced by Regional Authority April 08
• Devolution returns May 07 and Minister McGimpsey
  reviews structures
• Board and Agency replaces Authority

5
Stated objectives and unintended consequences of
mergers

• Stated objectives
• Savings
• Reducing performance variation
• Larger pool of staff, larger teams of specialists
• Other economies of scale, training,influence

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Unintended consequences of mergers

• Remote senior managers not devoting enough time
  to clinical staff
• Service managers remote from their services
• Loss of informality and familiarity, loss of
  autonomy and local decision making
• Unresponsive and slow decision making
• Previous direct access to senior managers now
  with middle managers
• Internal communications deteriorate
• Naomi Fulop et al

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Some advice from Machiavelli

• There is nothing more difficult to take in
  hand, more perilous in conduct, or more uncertain
  in its success, than to take the lead in the
  introduction of a new order of things

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Merging Six Trusts into One

• Brief shadow period
• Clarity of purpose and business
• Pace and engagement
• Kill the old organisations. Hold wakes
  Acknowledge grieving
• Managerial posts down to 5th level by competition
• Voluntary severance only after level below filled
• Structuring the new organisation

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Structuring three basic options
Professional Functional
User group Population cohort
Geographic Institutional
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Communication
Head of Office
Specialist Services
Clinical Services
22,000 employees 1,100 million revenue 340,000
population base
Mental Health Learning disability
Human Resources
Organisational Development
Finance
Chief Operating Officer Deputy Chief Exec
Nursing Patient Experience
Planning Development
Medical
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The Merger Iron Triangle
And.get organisational control
Safety and Quality
Access Responsiveness Expectations
Cost control Productivity
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People Management

• Volunteers not conscripts
• Staff and TU engagement and relationships
  management
• Clarity and honesty.
• Support mechanisms
• Investors in People award

13
Setting a strategic direction

• Business and purpose
• Values
• Involving you
• The Belfast Way
• New Directions
• Excellence and Choice

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SETTING A STRATEGIC DIRECTION The Belfast Way
PURPOSE
Improve health and wellbeing and reduce health
inequalities
BUSINESS
In partnership with others, and by engaging with
staff, deliver safe, improving, modernising, cost
effective health and social care
5 CORPORATE OBJECTIVES

• MODERNISATION
• Reform and renew our health and social
• Services
• Access
• Localise where
• possible, centralise
• where necessary
• Service reviews
• Aligned capital plans

• PARTNERSHIPS
• Improve health and wellbeing through partnership
  with users, communities and
• partners
• Citizen centred
• Joint working
• Civic leadership

• STAFF
• Show leadership and
• excellence through
• organisational and
• workforce development
• Investors in People
• Staff engagement
• Leadership
• Learning development
• Team effectiveness

• RESOURCES
• Make best use of
• resources by improving
• performance and
• Productivity
• MORE
• Workforce diagnostics
• Process improvement
• Resource utilisation
• VFM
• Performance management

VALUES AND BEHAVIOURS

Respect and dignity Accountabilities
Openness and trust Learning and development
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Financial challenges

• CSR and efficiencies 2.5 3.0 and 3.5 pa
• 90 millions plus a 30 m underlying deficit
• Not turnaround but MORE maximising outcomes
  resources and efficiencies
• Integrated into performance management and
  mainstreamed. Improvement and modernisation led
• The right patient getting the right treatment at
  the right time in the right place by the right
  person

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Performance management

• External top down pace setting approach at odds
  with internal culture
• Waiting time successes
• Sustaining improvements
• Board Assurance

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Senior team setting a tone

• Chief Executive or Chief Leadership and
  Engagement Officer
• A steady developmental journey weekly and
  monthly meetings and workshops
• Managing time and pace
• Setting the tone for the organisation respect,
  trust, boldness, diligence and fun
• Trust-risk-change-improvement
• Let purpose be our guide

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People and systems

• Success is 80 people and culture and 20 systems
  protocols etc
• But choose your systems carefully
• Toyota have average managers made good by great
  systems. The NHS has good managers made average
  by poor systems

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Areas for Improvement

• Moving from start up to sustainable progress
• Paretos 80/20 rule and wicked problems
• Systems, scheduling and capacity management
• Creating some headroom time out and support
• Making promotion attractive again
• Political leadership
• System commitment to stepped productivity
• Engagement especially clinical engagement

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• Getting started, keeping going, getting
  started again in art and in life, it seems to
  me this is the essential rhythm not only of
  achievement but of survival, the ground of
  convinced action, the basis of self-esteem and
  the guarantee of credibility in your lives,
  credibility to your selves as well as others.
• Seamus Heaney