Title: Seizing the Moment: Transformational Change
1Seizing the MomentTransformational Change
- Peter Bradley
- CEO LAS
- DH National Ambulance Advisor
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3The LAS
- 625 square miles within M25
- 32 PCTs and 1 SHA
- Over 4,000 staff at 70 stations
- 400 ambulances, 70 cars, 25 specialist vehicles
- 1.3 million 999 calls annually (20 of ambulance
call volume in England - 900,000 ambulance responses annually
- 400,000 patient transport service patients taken
to and from clinics annually
4What was the LAS like 7 years ago?
Poor operating systems Poor working
practices Management issues Poor reputation Major
IR issues
Increased calls Lower road speeds Static real
funding Higher expectations Misuse of the Service
Poor pay for frontline staff Personal safety
concerns Morale staff turnover issues Outdated
IT and equipment
Poor response time performance
Variable clinical performance Unsafe
utilisation levels
5What was the LAS like 7 years ago?
- Internally focused
- Not meeting key performance targets
- Focus on what we disagreed on, not what we agreed
on - Management lacked credibility we werent
delivering - Strong union weak management
- Short of resources
- High turnover
- Low morale, no pride, lost identity
- No common vision
6What did we do?
- Brought in new senior management team members and
Chairman - Admitted our shortcomings to ourselves and our
staff - Undertook some diagnostic work
- Developed shared vision, purpose and values
- Top team commitment
- Built support externally
- Listened internally
- Acted quick wins
- Obtained investment
- Built trust and confidence with the unions
- Developed a 6 year Service Improvement Programme
7Our Vision
- A world class ambulance service for London
staffed by well trained, enthusiastic and proud
people who are all recognised for contributing to
the provision of high quality patient care.
8LAS VALUES (Professional Standards)
- C linical Excellence
- R espect and Courtesy
- I ntegrity
- T eamwork
- I nnovation and flexibility
- C ommunication
- A ccept responsibility
- L eadership and Direction
9Organisational change critical success factors
Clear shared vision and values
Pressure for change
Capability and capacity for change
Actionable next steps
10Making change happen
Source Sarah Fraser
11Service Improvement Programme
- 6 year programme ended in 2006
- Designed by staff, managers, unions and external
stakeholders - Programme Manager appointed
- 266 individual initiatives
- 239 completed
- 40 outcomes agreed to measure our success
people, patients and performance
12Service Improvement Programmekey areas
- Bringing resources in line with demand
- Strengthening management
- Improve support for staff
- Improve staff safety
- Managing demand
- Improve clinical effectiveness
- Improve risk management
13Outcomes
- Patients
- Complaints down 25
- Call to needle times reduced
- Cardiac arrest survival up from 2.5 to 9 (now
15.8) - Performance
- Category A performance 36 in 8 mins at the start
of the Programme 75 for 2006/2007 year - 999 call answering up from 60 to 90 in 5
seconds - People
- Turnover down from 11 to 3
- Staff absence down from 8 to 6.5
- 40 reduction in reported assaults
- Substantial improvements with staff survey
results
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15What have we learnt?
Climate Change
WHAT
Cultural Change
HOW
16What have we learnt?
- Performance obsession can be unhelpful
- Focus on how as much as what
- Middle management engagement
- OD strategy alongside SIP
- Programme management not just project management
- Outcomes before initiatives
- Appropriate support and expertise to deliver
programme
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18What have we learnt ?
- Quick wins/celebrating success
- Regular demonstration of progress
- On-going staff involvement
- Detoxifying cynicism and pessimism (Kotter)
- Remember the history
- The feel good factor needs refreshing
- Multi-layered communication is key
19Communicate again, again and again
- Internet, intranet available to all staff
- 40 meetings with 40 of workforce annually
- In-house monthly magazine and weekly bulletin
- Regular rideouts on ambulances
- Annual management/union conference
- Monthly meetings with CEO, HR and union officials
- 2 day induction course for all new staff
- CEO newsletters to senior managers
- 5 senior managers conferences annually
- 10 conferences with firstline and middle managers
annually
20What next ?
- OGC Feedback
- Redefining success balanced scorecard
- Building on what we have achieved for the whole
organisation - Leveraging efficiency 10 minimum
- Incorporating lessons learnt into new 7 year plan
- Real benefit realisations for LAS and NHS
support from ISIP
21The 7 Year Plan
Six aspirations
- An accessible service
- That responds appropriately
- Remains focussed on delivery, AND
- Engages its patients and partners
- Provides greater options for patients, and
- Has a culture built on our CRITICAL VALUES
22And five programme strands
- Operational model
- Access and connecting the LAS for health
- OD and People
- Corporate processes and governance
- The Olympic and Paralympic games
- Underpinned by stakeholder engagement strategies
- Using MSP, Programme Managers appointed
- Overarching aim to create an organisation that
looks, feels, behaves and delivers differently
23The Ambulance Review Strategic Vision
- Mobile healthcare, not just patient transport
- Quality call handling and advice
- A wider range of services, e.g. diagnostics
and long-term conditions management - Even better care for patients with
immediately life-threatening conditions
24Ambulance Review
- 5 key work streams
- 70 recommendations
- DH support
- CEO lead roles
- Director groups
25Five key workstreams for ambulance services
- Supporting the NHS in assessing and improving
Quality and Consistency of care by improving the
evidence base, accrediting independent providers
and developing clinical and outcome indicators. - Supporting the NHS in improving Efficiency and
Effectiveness of ambulance trusts through
facilitating national/ regional capital
procurements and effective use of technology/ new
models of service delivery.
26- Developing Organisations that are fit for purpose
by creating strategic capacity and improving
leadership, both clinical and managerial, so that
organisation structure, culture and style matches
new models of care. - Supporting Performance Improvement and restoring
public confidence in reported performance through
consistent measurement, service re-design and
progressively tighter focus on response times for
Category A calls - Facilitating further development of the Workforce
so that it is capable of meeting patient needs.
27CEO Lead Roles
- Will Hancock Procurement
- Paul Sutton - Emergency Preparedness
- Ken Wenman Urgent Care
- Paul Phillips - Clinical Effectiveness
- Anthony Marsh Leadership
- Jayne Barnes Performance / Communications
- John Burnside IMT
- Tim Lynch Workforce Development
- Chris Carney Training Education
- Simon Featherstone Foundation Status, PBR
Commissioning - Peter Bradley Benefits Realisation
28Implementation of
Recommendations
- 05 Evidence base for call categorisation ?
- 20, 21 improved clinical care ? (but more to
do) - 27 lead commissioner for each service ?
- 33 minimum dataset ?
- 40 Reduced number of ambulance services ?
- 43 demand analysis tool ?
- 47 New category A performance ?
29Implementation of
Recommendations
- 48, 50, 52 Modernised performance measures ?
- 53 - Call prioritisation should be reviewed
annually? - 56 support performance improvement ? (but more
to do) - 65 new careers literature ?
- 70 Five year workforce plans ?
30Other achievements
- Sponsorship to promote research into pre-hospital
care, and publication of updated clinical
guidelines to reflect latest evidence base and
professional consensus - Updated PTS guidance issued
- Rollout of ambulance radio programme / live in
Essex region - Review of non-pay spend to identify areas for
collaborative procurement
31Other achievements
- Co-ordinated programme of work to develop the
workforce, led by stakeholders and facilitated by
DH - Control room review undertaken
- Emergency preparedness audit completed
- Management capacity and capability audit about to
start
32Short list of benefits to be measured
- To resolve patients needs without them having to
leave home - To take fewer patients to hospital
- To achieve better survival rates for patients who
are seriously ill and injured - Myocardial Infarction Cardiac Arrest Stroke
Serious Trauma Respiratory Arrest - To achieve even better patient satisfaction
- To achieve high levels of staff satisfaction
- To achieve organisational improvement
334) To achieve even better patient satisfaction
- Through
- Improved speed of call answering
- Faster response times
- Improved care from independent sector
- Improved triage of calls
- Improved patient assessment
- Improved telephone advice
- Seamless call transfer
- Enablers
- (Ambulance review recommendations) 5,7,18,47,53
54 - Trusts own initiatives
34TIME
TIME
- Appropriate Destination for Stroke CHD etc
TIME
TIME
35- Use of WICs, MIUs, other NHS
Clinical Telephone Advice
TIME
TIME
Cardiac Arrest Survivors
TIME
TIME
36Final Thoughts
- Whose morale is it anyway ?
- Knowledge skills and attitude behaviour
competence - What is world class, is it achievable is good,
good enough ? - 20 years ago if you had a vision you got locked
up. Now you cant get a job without one
37A service that responds appropriately to all our
patients
A service that looks, feels and behaves, and
delivers differently
38Thank You
39SEIZE THE MOMENTSuccessfully Managing Complex
Change