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Seizing the Moment: Transformational Change

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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 ... – PowerPoint PPT presentation

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Title: Seizing the Moment: Transformational Change


1
Seizing the MomentTransformational Change
  • Peter Bradley
  • CEO LAS
  • DH National Ambulance Advisor

2
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3
The 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

4
What 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concerns Morale staff turnover issues Outdated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
5
What 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

6
What 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

7
Our 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.

8
LAS 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

9
Organisational change critical success factors
Clear shared vision and values
Pressure for change
Capability and capacity for change
Actionable next steps
10
Making change happen
Source Sarah Fraser
11
Service 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

12
Service 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

13
Outcomes
  • 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

14
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15
What have we learnt?
Climate Change
WHAT
Cultural Change
HOW
16
What 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

17
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18
What 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

19
Communicate 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

20
What 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

21
The 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

22
And 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

23
The 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

24
Ambulance Review
  • 5 key work streams
  • 70 recommendations
  • DH support
  • CEO lead roles
  • Director groups

25
Five 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.

27
CEO 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

28
Implementation 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 ?

29
Implementation 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 ?

30
Other 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

31
Other 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

32
Short 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

33
4) 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

34
  • Emergency Admissions
  • Workforce Skills

TIME
TIME
  • 999 Call Waiting
  • Appropriate Destination for Stroke CHD etc

TIME
TIME
35
  • Use of WICs, MIUs, other NHS

Clinical Telephone Advice
TIME
TIME
  • Costs per Call

Cardiac Arrest Survivors
TIME
TIME
36
Final 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

37
A service that responds appropriately to all our
patients
A service that looks, feels and behaves, and
delivers differently
38
Thank You
39
SEIZE THE MOMENTSuccessfully Managing Complex
Change
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