Management Quality Achieving Excellence in Physiotherapy Service Provision October 2011

Introduction Dr Robert Jones, Head of Therapy Services Directorate, East Sussex Healthcare NHS Trust Fiona Jenkins, Executive Director Therapies and Health Science Cardiff and Vale University Health Board

Objectives To understand the key concepts of Management Quality and Impact on patient care To understand the key concepts of Management Quality and Impact on patient care Share knowledge and Experience around UK Share knowledge and Experience around UK (With audience participation!) (With audience participation!) Encourage innovative thinking/action planning Encourage innovative thinking/action planning Damage limitation Damage limitation Introduce our Management Quality Matrix Introduce our Management Quality Matrix

Its not an easy time

Infinite Demand

The Health and Social Care Bill 2011 Themes Commissioning Commissioning Increasing democratic accountability “Public Voice” Increasing democratic accountability “Public Voice” Liberating NHS service provision Liberating NHS service provision Strengthening Public Health services Strengthening Public Health services Reform of arms-length bodies Reform of arms-length bodies

Coming to you Soon Chronic Disease Management, including Mental Health and carer support Chronic Disease Management, including Mental Health and carer support New science New science Building technology Building technology Flexible design Flexible design E prescriptions E prescriptions Prosthetics regeneration and bio engineering Prosthetics regeneration and bio engineering

Management Quality in Physiotherapy and the Allied Health Professions Key concepts of Management Quality Key concepts of Management Quality Impact on Physiotherapy Impact on Physiotherapy Where does it come from? Where does it come from? - the evidence-base and conceptual framework - the evidence-base and conceptual framework Why is it important? Why is it important? - patients and their families/carers - clinical practice - clinical practice - the staff - the staff - the organisation - the organisation - the Profession - the Profession

The Roles of Managers and Leaders Roles, duties and responsibilities The evidence-base - research - the literature The politics of therapy management and leadership today

Six Dimensions of Quality Communication Communication Participation Participation Employee development Employee development Measurement Measurement Delegation Delegation Integration Integration

The Three Phases of Excellence 1. Lean 2. Supply Chain 3. Strategic

The Don’t Dos 1.Regard any new idea from below with suspicion 2.Insist a hierarchy exists 3.Criticise others’ ideas 4.Treat problems as a sign of failure 5.Express criticisms; don’t praise 6. ‘Name and shame’ 7. Control everything 8. Plan change in secret 9. Delegate difficult decisions 10. Count everything that moves... frequently

Useful Questions What is the vision? What is the vision? What are the service goals? What are the service goals? How are we measuring performance? How are we measuring performance? What are the key processes and behaviours ? What are the key processes and behaviours ? How would YOU make this happen? How would YOU make this happen?

Management Quality Matrix: Standards 1. Strategy 2. Patient and service user experience 3. Clinical excellence 4. Finance 5. Information/metrics 6. Activity 7. Staff resource effectiveness 8. Staff management and development 9. Service improvement and re-design 10. Leadership and management development 11. Risk management 12. Corporate governance 13. Communications and marketing 14. Key performance indicators

How the Matrix is Constructed Standards Standards Components Components Systematic review and evaluation Systematic review and evaluation Measurement Measurement Targets are not goals in themselves Targets are not goals in themselves

Damage Limitation

Towards Excellence Evidence-base Evidence-base Comprehensiveness Comprehensiveness Responsiveness Responsiveness Added value Added value Sustainable Sustainable Cost efficient Cost efficient

Evaluating a wide range of performance parameters Evaluating a wide range of performance parameters Draws on management quality, industrial and healthcare excellence work Draws on management quality, industrial and healthcare excellence work Concepts: Performance Management ‘Lean’ Six Sigma Balanced Scorecard ‘Dashboards’ TQM Benefits Realisation Management Quality Matrix

Think about your service Is everyone in the team 'pulling' in the same direction? Is everyone in the team 'pulling' in the same direction? Does the direction benefit the patient? Does the direction benefit the patient? Are we measuring so that we know whether we are improving? Are we measuring so that we know whether we are improving? Do staff have the training, motivation and respect to provide value and bring about improvement? Do staff have the training, motivation and respect to provide value and bring about improvement? Are tensions around fear of change recognised and managed? Are tensions around fear of change recognised and managed? Are problems/mistakes treated as opportunities to improve? Are problems/mistakes treated as opportunities to improve?

“Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.” William A. Foster “Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.” William A. Foster “What gets measured gets managed.” Peter Drucker

Does Your Service Have Alignment? Between : Strategy Strategy Vision Vision Desired Outcomes Desired Outcomes Performance Performance

Metrics Measurement indicates progress towards value and responsiveness for patients. Measurement indicates progress towards value and responsiveness for patients. Facilitates best possible clinical outcomes, efficiency, effectiveness and optimal resource use. Facilitates best possible clinical outcomes, efficiency, effectiveness and optimal resource use.

Standard 1 Strategy: The service has a documented strategy which is reviewed and updated annually. 1.2 Do you have an up-to-date strategy for your service, that is currently available? 1.6 Major goals/objectives for your service; are these documented? What are they ? please list 1.9 Do you produce a service annual report outlining for example……

Standard 2 Patient and Service User Experience Patients’ views and experiences are actively sought and incorporated into service redesign Standard 2 Patient and Service User Experience Patients’ views and experiences are actively sought and incorporated into service redesign 2.1 Does your service use patient survey data to benchmark its services to patients 2.1 Does your service use patient survey data to benchmark its services to patients If yes, can you provide evidence where you have used this to improve services? If yes, can you provide evidence where you have used this to improve services? 2.13 Do you have a web site that the public can access information about your service? 2.13 Do you have a web site that the public can access information about your service?

Standard 5 Information and Metrics: The service gathers timely, accurate and relevant data as a by-product of clinical activity. Appropriate metrics are used for clinical and managerial purposes. 5.1 Does your service have a data collection system which is fit for purpose? 5.2 Does your service have a computerised data collection system fit for purpose? 5.3 Do clinicians input data at the same time that treatment takes place (real time)?

Standard 7 Staff Resources: There is a comprehensive knowledge and understanding of the staff resources used by the service and they are deployed effectively and reviewed frequently 7.2 What is the Whole Time Equivalent grade profile of your staff? 7.3 What is your ratio of registered to non-registered staff 7.6 What is your annual percentage absence 7.8 Does the service have sufficient expertise to provide comprehensive in-service education/training?

Standard 9 Service Improvement and Re-design: Your service actively undertakes re- design and service improvement Is service improvement embedded in staff job descriptions? 9.6 Have you undertaken ‘horizon scanning’ of other services (internal/external) to inform your service improvement needs? 9.11 Do you have staff trained with service improvement techniques to undertake service re- design?

Standard 10 Leadership and Management Development The service has effective leadership and management arrangements in place 10.1 Does the organisational structure support effective leadership and management? 10.1 Does the organisational structure support effective leadership and management? 10.4 Is leadership and management development programme in place for your staff? 10.4 Is leadership and management development programme in place for your staff? What % of staff in leadership/ management positions have undertaken management training? What % of staff in leadership/ management positions have undertaken management training?

How its used Share with your team Share with your team Completed standard by standard Completed standard by standard Evaluation Evaluation Summary Summary Action plan Action plan USE

Continual Process for Quality Improvement Innovate Whether your service is under attack or developing Look at what you do well Strive to be the best you can

Be a great leader…your team needs you!

References Loch C, Van der Heyden L, Van Wassenhove L, Industrial Excellence. Berlin: Springer. Loch C, Van der Heyden L, Van Wassenhove L, Industrial Excellence. Berlin: Springer. Loch C, Chick S, Huchzermeier A Industrial Excellence Award, Healthcare Questionnaire. Fontainebleau, INSEAD. Loch C, Chick S, Huchzermeier A Industrial Excellence Award, Healthcare Questionnaire. Fontainebleau, INSEAD. Jones, R, Jenkins, F., 2006 Managing and Leading in the Allied Health Professions. Oxford: Radcliffe Publishing Ltd. Jones, R, Jenkins, F., 2006 Managing and Leading in the Allied Health Professions. Oxford: Radcliffe Publishing Ltd. Jones, R, Jenkins, F., Developing the Allied Health Professions. Oxford: Radcliffe Publishing Ltd. Jones, R, Jenkins, F., Developing the Allied Health Professions. Oxford: Radcliffe Publishing Ltd. Jones, R, Jenkins, F., Key Topics in Healthcare Management: understanding the big picture Professions. Oxford: Radcliffe Publishing Ltd. Jones, R, Jenkins, F., Key Topics in Healthcare Management: understanding the big picture Professions. Oxford: Radcliffe Publishing Ltd. Jones R, Jenkins F Managing Money Measurement and Marketing in the Allied Health Professions. Oxford: Radcliffe Publishing Ltd. Jones R, Jenkins F Managing Money Measurement and Marketing in the Allied Health Professions. Oxford: Radcliffe Publishing Ltd. Jones, R, Jenkins, F., 2011 Top Tools and Techniques in Management and Leadership of the Allied Health Professions. London: Radcliffe Publishing Ltd. Jones, R, Jenkins, F., 2011 Top Tools and Techniques in Management and Leadership of the Allied Health Professions. London: Radcliffe Publishing Ltd. Official Marine Corps Biography. William A Foster. Who's Who in Marine Corps History. History Division, United States Marine Corps. Retrieved Official Marine Corps Biography. William A Foster. Who's Who in Marine Corps History. History Division, United States Marine Corps. Retrieved

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