1. Accountable care systems and insight and feedback
HOPE Network Presentation
Dan Wellings
DAN

3. STPs
STPs were announced in NHS planning guidance published in December 2015
At their most simple, STPs are plans for the future of health and care services across 44 geographical areas in England
The plans cover all areas of NHS spending, as well as focusing on better integration with local authority services and are long-term, covering the period from October 2016 to March 2021
NHS organisations in each STP area were required to work together to develop their plans; they are ‘place-based’ rather than focused on individual NHS organisations
STPs are a workaround of a complex and fragmented set of organisational arrangements

4. What does ‘place-based’ mean?

5. Accountable care
‘ACSs will be an ‘evolved’ version of an STP that is working as a locally integrated health system. They are systems in which NHS organisations (both commissioners and providers), often in partnership with local authorities, choose to take on clear collective responsibility for resources and population health. They provide joined up, better coordinated care. In return they get far more control and freedom over the total operations of the health system in their area; and work closely with local government and other partners to keep people healthier for longer, and out of hospital.’

6. Or as Rob Webster said…
Forget the acronym - a cipher for collaboration between local gov & NHS to deliver medium term changes using collective resources.

7. Opportunity in new systems to share insight and understanding about populations?

8. The work we did

9. Our objectives
Understand what an effective Insight and Feedback system looks like for Accountable Care Organisations (ACOs) and Accountable Care Systems (ACSs) at both a local and national level?
How is insight and feedback currently used?
Where does insight and feedback fit in decisions?
What are the opportunities and barriers for ACOs and ACSs? 
How could any barriers be overcome? 

10. What we’ve done
Initial literature scoping
Interviews with national and local NHS leaders, and non-NHS thinkers
ACO network
The population health analytics network
HARRY
Initial literature scoping
To understand what has been looked into already
What innovation there is in patient experience measurement and use
Interviews with national and local NHS leaders, and non-NHS thinkers
ACO network
The population health analytics network
Roundtable for testing ideas and discussion

11. Emerging thinking…

12. Patient feedback in NHS organisations now
Patient feedback’s role in the current system
Sits across patient experience leads, public engagement
Siloed
Seen as a ‘nice to have’
Seen as ‘soft’ data
Individual service focussed
Things lacking in current system
Joined up view of patient :
Joined-up within organisations
Joined-up across organisations
Putting patient feedback intelligence on an even keel with other data
Skills
An understanding of what patient feedback can do
Skills to gather and use feedback for change
And – effectiveness/efficiency debate?

13. Pathway dependencies Organisational Measure Expertise
Our patient experience lead has responsibility for the hospital
We don’t have any of the tools to measure patient experience over pathways
We only have quant/qual knowledge and that problem requires qual/quant
Responsibility does not extend beyond organizational boundaries
What can be measured dictates what can be changed
Methodological expertise narrows diversity of research
HARRY

14. Where we could get to STP/ACS
Accountability for the patient experience across the system
Patient-centred data collection across pathway
Data used to prompt further research (qualitative)
Patient insights used to instigate quality improvement across a pathway
Patient insights linked to population outcomes, used in risk modelling
Specific feedback being used as an input for self-care and remote monitoring
Ownership and trust between organisations
A learning system
Effective MDT-working with technology infrastructure
STP/ACS
Capacity and capability to ask the right questions
HARRY
Alignment between data teams and PX teams
Ownership and leadership within organisations

15. Ownership and leadership
What’s needed
Skills
Market
Incentives and levers
Ownership and leadership

16. Capacity and capability
This is likely to be issue
Who is insight lead in each organisation?
How do they work together?
Concern about capability at a senior level?
As ACSs start to redesign roles and redeploy staff how can you ensure right skills mix is taken into account?
Skill mix of analysts
External expertise? Agencies, academics?
Recruit specifically for the role?
Retrain existing staff?

17. What can we learn from New models of care?
Example of pathway dependency?
Using methods already available
Asking the wrong questions?
Listening in the same way?
Much more interventionist approach needed?
DAN

18. Asking the right question
People get the data and say we’re doing this badly so we’ll do this to make it better with out doing any diagnostics. They create an action plan without understanding the problem they are trying to solve. You need to ask “why” four times

19. Lessons from Getting it Right First Time
It’s about the method
Bring data together to ask questions
Approach of improvement not regulation
Practical solutions
Ownership

20. Improve PEX and Resource utilisation
Identify measures that work as well for finance directors and boards as PEX leads
Provide actionable insight as to how to improve PEX and resource allocation
This has to be a goal
Work with finance directors, directors of strategy to commission piece of work
DAN

21. DAN

22. Changing the purpose Patient experience Incentivise on collection
Insight
Incentivise on collection
Incentivise improvement
Organisations
Pathway approach
Data for holding account? ?

23. 20% usage 80% collection Building or refocusing a market
FFT market dominates
New types of supplier
Need to move to insight focus
Pathways and ethnography
New methods
Role for NHS England and NHS Improvement?
Suppliers to recommend improvements

24. Senior buy-in Director of patient experience? Senior ownership
Getting finance directors interested
Linking in with other initiatives: GIRFT, right care, data hubs
A focus nationally
How to get NHS England/Improvement boards as champions
Senior buy-in

25. Options for next steps

26. What’s possible? Work with a number of local areas
Make recommendations and work to implement them
Identify research questions/methods
Compile existing intelligence
Identify local areas
Work with a number of local areas
Do we identify a specific question to ask? DTOC, re-admission, pathways etc
What data? (not just PX data)
Research question – what further research needs to be done?
How should this research be done?
Making concrete recommendations?
Working to implement improvements
DAN

28. It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change
Charles Darwin
(and a Director of Operations from the West Midlands)

29. What are the priorities of your STP?
Which parts of your local population does your STP need to understand better to deliver these plans?
How, if at all, are your STPs getting insight into these populations and services? What do you know already? What else do you need to know?
What kinds of methods for understanding your population are they using?
Are there some methods you need to use more/less?
What about new techniques?
How might you and your organisation contribute to this work?
Who do you need to be working with?