Mission
Background
Due to the poor performance seen in the recent clinical governance reports, especially in the following indicators, Infections, Medication errors, Falls, NDAR (unexpected deaths), Nutrition (weight tracking), in a bid to improve clinical performance, we reviewed our Clinical Policy and aligned our vision, goals and objectives toward achieving better clinical outcomes. An implementation plan was developed to achieve this. Thuku (2014) described strategy implementation plan is as a method of assigning resources to support selected strategies in order to achieve organisational goals.
Mission 1. Promote health, generate confidence and trust in populations we work in 2. To strengthen the believes and attitudes among the patient population |
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Domain |
Strategic Objectives |
Actions |
Timeline |
Key Performance Indicators |
Clinical |
Improve quality of care provision. Promote clinical safety and best practices. Improve clinical outcomes. Reducing hospital acquired infections |
Provide evidence-based care. Provide client cantered care. Acknowledge malpractice including adverse events Reflect and learn from errors Promote a clinical culture of quality improvement. |
Improved recording and reporting of incidents. 100% resolved infections. All falls reviewed and actioned upon. Reduced number of unexpected deaths. Less than 10% drug errors 100% reflective accounts on errors. All patients involved in incidents informed and given options of further actions. |
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Staffing |
Safe staffing skills mix |
Support safe staffing levels with required skills set. Staff development and upskilling that is in line with sector needs. Appropriate recruitment policy Establish a reward strategy (rewarded staff perform better) Involve staff in operations planning for and policy development |
Aligned recruitment practices. Personalised development plans. % Of staff completed mandatory learnings requirements. Appropriate work life balance. Staff wellbeing clinics in place. Achieving required staffing levels. Employee absenteeism index |
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Effective Leadership |
Leadership for Implementing change (Yukl 2016) Management style that support outcomes (Alshaher 2013). |
Establish an internal culture where clinical quality is guaranteed for all patients (McSherry2015). Resolve barriers to change and quality improvement. Enable a culture of learning from mistakes (duty of condor) Enhance interdepartmental collaborations and harmony Flexible management styles as to needs. Clear policies Effective communication |
Transformational and compassionate leadership practiced. High staff morale Engaged staff Less errors |
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Engagement |
Ensure staff and patient engagement in the Trust |
Recognise and reward good performance. Staff wellbeing. Enable open communication between management and staff. Support with required infrastructure including policies. Facilitate external stakeholder engagements |
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Resources |
Provide adequate resources to facilitate quality provision of care |
Allocate adequate finance for research, equipment, supplies, and trainings. Put in place required policies and guidelines. |
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Patients |
Patient centred Care |
Reduced waiting time |
Strategy implemented is most crucial, the organisations viability depends on it, only about 10-15 % strategies are successfully implemented (…). Having a brilliant strategy does necessarily translate to successful implementation (……). As to the American Institute of Medicine, when implementing health services strategy, a STEEP analysis has to be conducted. It involves: 1. Safety, 2. Timeline – lessen harmful delays, 3. Effectiveness – services must be evidence based and applied in appropriate proportions, 4 Efficient – avoid waste and 5. Equitable- provide care that does not vary. Robert & Tom (1980) of the Mckinsey model stated that 7 elements have to be in place for successful implementation, that is strategy, structure, systems (hard factors), staff, style, skills, and shared values (soft factors) have to be in place and aligned. Taking from the Mckinsey 7’s Framework, all factors of strategy formation need to be aligned in order to achieve good outcomes (Tom P @ al. 1980). For instance, having a good structure and systems in place does not assure effective implementation instead you will need to have safe staffing levels with required skills mix accompanied by fitting leadership and management styles. The right resources will have to be allocated and proper engagements with internal and external stakeholders has to occur. In our case we also decided that decision making has to be decentralised to include people who actually do the work, this helps a lot as decisions befitting practice can be made quickly (Bower and Gilbert. 2005) In addition the culture of the organisation hugely contributes to successful implementation, a supportive culture is a must to attain changes pursued, a culture that promotes inquiry, purpose, reflection, and systems thinking.
As part of the implementation process, performance has to be measured to determine effectiveness of strategies. As said by Drucker (1962)’ you cannot improve what you don’t we decided to conduct continuous assessment in order to address deficiencies in real time. We used Norlan’s (1992) Plan-do-study-act (PDSA) cycle because it permits setting aims, assessing, gaining knowledge, reflection and making changes as we go, this permits continuous improvement. We used data collected from the Clinical governance indicators to measure and evaluate performance on an ongoing basis.
The evaluation of a SIP begins with the impact of such new care plan will have in the targeted population. The new care plan will reduce the number of emergency admission in comparison with not having any care model. Accessing the impact is a significant aspect of evaluation as it gives answer to the questions such as what is the overview of the model and how the model would work and how the model will bring the change and what is the potential benefit and result of it (Kingsfund.org.uk, 2017). All these questions are necessary to answer when evaluation of a care plan is explained in order to understand the effectiveness of such care plan and the spectrum the plan will reach. After understanding the impact of the plan, the next question is to understand the cost of the care plan. If the cost of implementation of care plan is more it means more stakeholders and spectators are involved as well as demographic and barriers also need to be evaluation, as because such services will be affordable and accessible to the individuals or not. There are several other aspect of the evaluation one of such is the logical models. The logical models are a significant part of a preliminary stages of care models. It creates a fundamental diagrammatic way for understanding how the changes made in the models can impact the outcomes (Pcmh.ahrq.gov 2013). Examples of such models are dashboards, local metrics and national metrics, and independent evaluation. For instance, Kent and Manchester university have been appointed to evaluate the new care modes, for which the first step they have selected is the impact of such model on the population. Impact and progress can be also studied on the Integrated primary and acute care systems (PACS) and Multispecialty community provider (MCP) cohort levels (Maniatopoulos et al. 2019). The first analysis would be done on understanding the impact followed by creating intervention strategies and then implementing the intervention strategy. Different approaches can be implied to evaluate the impact and for the cohort level it is done by national analysis of the timeframe. The Vanguard also work in the same principle and gather data from the local metrics and analysing and producing their own result leading to in-dept evaluation of the interventions. The individual intervention is also very essential understanding the evaluation of the individual have analysed. In vanguards there are pilot studies going on regrading the analysis of the MCP and the care home intervention plan. In the national analysis it can be noted that, at the top line around 3.8% of the community providers have agreed that MCP have grown to 3.8% from 2014-2017 and Growth rate of PACS is slight lower than MCP which is noted to be 2.2. In 2015, NHS England launched the New Care Models initiative. The initiative was provided through 50 ‘Vanguard’ facilities throughout the country (England.nhs.uk 2015). One of those locations, Dudley, was chosen to put the MCP paradigm to the trial. The MCP paradigm was created with the goal of providing greater care from outside medical settings, such as in surrounding populations and GP practises. The Dudley Vanguard programme is a patient-centered concept for offering integrated care to persons who are most vulnerable to emergency hospitalizations. The 50 Vanguard sites in the New Care Models programme were supposed to test new ideas, digital programs, and functioning practises (Commonwealthfund.org 2020). These adjustments would be implemented in other portions of the nation if they proved to be successful. As a result, convincing documentation and aggressive communication of lessons are essential in this approach. As the Vanguard initiative comes to a close, this site can serve as a repository, allowing Dudley’s storey to be shared worldwide. The Strategic planning Unit, in collaboration with ICF and the University of Birmingham’s Health Services Management Centre, has evidence supports, assessment, assessment, and strategic guidance to the better collaboration (The Strategy Unit 2018). Several of the outcomes from that work can be found on this website, which draws together lessons and insights that others who want to benefit from Dudley’s experience might find useful.
Conclusion
In the recent time poor performance is seen in providing care and as well as in the clinical reports which is lowering the quality of life. There is a strong need of intervention strategies in order to improve such condition. In 2015, the NHS UK launched a program after understanding the impact the project would create. The vanguard MCP project is known to reduce the hospital visits and offer integrated care to the vulnerable persons in the emergency hospitalization unit.
References
Commonwealthfund.org, 2020. Dudley Vanguard. [online] Commonwealthfund.org. Available at: <https://www.commonwealthfund.org/publications/international-innovation/2020/oct/dudley-vanguard> [Accessed 8 January 2022].
England.nhs.uk, 2015. NEW CARE MODELS: Vanguards – developing a blueprint for the future of NHS and care services. [online] England.nhs.uk. Available at: <https://www.england.nhs.uk/wp-content/uploads/2015/11/new_care_models.pdf> [Accessed 8 January 2022].
Kingsfund.org.uk, 2017. Charles Tallack, Head of NHS Operational Research and Evaluation, NHS England, presents data and findings from evaluation of the new care models. [online] Kingsfund.org.uk. Available at: <https://www.kingsfund.org.uk/audio-video/charles-tallack-evaluation-new-care-models> [Accessed 8 January 2022].
Maniatopoulos, G., Hunter, D.J., Erskine, J. and Hudson, B., 2019. Lessons learnt from the implementation of new care models in the NHS: a qualitative study of the North East Vanguards programme. BMJ open, 9(11), p.e032107.
Pcmh.ahrq.gov, 2013. The Logic Model. [online] Pcmh.ahrq.gov. Available at: <https://pcmh.ahrq.gov/sites/default/files/attachments/LogicModel_032513comp.pdf> [Accessed 8 January 2022].
The Strategy Unit, 2018. Dudley MCP. [online] The Strategy Unit. Available at: <https://www.strategyunitwm.nhs.uk/dudley-mcp> [Accessed 8 January 2022].