Improvements in Healthcare Sytems

The Assignment
Case study scenario
You are Sally Smith, the newly appointed Deputy Chief Executive at St Paul’s NHS Foundation Trust, a 700-bedded, multi-site acute trust in the midlands. The trust is part of the Ostershire and Trevil Vale Integrated Care System. The trust provides a typical range of emergency and elective services to a local population of 450,000 people in a semi-rural setting It provides no specialist or tertiary services to people outside the local area, and it has no teaching or research function. You have received an email from Maggie McDonald, Chief Executive (your direct boss), who is away attending a conference on healthcare improvement for non-finance specialists in healthcare.
To: Sally.smith@StP.nhs.uk
From: Margaret.McDonald@StP.nhs.uk
Hi Sally,
I have been thinking about our conversation last week regarding key performance indicators, both at an organization and system level. As you know we have been asked to review the current set of performance reports being presented to the board; there is a concern that they are too focused on inputs, and that there is a variation in content that makes it hard to see the overall picture (at a trust level, but also within the system context). The board agreed that it was important that all stakeholders can understand the reporting, that the reports contribute to an overall understanding, and that there is consistency when reporting equivalent information, although I am not sure if the importance is fully understood by all parties. We need to introduce the board to a new set of performance indicators that really support us in achieving our goals. I was also thinking that as a health system we have a key principle of Achieving excellence and value in patient care, but we do not define what this means and in addition, if we have not identified how we will measure our performance against this, how do we know if we are even achieving our number one system-wide principle! I wanted to introduce the board to a new set of key performance indicators. They would really assist us in monitoring our progress towards achieving our strategic goals, rather than the usual bland reporting sets, which are three weeks old and too inputs based. As you know I have been attending a healthcare improvement conference in Edinburgh, and at one of the sessions we had a presentation on Michael Porter’s work at Harvard University on value in healthcare. His approach provides a framework for reconciling these measurement issues. I also found some quite inspiring quotes from Porter, which you might find useful. I made a note of some of his quotes:
“Achieving high value for patients must become the overarching goal of healthcare delivery.”
“Value should define the framework for performance improvement in healthcare.”
“Rigorous disciplined measurement of value is the best way to drive system progress.”
These struck a chord with me because I feel that our board has a set of goals that can at times seem to be in conflict. Graham as Medical Director and Janet as Director of Nursing, seem to want to spend more and more to deliver a higher quality of service, because the Care Quality Commission is concerned about rationing treatment and how we prioritize patients. Meanwhile Sunil, our Chief Finance Officer, is pressing for more cash-releasing savings to drive efficiency and to help pull the Trust out of its current poor financial situation. As chief executive I must lead the board in managing these pressures such that they are aligned and delivering the very best we can with the limited resources we have. It does sometimes feel that during board discussions, and also during executive team meetings, that we are between the infamous rock and a hard place. I can also see that these issues are playing out both between, and within, our system partners! We cannot have operational and financial reporting that are not joined up, and do not reflect the importance of each of these areas; we cannot just focus on one aspect, and given the financial pressures that exist, it can be easy for the financial position to become all consuming. Sally, this sums up the approach that we need to take to the board; if we are serious about promoting value as our mission, then we need to define what it is and measure it through a range of key performance indicators (KPIs).
These need to be every bit as important as the financial statements that Sunil produces each month and the simple statistical returns that just report on volumes against targets. Neither of these, on their own, tell the full story. This is particularly pressing given the financial pressures across the ICS, and the need to provide and develop high quality health services that are financially sustainable. I have schedule this as item 4 at the next board meeting. Can you please produce a report for the board, and also prepare a slide deck for presentation at the meeting.
All the best
Maggie

Required
Using the scenario above, information in appendix 1 and your own research, write a report, including recommendation, together with an accompanying slide deck, for presentation to the board. You should include, but are not limited to, the following:
• Critically analyze the concept of value in contemporary healthcare and the implications of that concept for the Trust and the health system.

• A critical evaluation of the use of costing and reimbursement approaches to drive value and to enable service improvements and transformation (examples would be especially useful).

• Critically evaluate how value can be enhanced by adopting different approaches and how key decisions can be made about prioritizing which approach(es) to take (examples would be useful). You should undertake independent research, use a formal academic writing style with references, and your preferred report format.

Appendix 1
St Paul’s NHS Foundation Trust: Achieving excellence and value in patient care
Strategic goals:
• To be highly regarded by our peers for the quality of our services.
• To provide cost-effective care to our patients and value to the taxpayer.
• Committed to excellence in everything we do.
• Working together as one team dedicated to meeting patients’ needs.
• Committed to continuously improve our performance and adapting services to meet patient’s needs.
Expected behaviors:
• Strive to achieve goals to the highest possible safety and quality standards.
• Take responsibility for public money spent and seek better value for the trust.
• Compare their performance with the best and learn from others.
• Challenge poor performance in others and challenge your own performance.
• Are friendly, welcoming, courteous, and caring.
• Act fairly and compassionately.
• Are open, honest, and candid with others. Monthly finance quality and performance report to the board
• Income and expenditure statement.
• Statement of comprehensive income.
• Statement of financial position (balance sheet).
• Cash flow statement.
• Divisional financial forecasts.
• NHS oversight framework rating.
• Cost improvement programe.
• Quality and safety – exceptional items to report by exception.
• Access and waiting time performance.
• Agency spending report.
Assessment level criteria

1. Knowledge Weighting – 25% Compelling evidence of comprehensive and systematic knowledge of an extensive range of appropriate concepts, theories, issues, and research
2. Critical Evaluation, with Analysis and Synthesis Weighting – 30% A criticality that is integral to the work in its use of advanced knowledge to evaluate key concepts and research; critiques methodologies and techniques; analyses of issues and synthesis of information to make arguments that are insightful and that produce effective solutions that drive knowledge forward.
3. Application of Knowledge and Reflection to Practice Weighting – 30% Originality and innovative in the application of and reflection on new insights, thoughts, and practice at the forefront of the discipline to decision making in complex and unpredictable situations.