Operational Performance Improvement Plan

Meeting:

 Public Board

Date:

 15.03.2023

Report Title:

 Operational Performance Improvement Plan (OPIP)

Agenda Item:

PUB22/3/95 

Author:

Claire Creek, Executive Support Manager (Interim)

Lead Director:

Melissa Dowdeswell, Interim Chief Operating Officer & Director of Nursing, Safety & Quality

X

SR1b: If we do not ensure our leaders are developed and equipped, there is a risk that we will not be able to change our culture, and value, support, develop and grow our people

X 

SR2: If we do not deliver operational and clinical standards then there is a risk of poor patient outcomes and experience

X 

SR3: If we do not ensure we have the ability to plan, influence and deliver across our systems to secure change, we will not be able to meet the needs of our public and communities

X 

SR4: If we do not resolve long standing organisational inefficiencies we will be unable to deliver an effective, sustainable, value for money service to our public

X 

SR5: If we do not clearly define our strategic plans we will not have the agility to deliver the suite of improvements needed

X 

SR6: If we do not deliver sustainable regulatory compliance and develop positive relationships, we will have limited ability to deliver our strategy

Equality Impact Assessment

No negative impact identified

 X

Recommendation:

The Board is asked to note the attached Operational Performance Improvement Plan (OPIP) and to be assured regarding the approach being taken for the development, implementation, and governance of the plan.

The Board should note the iterative nature of the plan, deliverables and the short- and long-term targets, and test the appetite and ambition for further improvement.

Previously considered by:

The latest iteration of the plan was received at Performance and Finance Committee in February for oversight and assurance. Creation of the plan and its subsequent delivery have been overseen via the following groups: Executive Leadership Team via the Operational Sprint Cell and the Operational Service Delivery Group.

The plan has been supported by a matrix team including the CEO, Director of Corporate Affairs and Performance, Deputy COO (A&E), Deputy COO (EOC), Head of Performance and Service Planning, Deputy Clinical Directors and Project Management Office. 

Purpose

The purpose of this report is to provide the Board with the opportunity to review the OPIP collectively and assure itself of the plan and its deliverability.

Executive Summary

The purpose of the OPIP is to establish clear priority areas for improvement in delivery of timely response to patients, resulting in safer, faster care and supporting the Trust to progress towards delivery of the national operational performance targets.  This is managed by focussing on four main objectives:

• Key Objective 1: Top Line Performance Measures - Out-turn Performance
• Key Objective 2: Supply Measures
• Key Objective 3: Demand Measures
• Key Objective 4: Delivery - Productivity Measures

The OPIP comprises of a suite of actions and activities at corporate, directorate and sector level, in order to ensure suitable responsibility for delivery of the required improvements. Progress is managed by the COO office and reported on a weekly basis into executive directors via the Operational Sprint Cell.

The OPIP was submitted to Performance and Finance Committee (PAF) on 22 February 2023, it was well received and agreed that the OPIP will be included in the operational performance report to PAF for each committee. Areas of focus include the need to ensure that quarterly targets are monitored and delivered against, with clear escalations should there be a risk of non-delivery. The Committee also noted areas of the plan with greater clarity needed on the targets to support the overall improvement, alongside stress testing the ambition of the plan, particularly with respect to abstraction levels.

The plan is live; and therefore, it is continuously evolving in line with the Trust’s demands and needs.

The OPIP has been developed to set out the actions required to improve performance in the areas highlighted in the Trust’s Oversight and Support Meeting pack, the NHSE Urgent and Emergency Care Actions 2022/23 and the Operational Research for Health Report (ORH) 2022.

The Trust is in the Single Oversight Framework Category 4 (SOF4) following the Care Quality Commission (CQC) rating the Trust as “Inadequate” for Well Led in 2021. Whilst this rating has now improved to Requires Improvement, there is the joint recognition that the critical area of focus for improvement is the delivery of timely care to patients.

The OPIP has been developed to deliver clear actions to support improved operational performance in the areas of greatest concern.

Risks to agreeing actions and successful delivery of the OPIP are:

• Capacity of operational teams to deliver actions due to operational pressures. This is mitigated through the utilisation of the operational mechanisms already in place (Operational Delivery Groups) to oversee and drive improvements. Delivery of the actions will also reduce operational pressures in the longer term.

• Availability of timely data to inform progress on the trajectory – this has been mitigated by the creation of an OPIP dashboard to be reviewed on a weekly basis to support focus on actual impact of actions taken.

• PMO and QI Team support for operational teams to deliver and monitor the agreed actions in the plan – this has been mitigated through two PMO team members being assigned to the project. Additionally, through SOF4 support an overall programme lead for the OPIP is commencing with the Trust on 20 March who will oversee and coordinate, as well as identify additional resources and techniques required to maximise likelihood of success.

The OPIP enables the Trust to have a method of delivering operational performance improvement within a robust existing governance structure. It will give clear understanding of actions that are on track for delivery and the impact these are having.

Governance Structure

The following schematic provides the governance approach to the OPIP. It is based upon the premise of ownership and delivery of the plan being at Head of Operations and Deputy COO level, with weekly progress reviews and updates reporting through the Executive level so that rapid corrective action can be taken where needed. The OPIP plan and progress will be reported to every Performance and Finance Committee meeting for assurance.

OPIP Key Objectives and Targets

As outlined above, there are four key objectives set out within the OPIP, all with a suite of key performance indicators and deliverable actions underpinning them. A summary is as follows:

• Key Objective 1: Top Line Performance Measures - Out-turn Performance
  • Within this objective is tangible improvement within the overall metrics relating to responsiveness to patients. Specifically, C1 and C2 mean and 90^th, call pick up times and the volume of calls over two minutes.
  • Long term targets remain the national standard, with phasing over the coming 18 months to deliver.
  • Trajectories for C1 and C2 are dependent upon delivery of the plans in line with the Urgent and Emergency Care recovery fund, as well as a sustained reduction in arrival to handover delays, which negatively impacts the Trust’s ability to respond. As such, trajectories for these measures will be finalised once clarity is received on these aspects.

• Key Objective 2: Supply Measures
  • This section focuses upon those measures that provide the ability to increase our level of staffing and therefore increase ambulance availability. Measures such as overall operational staffing, turnover, staff unable to drive ambulances due to awaiting C1 licence or emergency driving training, and overall patient facing staff hours
  • Trajectories in place for operational staffing are subject to increase in line with the additional staffing recommended as part of the recovery fund. In the first instance for turnover, focus is on stabilising and reducing variation between the sectors.

• Key Objective 3: Demand Measures
  • This section focuses on ensuring patients are managed in the most effective way for their condition, and where this is not via an ambulance attendance or transfer to hospital, that the patient is supported and managed via the correct pathway for their symptoms.
  • Increase of hear and treat, and transfer of patients to appropriate pathways with other providers via our access to the stack scheme are key areas of focus.

• Key Objective 4: Delivery - Productivity Measures
  • This section of the OPIP focuses on maximising efficiency within operational delivery based on the way we deploy our people and use the resources we already have in place.
  • Working on reducing overall abstractions is a critical area, as we have a greater abstraction rate than other ambulance services. A significant proportion of this relates to the volume of training required to fill the apprenticeship and career pathways we have in place, however other key elements include sickness management and third manning (predominantly caused at present by the C1 and emergency driving training requirements).
  • Out of service time is also a key area of efficiency focus, including the greatest volume of hours being lost to cohorting patients at hospital, followed by drug restock downtime.
  • From a frontline staff perspective, there is the requirement to reduce handover to clear times back to the target of 15 minutes, as well as reduce variation in on scene times.

Current Targets

The following table provides the Board with the current long term and quarterly targets for the key measures within each of the four objectives. The Board should note that these are iterative and subject to refinement once confirmation of the recovery fund is received, and the intended target reduction in arrival to handover times in the region.

As previously noted within the report, top line measures in the first table below are subject to review pending the recovery fund and confirmation of handover delay trajectories to complete these.

It should be noted in the table above that the target for abstractions is currently cited in the OPIP as 43% average for the year, in line with current projected and expected forecast. The team is currently reviewing this and the impact of variances in each aspect of abstraction with the predicted impact of the additional capacity funding incorporated into the plan. Whilst not yet confirmed and finalised, predictions are currently as follows, and are subject to change as additional actions are identified, and the rationale for the assumptions are tested: