In previous letters I’ve discussed our approach to strategy, involving four different perspectives.
In this letter I’m going to explain how these elements are tied together into a way of working that allows us to understand how decisions are made, priorities are set and progress made.
The system we will be using is very simple. It has two components.
- A plan
- A review mechanism.
Let’s start by looking at what we mean by a plan. There is a lot of unnecessary mystique about what it means to have a plan. At Al Wakra Hospital our definition of a plan is as follows:
Definition Of A Plan
A plan is a description of the steps (tasks) that are necessary to achieve an agreed objective.
First there must be an agreed objective. We agreed our objectives for 2017 by deciding on which priorities we will focus on. As you know we have agreed these priorities for the current year.
- Agree how we will meet national waiting time standards fro outpatients and diagnostics.
- Reduce congestion in our inpatient wards by reducing length of stay, increasing discharges before 11.00 each day and treating more patients as day cases.
- Increase our use of standardised, evidence based treatments for common clinical presentations – this will help make what we do more consistent and safer.
Secondly, having agreed our objective we must decide what steps, resources and facilities will be required to achieve it.
Fictional Example Of A Plan
Here’s an example of a fictional plan to create an admission on day of surgery facility.
Plan To Deliver: Admission on day of surgery Target date 1st June
1. Identify space for admission and discharge lounge (end of April).
2. Agree scheme to convert space (Mid-April).
3. Identify staffing model and agree workforce budget (end April).
4. Agree deployment of temporary staff to enable opening at beginning of June (2 week in May).
5. Work completes on converting space (end May).
6. Work to design support for patient administration pathway starts (early April).
7. Design of patient administrative pathway complete along with staffing model (end of April).
8. Pathways for specific surgical procedures agreed (mid May).
9. Agreed anaesthesia pathway finalised (mid May).
10. Dry run of three pathways to test pathway (end of May).
11. Analyse results and recalibrate where necessary (1st June).
12. Day of admission starts second week in June.
To report against this plan, a table is produced, with each action step/task BRAG rated (see below).
Black – there is no current plan to deliver an acton step.
Red – a plan exists, but action step will not be achieved according to timetable.
Amber – a plan exists and is currently behind plan but there is potential to catch up.
Green – delivery is according to plan.
A plan contains the list of tasks which must be completed in sequence to achieve the objective. Each task has a description and a due date.
The second part of our system is Performance Review. Our expectation is that each Division (or equivalent) will have an agreed plan. Each month we will have a discussion about how well the plan is progressing.
The idea of performance review isn’t to find fault and attribute blame. The idea is to locate problems and agree ways of resolving them together.
Our process of implementing performance reviews will start for real in May 2017. During April we will clarify expectations and confirm the agenda for each Division or equivalent.
Our belief is that by working in this way we will all have a much clearer idea of what Al Wakra is working on and how much progress is being made.
We will share our progress in a simple report that everyone can read once every three months.
I hope that over the coming months we will all begin to have a much clearer picture of how we are doing against our agreed priorities.
I will close this letter as I usually do, by wishing you and your family good health and happiness for the week ahead.