Date of Trust Board 29 th January Title of Report Performance Management Strategy

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1 ENCLOSURE: P Date of Trust Board 29 th January 2014 Title of Report Performance Management Strategy Purpose of Report Abstract To set out the Performance Management Strategy of the Trust in relation to the delivery of its corporate objectives. The attached strategy sets out the principles of performance management, and the framework that will be used by the Trust to ensure delivery of its corporate objectives. The strategy has been approved by the Finance and Performance Committee who commend it to the Board. Risks and benefits of proposed action The Trust needs to be clear how it will performance manage delivery of its corporate objectives. It will then need to implement this in order to maximise the chances of achieving these objectives. Recommendation Presented by The Board are asked to make the decision as to whether to approve the Performance Management Strategy. Paul Cracknell, Director of Strategy and Transformation 1

2 Performance Management Strategy Looking after you locally

3 Contents 1 Introduction 2 2 Vision, values and objectives 3 3 Performance Management Principles 4 4 Quality Performance Management 5 5 Agreeing and Reporting against Performance Targets Agreeing Targets Performance Reporting Rewarding Good Performance and Rectifying Poor Performance Information Management 7 6 Performance Management Framework Overview Programme management Management of Change Alignment Business Unit Performance Review 10 7 Conclusion 10 Appendix A - Performance Management Framework Appendix B - Framework for Business Unit Performance Meetings Page 1

4 1 Introduction 1.1 This document will provide Norfolk Community Health and Care NHS Trust ( NCH&C ) with a Performance Management Strategy that supports the delivery of its corporate goals and objectives. 1.2 The fundamental purpose of the strategy is to ensure the delivery of corporate objectives whilst instilling a culture of continuous performance improvement to achieve the Trust s vision of excellent patient care. 1.3 The strategy includes the Trust s framework for performance management, which describes the arrangements and accountabilities that will translate the strategy into a workable process for driving improvement in operational performance. 1.4 The Trust is operating in a challenging environment where targets and standards are set centrally and locally. These targets are set internally, by our commissioners, the Trust Development Authority (TDA), the Department of Health (DH), the Care Quality Commission (CQC), and in future, Monitor, the regulator for Foundation Trusts. The requirements are not static and changes are implemented each year, particularly with the move to commissioning on outcomes, rather than inputs, as has traditionally been the case. 1.5 Over the life of this strategy commissioning has shifted from Primary Care Trusts to Clinical Commissioning Groups, whilst the requirement to do more for less will be an increasing feature of health and care delivery. It is therefore essential that NCH&C is able to deliver on-going improvements in all aspects of performance finance, efficiency, quality, safety, patient experience and workforce. 1.6 The Performance Management Strategy is in line with the Monitor guidance on Service Line Management, which describes performance improvement in five steps: Page 2

5 1.7 Step 1 Clear targets and accountabilities. This is covered in section 5.1 which outlines the process for setting targets and cascading them throughout the Trust. Step 2 Performance tracking. Section 5.2 sets out the performance reporting arrangements at both Board and Business Unit levels that allows the Trust to see clearly whether targets are being achieved. Step 3 Effective review meeting structure. Section 6 sets out the structures that are in place within the performance management framework to enable effective review and challenge of performance at Board, Executive Director and Business Unit level. Step 4 Good performance conversations. Appendix B sets out the framework for the Business Unit Performance meetings, and includes the ground-rules for good performance based conversations. Step 5 Rewards and consequences. There need to be real consequences for teams and managers for the delivery or non-delivery of targets. Section 5.3 sets out the Trusts approach to rewards and consequences. 2 Vision, values and objectives 2.1 The Trust s vision will be delivered through the achievement of a number of longterm strategic objectives. 2.2 These are: Improving quality for patients and the public as experts in community health and care delivery and offering the best patient experience in the East of England Transforming services being the commissioners first choice provider and being the positive alternative to acute hospital care Building the organisation the Trust wants to be the first choice employer for staff and be a clinically-led, high performing organisation Building sustainability to deliver a long-term business model that demonstrates value for money, supports the delivery of innovative services and meets the requirements of the Trust s regulators Building our reputation to be the first choice for patients and GPs, with engaged members and governors, and to play a leading role within the local health economy 2.3 The performance management strategy will ensure the organisation focuses on delivery of these corporate objectives, whilst remaining true to our values of: Home and community Personalised care Enabling our people Pioneering Page 3

6 These values are enshrined in the Trust s Behaviour Framework which is used as part of the recruitment and appraisal process. 2.4 These values are consistent with a culture of high performance, which implementation of this strategy, combined with the principles of Service Line Management, will embed within the organisation. 3 Performance Management Principles 3.1 NCH&C will be using an integrated performance approach to identify, improve, assure and review all aspects of the organisation s performance. 3.2 The general principles that govern all our performance management arrangements are as follows: High quality and patient safety is the over-riding goal Clear targets are set reflecting national and local priorities, including the Monitor Risk Assessment Framework Board level targets are broken down to service, team and individual targets Key performance indicators are established, and are subject to continual review Teams own their targets, are empowered to deliver them, and are held accountable for them There are consequences for teams and managers for their performance Targets provide a balanced view of performance finance, efficiency, quality, patient experience and workforce An open and honest approach is used for dealing with poor performance An emphasis on learning from mistakes rather than a blame culture Decisions will be based on high quality, timely and reliable information Information will be shown in trends and include forecasts Performance will be benchmarked internally and externally to identify services for improvement and services to be celebrated 3.3 These principles are consistent with those set out in The Intelligent Board document, and they will enable a culture of high performance to be embedded across the Trust. 3.4 Service Line Management was developed by Monitor for Foundation Trusts as a methodology for allowing Trusts to understand their performance and organise their services in a way which benefits patients and delivers efficiencies for the Trust. It also provides a structure within which clinicians can take the lead on service development, resulting in better patient care. At its root, it is about empowering local clinicians and managers to deliver service improvements, and holding them to account for their performance. Page 4

7 3.5 The Performance Management Strategy has been written to align with the underlying philosophy of Service Line Management, but it is not dependent on its implementation to deliver the performance improvements required during the period covered by the strategy. 4 Quality Performance Management 4.1 The Trust has historically focussed its performance monitoring on meeting national standards and targets relating to the NHS and Monitor requirements, together with local service delivery requirements as previously set out in the contracts with NHS Primary Care Trusts (now Clinical Commissioning Groups and NHS England). 4.2 The Trust recognises the need to develop additional measures to report on that cover patient safety, clinical effectiveness and patient experience. The drive to improve the comprehensiveness of these measures is a key element of this performance strategy. 4.3 Quality measures have been developed to support the current Integrated Performance Report, the monthly Trust Board Quality Report and the Quality Account. In addition, the Commissioning for Quality and Innovation (CQUIN) process has resulted in quality measures being developed in a number of services across the Trust. 4.4 The Trust has developed an Early Warning Trigger Tool (EWTT) which is completed monthly by all services and provides the Executive Directors Team (EDT) and Quality and Risk Assurance Committee (QRAC) with an assessment of those services that are at high risk of an imminent reduction in performance or quality to allow early intervention. 4.5 The use of an integrated approach to performance, and the Balanced Scorecard contained within the Annual Plan and Integrated Business Plan will further drive the importance and visibility of quality performance reporting. 5 Agreeing and Reporting against Performance Targets 5.1 Agreeing Targets Where national targets exist, from the DH, TDA, CQC or Monitor, these are to be adopted by the Trust. As part of the annual business planning cycle, the Trust will decide whether to set itself more stretching targets to deliver improved value for money, quality or added value to its commissioners and patients. The Trust will also review any known national targets due to come into force going forward, and include these where appropriate In addition to national targets, the Trust will agree contractual measures with its commissioners which will feature in the performance management framework Finally, the Trust will review its strategic objectives on an annual basis and ensure that targets are agreed that will result in the successful delivery of those objectives Targets will be measurable and subject to a traffic light (RAG) rating, where appropriate. They will be broken down to Directorate, Business Unit and service level targets to ensure all areas of the organisation are working to common goals. Page 5

8 5.2 Performance Reporting The Trust Board receives a monthly Integrated Performance Report (IPR) that assists the Board in its assessment of achievement of the corporate objectives and key targets. The report includes a number of dashboard style reports that provide the Board with at a glance RAG-rated positions against the TDA s governance risk rating and commissioners KPIs. The Board report also includes a corporate dashboard that allows it to triangulate the financial, operational, quality and workforce performance. Finally, the IPR includes a Quality and Safety dashboard, and a Data Quality dashboard This suite of dashboards will allow the Board to evaluate whether the Trust is meeting national and contractual standards and targets, and operating efficiently and effectively, while continuously improving the quality of its services. The IPR includes details of what action is being taken to address any areas of poor performance that have been highlighted by a Red rating. The IPR will be developed, as required, to include forecasts of future performance in order that the Board understands which areas are at risk of failing to meet targets, standards, thresholds or ceilings in future An Information Assurance Framework is in place that provides the Board with an explanation of each KPI used in the IPR, and the data source and quality of the information used to calculate the KPIs. Data quality confidence indicators are used in the IPR to give the Trust Board an at a glance view on the data quality of the KPIs The Board receives a quarterly report on the delivery of the Trust s Annual Objectives that provides assurance that objectives will be met, or gives detail of corrective action where there are risks to delivery KPI dashboards are also produced for each operational Business Unit, and these are discussed in a monthly performance review meeting between the Business Unit management and the Executive Director Team. 5.3 Rewarding Good Performance and Rectifying Poor Performance Where a manager has delivered sustained good performance, then the Trust may recognise this in a number of ways: Praise to be provided by their line manager Congratulations from their Director A letter from the Trust Board Nomination for Certificate of Recognition Nomination for annual Stars Awards The Trust does not currently reward staff with financial remuneration or non-financial rewards. As the Trust increases the levels of autonomy and accountability to Business Units, it will consider what incentives it should provide teams and managers for sustained high performance. Page 6

9 5.3.3 Where performance reporting or self-assessments identify either the failure to meet a target, or a high risk of meeting a target, then the Board will be notified through the IPR Whenever a target is not being met, or at high risk of not being met, then the responsible manager will be required to produce an Action Plan, with identified leads and completion times. This Action Plan will be monitored by the Performance Directorate, with responsibility for delivering the Action Plan sitting with the relevant Assistant Director Where the Action Plan is either not sufficiently robust, or performance does not improve as a result, then the Trust may take the following measures: Provide targeted support from the Performance Directorate, if required; Intervention from a Director or Chief Executive to remove significant obstacles; Use of the Capability Policy to address individual performance issues; Use of Deep Dive methodology to identify service improvement opportunities; Review of progression through annual gateway incremental pay awards; Parachuting a new manager into the service; Benchmarking service against successful comparator services, and identify improvement opportunities Where all of the above measures have been taken, and performance continues to be poor, the Trust will ultimately have to decide whether to continue providing the service, or whether to give notice to commissioners to cease provision. 5.4 Information Management Effective performance management requires accurate, relevant and timely information. Where there is poor quality data, the usefulness of performance information is reduced and the credibility of the performance process undermined. The Trust will continue to audit its data quality, and to roll-out the Data Quality dashboard to ensure that the quality of the data is sufficient to make business and operational decisions The development of ICARUS, the Trust s Management Information System, will be focussed on providing a wide range of information on services, in a user-friendly manner, to the widest possible audience so that clinicians and managers can understand the quality and performance of their services. ICARUS is a web-based system, meaning that it can be accessed easily and has an intuitive user interface The Trust will continue to develop Service Line Reporting, in order that financial, efficiency and productivity information is readily available to clinicians and managers through the ICARUS system. As the Trust implements the principles of Service Line Management, reporting will be developed to provide Service Line Managers with reports that enable them to truly understand all aspects of their service s performance, such as productivity of staff members and teams, new to follow up Page 7

10 ratios, bed usage, staffing levels, Did Not Attend (DNA) rates, sickness levels and financial performance The Trust is committed to using information in order to improve services as well as monitoring performance. Benchmarking will be used to enable performance to be compared against others, both within the Trust and with other organisations. Benchmarking will be undertaken systematically to look at the following areas: Cost and price Efficiency and productivity Quality and safety Patient experience Workforce The Trust will develop its forecasting capability in order that it can report performance against future trajectories, as well as year-to-date, in order that the Board can understand where services may deviate from plan later in the year. 6 Performance Management Framework 6.1 Overview The performance management framework has been developed to support the delivery of the Trust s major workstreams, local and national targets Close attention is paid to the performance management arrangements of the Trust, with particular focus on the major workstreams and priorities for delivery. In particular, the processes whereby key decisions are made and accountability is maintained have been reviewed. The performance management processes have been strengthened and formal mechanisms established to strengthen the existing systems and processes to enable the effective operation of the Trust. 6.2 Programme management The Trust has a large number of significant programmes of work to deliver: Corporate Objectives Cost Improvement Programme (CIP) Commissioning for Quality and Innovation (CQUIN) Contractual targets agreed with commissioners Achievement of Foundation Trust status A performance management structure has been established which: Provides a clearly defined structure for tracking, assessing and reviewing performance Effective performance review at the appropriate level in the organisation A rapid process to review progress on agreed activities, to focus on targets which are not on track, and to identify new required actions and responsibilities. Page 8

11 6.2.3 There are a number of formal meetings within the Trust which provide executive assurance for these work programmes: A weekly EDT meeting that reviews hot topics on a weekly RAG-rated dashboard A fortnightly Cost Improvement Programme (CIP) Steering Group A monthly Foundation Trust Programme Board A monthly CQUIN Steering Group 6.3 Management of Change An integral element of programme and performance management is the management of change. The Trust s Programme Management Office (PMO) has oversight of all the projects and schemes within the Trust s CIP and transformation programmes. The PMO is responsible for working with scheme leads and stakeholders to plan and develop schemes which will deliver transformational change, cost and efficiency savings. The PMO is also responsible for tracking the progress of schemes against agreed milestones and reporting adverse progress on an exception basis to the CIP Steering Group and Finance & Performance Committee. The Group also receives regular reports on the impact of the scheme and the changes arising as a result In support of the management of change, the Trust has in place a Change Management Policy that sets out the arrangements that will apply to all staff affected by organisational changes regardless of the rationale for the change. The policy applies to all employees of NCH&C. NCH&C has committed to consulting with staff and their representatives before any significant organisational change takes place. Where possible the views of individual employees are taken into account both in planning changes and in how those changes will be implemented, managed and tracked To ensure that employees engage with proposed organisational changes, the following measures are in place: Briefing documents explaining the rationale for the proposed changes and circulated widely using varied communication channels; Employee engagement events where staff can openly voice their opinions on proposed changes; For larger organisational changes the appointment of Change Champions who will provide two way communications channels helping keep employees informed of organisational change proposals and advising senior management for feedback from engagement events; Early informal engagement with staff side representatives in advance of formal consultation; Formal consultation with staff side representatives, and Strict adherence to the agreed Change Management Policy. 6.4 Alignment Delivery of corporate objectives requires all parts of the organisation to be pulling in the same direction. It is essential the key targets and programmes are disaggregated throughout the organisation and KPI hierarchy to ensure the delivery of targets at every level and across the Trust as a whole. Individual members of staff Page 9

12 need to know what is expected of them and the part they play in the overall success of NCH&C The diagram in Appendix A below shows the Performance Management Framework with the cascade of the corporate objectives and the process for capturing information on delivery. The right hand section shows how the assurance process has been strengthened, particularly at the Executive Team and Business Unit levels. 6.5 Business Unit Performance Review Monthly performance meetings are held with each of the Business Units. The agenda includes a key highlights report presented by the Assistant Director for the Business Unit and a review of the key performance issues in relation to CIP and finance, human resources, quality and service delivery. Appendix B details the framework for these meetings These meetings have formalised the performance process with the Business Units, enabling robust performance conversations with the Executive Director Team (EDT), focusing on solutions, agreeing where recovery plans are required and any support needed As NCH&C embraces the principles of Service Line Management, it is expected that Business Units will take greater responsibility for all aspects of their performance and the Business Unit Performance Review meetings will be the forum by which managerial and clinical Service Line leaders are held accountable for performance. 7 Conclusion 7.1 This strategy provides the vision and framework for performance management in the Trust. The framework will be reviewed regularly and will continue to evolve and develop, and will be adapted to meet changes in national and local requirements. 7.2 The adoption of Service Line Management principles will promote further the culture of high performance and continuous improvement in the Trust, and will also lead to the development of the performance management framework to support this new way of working. Page 10

13 Page 11 APPENDIX A

14 APPENDIX B Framework for Business Unit Performance Meetings Terms of Reference Objective To review the performance of the Business Unit in relation to a balanced suite of KPIs, and to agree how to improve performance further. To ensure the Executive Directors are aware of the issues and challenges facing the Business Units and to identify support where required. Participants Chief Executive (Chair) Director of Finance Director of Performance & Information Director of Strategy and Transformation Director of Nursing, Quality and Operations Deputy Director of Performance Business Unit Assistant Director Key service heads as required Inputs Monthly dashboard Business Unit Presentation Papers on key issues (if required) Performance Review Agenda Introductory remarks Update on actions from last month Discussion of monthly dashboard Discussion of key issues Debrief Outputs Actions ( from Director of Performance and Information) Synthesis for EDT Debrief Page 12

15 Sequence of Performance Review Meetings Best Practice Example Review Forum Trust Board Trust Board: Trust priorities and Trust-wide issues External developments and implications Critical specific service issues Executive Directors Business Unit Performance Meeting Each service s performance is reviewed Business Unit Management Internal Business Unit meeting Each team within service reviewed Team / Service Internal team performance review Required reports Team KPI Report KPI report from each team Service/Business Unit dashboard Trust Integrated Performance Report Good performance-based conversations ground-rules Participants have taken time ahead of the meeting to obtain relevant input Business Units to expect challenge it is part of the process Discussion is based on facts wherever possible Focus on root-causes rather than symptoms Focus challenge on content and solutions rather than data/methodology Adopt a collaborative approach Data and other non-operational issues are logged for off-line resolution Page 13

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