Consultation Document. Ashburton & Rural Leadership: Proposal for Change

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1 Consultation Document Ashburton & Rural Leadership: Proposal for Change April 2015

2 For information on this paper, please contact: Name: Michael Frampton, General Manager People and Capability Kelly Balloch, PA to Michael Frampton

3 Executive Summary 1. The Canterbury DHB 2020 vision and direction is the strategic context for Ashburton and Rural. 2. Investment in new facilities, model of care and workforce development and the need for locally focused, sustainable integrated health services in each rural area is creating an environment of change. 3. There is a move towards greater clinical leadership of healthcare in rural settings. A number of transformations are underway in Canterbury s rural areas. We are in the process of: 3.1 Enhancing and improving the delivery of patient centric, whole of system integrated care in Ashburton. 3.2 Integrating health services and facilities redevelopment in Kaikoura. 3.3 Integrating and transferring services and facilities into community ownership in Akaroa. 3.4 Seeking to create fit for purpose, sustainable health services in all rural areas. 3.5 Taking on responsibility for the delivery of health services for the Chatham Islands. 4. This proposal is to change the existing leadership and management structure of Ashburton and Rural Health Services so that Ashburton leadership can focus on Ashburton, and other rural areas are better supported to progress towards sustainable health services that are customised for their areas and communities. The proposed changes support a continued focus on rural health services across Canterbury. 5. The key principles underpinning the change are: 5.1 Separation of Ashburton and Rural [over a transition of up to two years] to enable dedicated management and leadership to focus on integration of health services for the Ashburton district. 5.2 Provision of focused management resource to engage with local communities in other rural areas to identify models of health services which will meet their specific needs. 5.3 Integration of the Chatham Islands into the Canterbury Health System. 5.4 Enhanced clinical and operational connectedness between Ashburton hospital services and the Christchurch City Hospitals. 6. The main elements of the proposal are to: 6.1 Disestablish the currently vacant position of General Manager, Ashburton and Rural Health Services. 6.2 Disestablish the position of Operations/Finance Manager, Ashburton and Rural Health Services. Ashburton & Rural Health Briefing Paper Page 3

4 6.3 Create a new establishment position, being Manager - Ashburton Health Services. 6.4 Create a new fixed term position, being Transition Programme Manager - Rural Health Services. 6.5 Create a new establishment position, being Finance Manager - Rural Health Services reporting to GM Finance and Corporates Services. 7. The Manager, Ashburton Health Services will report to an EMT sponsor over the transition period. 8. We will consult on reporting lines for the Transition Programme Manager - Rural Health Services for the transition period. Options for reporting are: 8.1 Report to Manager, Ashburton Health Services. 8.2 Report to EMT Sponsor. 9. Staff in CDHB rural hospitals other than Ashburton will report to the Transition Programme Manager - Rural Health Services. 10. The Transition Programme Manager - Rural Health Services will also have operational oversight of the integration of the Chatham Island Health Centre into the Canterbury Health System. 11. The Director of Nursing - Ashburton & Rural Health Services will report to the Manager, Ashburton Health Services. There is no change to the role and responsibility of this position. 12. The Director of Nursing will continue to provide strategic and professional accountability for nursing across both Ashburton Health and Rural Health Services. 13. The Clinical Director will continue to provide strategic and professional accountability for medicine across both Ashburton Health and Rural Health Services. Introduction 14. The Canterbury DHB 2020 vision and direction is the strategic context for Ashburton and Rural. 15. Investment in new facilities, model of care and workforce development and the need for locally focused, sustainable integrated health services in each rural area is creating an environment of change. Ashburton & Rural Health Briefing Paper Page 4

5 16. There is a move towards greater clinical leadership of healthcare in rural settings. A number of transformations are underway in Canterbury s rural areas. We are in the process of: 16.1 Enhancing and improving the delivery of patient centric, whole of system integrated care in Ashburton Integrating health services and facilities redevelopment in Kaikoura Integrating and transferring services and facilities into community ownership in Akaroa Seeking to create fit for purpose, sustainable health services in all rural areas Taking on responsibility for the delivery of health services for the Chatham Islands. 17. Following a series of conversations and planning workshops at Ashburton, involving a wide range of staff, a number of opportunities were identified to improve and enhance the delivery of patient centric, whole of system integrated care. 18. The goal is to enable and support the 2020 Best For Patient, Best For System vision while optimising patient care today [quality and flow] and delivering continuous patient journey improvement so it is better tomorrow. Ashburton and other rural areas must have a leadership structure which supports: 18.1 Common purpose and shared values Clear direction and a plan Clinical leadership Organisational leadership and management to enable and support clinical leadership Clinical alignment [across medicine, nursing and allied health] Clinical integration of primary, secondary and tertiary services CDHB functional integration, support and direction Effective internal and external relationships and communications. Key Principles 19. Some key principles have emerged from these conversations and workshops to underpin proposed changes; 19.1 Separation of Ashburton and Rural [up to a two year transition] to enable dedicated management and leadership to focus on integration of health services for the Ashburton district Provision of focused management resource to engage with local communities in other rural areas, to identify models of health services which will meet their specific needs Integration of the Chatham Islands into the Canterbury Health System Enhanced clinical and operational connectedness between Ashburton hospital services and the Christchurch City Hospitals. Ashburton & Rural Health Briefing Paper Page 5

6 20. The current leadership structure is shown in Appendix one a] and two possible new leadership structures are proposed [Appendix one b and one c] which aim to better support the Ashburton mission: to become an exemplar of seamless health system integration. The Proposed Structure 21. The proposed structural options aim to create: 21.1 Stronger clinical, operational and functional connections with wider Canterbury health system Stronger management enablement of clinical leadership to release time to lead Improved integration of Primary, Secondary and Tertiary services Renewed relationship management across the wider Ashburton community Support for the development of sustainable rural health services in other rural areas that best meets the needs of those rural communities A reporting line for the Chatham Island health service Enhanced focus and resources brought to capability development, performance management and the change program of work. Rationale for Proposed Structure 22. The purpose of this document is to propose a change to the leadership structure for Ashburton and Rural Health Services. 23. This proposal is provided as an initial consultation paper and is a baseline document for all feedback throughout the consultation period. Proposal for Change 24. It is proposed that: 24.1 A new establishment position, being Manager - Ashburton Health Services is established A new fixed term position, being Transition Programme Manager - Rural Health Services is established, preferably located in Kaikoura initially A new establishment position, being Finance Manager - Rural Health Services is established The position of General Manager, Ashburton and Rural Health Services is disestablished The position of Operations/Finance Manager, Ashburton and Rural Health Services is disestablished. 25. The two possible proposed structures are provided in Appendix 1b and 1c. Ashburton & Rural Health Briefing Paper Page 6

7 26. Draft accountability statements have been prepared for new roles and are provided in Appendix two a, two b and two c. If the proposal proceeds, these will be developed into full position descriptions. Proposed Key Responsibilities for New Roles 27. Proposed Key Responsibilities for Manager - Ashburton Health Services 27.1 Enabling and supporting a sustainable Ashburton health services model of care which delivers on our vision and key priorities, is best for patient/families and ensures best use of resources Developing and growing services to meet the changing needs of our population through leadership, business planning and encouraging continuous service improvement Integrating Ashburton hospital services with the wider health system through facilitating strategic clinical and community relationships and leveraging functional and operational expertise, tools and resources Encouraging a multi-disciplinary partnership approach to service delivery which transcends traditional geographical and professional boundaries Enabling the development of a small hospital and rural innovation, research and learning centre, through capitalising on our unique strengths and opportunities Ensuring participation and achievement of the CDHB s accountability deliverables, such as the Annual Plan, the South Island Health Service Plan, and the Canterbury Clinical Network [CCN] Ensuring service priorities are understood and met through communicating, monitoring and responding to key performance indicators and building a capable and engaged workforce. 28. Proposed Key Responsibilities for Transition Programme Manager - Rural Health Services 28.1 Providing interim operational leadership and management for CDHB rural facilities and staff as we transition towards fit for purpose, customised and sustainable models of care for other rural areas. In time, manage the transition of these services to new models of care Providing DHB management for the Chatham Island Health Centre Working with clinical leaders, managers, and Kaikoura SLA and the Model of Care Work Group, to enable transformation of services in line with Kaikoura IFHC Vision Managing the transition of the Canterbury DHB maternity, hospital nursing and Aged Residential Care [ARC] services, and Kaikoura Medical Centre primary and community health services]; along with the Kaikoura Physiotherapy Services into an Integrated Family Health Service Providing over-site to the Transition Manager, Akaroa Health Services in delivering a fit for purpose, customised and sustainable model of care for Akaroa. Ashburton & Rural Health Briefing Paper Page 7

8 29. Proposed Key Responsibilities for Finance Manager - Rural Health Services 29.1 Financial and service management planning, analysis and information provided to support effective decision making and compliance with legislative and corporate requirements for all budget holders Continued reduction in waste and improvement in operational resource allocation achieved through identifying areas of opportunity and providing analytical support and advice for lean methodology to be embedded throughout the Ashburton health system Clinical leadership enabled through the provision of clear financial and business advice and support, to release time to care and lead The one-bucket funding principle to be supported through the development of strategic relationships and leveraging support services operationally, particularly within the Finance, ISG, Business Development Unit and Business Support functions, for application in the Ashburton context Business risk managed effectively through proactive risk identification, monitoring and strategic advice and support. Impact of Proposed Changes 30. If implemented: 30.1 All current direct reports of the Operations/Finance Manager would now report to the Manager - Ashburton Health Services, other than Senior Accounting Officer A Transition Programme Manager - Rural Health Services would be appointed on a fixed term and report to either the Manager, Ashburton Health Services or directly to the EMT sponsor Establishment of a Finance Manager - Rural Health Services would occur, reporting to the GM Finance and Corporate Services The Senior Accounting officer and accounts staff would now report through to the Finance Manager, as part of the Corporate Finance team Staff in rural hospitals other than Ashburton Hospital will report to the new Transition Programme Manager - Rural Health Services Other staff reporting relationships will remain unchanged. 31. Benefits: 31.1 It is proposed that these changes would increase the Ashburton integration with Canterbury Hospital and Specialist Services through an EMT sponsor. It would increase our ability to enable clinical leadership and clinical integration through the creation of a focused leadership and management resource for Ashburton. The proposed Transition Programme Manager - Rural Services, will provide operational leadership and management for rural health services throughout the Canterbury region as we transition towards fit for purpose, customised and sustainable models of care for other rural areas. Ashburton & Rural Health Briefing Paper Page 8

9 32. Impact on Staff 32.1 Under this proposal, the role of Operations/Finance Manager and the vacant role of General Manager would be disestablished There will be changes to reporting lines for some staff. Consultation 33. Consultation is the formal process that occurs either individually or as a team where change is proposed to discuss the reasons for it and the potential benefits. No decisions have been made in regard to what is proposed, with the purpose of the consultation period being to request feedback from all affected employees on the proposal. 34. It s important that you have opportunity to ask questions and understand what is being proposed, and the potential impact on you. This is your opportunity to feedback on the proposal and provide any alternative suggestions. Once all the feedback has been received this information will be considered before making a final decision. 35. Consultation will be carried out over the period 15 April through to 13 May Feedback is invited electronically regarding all aspects of the proposal. 36. Confidential feedback can be sent to Michael Frampton by to his assistant Kelly Balloch You can use the attached template [Appendix One] to do so if you wish. 37. All feedback will be acknowledged, collated and fed into the decision making process. Upon completion of the consultation period, all feedback will be considered and a review of the proposal undertaken by late May early June Next Steps 38. A summary of the consultation timeline is detailed beneath: Activity Date Announcement of proposed change and consultation period begins Consultation period ends Feedback considered and review of proposal Decision made and released to staff 15 April 13 May 13 May - 20 May Late May-early June Ashburton & Rural Health Briefing Paper Page 9

10 Support Services 39. Change processes can be a time of uncertainty for people. It is our intention to ensure individuals are supported throughout the entire process. The following services are available to all staff should they be required. 40. EAP Services - Counselling is available through the CDHB funded Employee Assistance Programme [EAP]. This programme is completely confidential. Employees using this service are not identified and we encourage you to contact the service to discuss any issues you may have as a result of the proposed changes. An 0800 number [ ] is staffed by EAP and available on a 24 hr / 7 day basis. Alternatively EAP may be contacted by at Workplace Support Services - Support is also available through the CDHB funded Workplace Support Programme. This programme is completely confidential. Employees using this service are not identified and we encourage you to contact the service to discuss any issues you may have as a result of the proposed changes. Workplace Support can be contacted on Alternatively their website is This proposal has been provided to all site unions. Ashburton & Rural Health Briefing Paper Page 10

11 Appendix One: Feedback Template Name: Position: Comments on proposed changes to leadership roles in Ashburton and Rural Any other information you think is relevant and of value to consider in this process?. Ashburton & Rural Health Briefing Paper Page 11

12 Appendix One A Previous Structure CDHB-wide support Health and Safety HR Shared services General Manager Personal Assistant CDHB Functional Reports Pharmacy Manager Radiology Manager Laboratory Manager Site Maintenance Manager Divisional wide support Quality Coordinator Maori Health Advisor Complaints Manager Clinical Director Director of Nursing Finance and Operations Manager Transition manager Akaroa Rural Nurse Managers Kaikoura Waikari Oxford Darfield Ellesmere Ashburton & Rural Health Briefing Paper Page 12

13 Appendix One B: Proposed Structure 1 CDHB-wide support Health and Safety HR Shared services Divisional wide support Quality Coordinator Maori Health Advisor Complaints Manager EMT Sponsor Ashburton Health Services Manager Personal Assistant Clinical Director Director of Nursing Transition Programme Manager, Rural Health Services Transition manager Akaroa Rural Nurse Managers Kaikoura Waikari Oxford Darfield Ellesmere Chatham Island Health Centre CDHB Functional Reports Pharmacy Manager Radiology Manager Laboratory Manager Finance Manager Site Maintenance Manager Key: Red indicates new position Straight lines direct reports Dotted lines: functional relationships Ashburton & Rural Health Briefing Paper Page 13

14 Appendix One C: Proposed Structure 2 CDHB-wide support Health and Safety HR Shared services EMT Sponsor Ashburton Health Services Manager Personal Assistant CDHB Functional Reports Pharmacy Manager Radiology Manager Laboratory Manager Finance Manager Site Maintenance Manager Divisional wide support Quality Coordinator Maori Health Advisor Complaints Manager Clinical Director Director of Nursing Transition Programme Manager, Rural Health Services Transition manager Akaroa Rural Nurse Managers Kaikoura Waikari Oxford Darfield Ellesmere Chatham Island Health Centre Key: Red indicates new position Straight lines direct reports Dotted lines: functional relationships Ashburton & Rural Health Briefing Paper Page 14

15 Appendix Two A - Draft Accountability Statement: Ashburton Health Services Manager Team: Position title: Reports to: Role Purpose and Accountability: Key Responsibilities: CDHB Operations Leadership Ashburton Health Services Manager EMT Sponsor, [to be confirmed] The Ashburton Health Services Manager provides operational leadership and community and wider health system engagement, to plan for and deliver, the health needs of the Ashburton community. As a member of the operations leadership team, this role has shared accountability for: Patient centric, whole of system, integrated care Patient quality and safety Enabling and supporting clinical leadership Staff health, safety and wellbeing The Ashburton Health Services Manager is accountable for developing an integrated Ashburton health service strategy and for the Operational leadership and management required to bring it to life. Specifically; Enabling and supporting a sustainable Ashburton health services model of care which delivers on our vision and key priorities, is best for patient/families and ensures best use of resources Developing services to meet the changing needs of our population through leadership, business planning and continuous service improvement Integrating Ashburton hospital services with the wider health system through facilitating strategic relationships, management both clinically and across the community and leveraging functional and operational expertise, tools and resources Encouraging a multi-disciplinary partnership approach to service delivery which transcends traditional geographical and professional boundaries Enabling the development of a small hospital and rural innovation, research and learning centre, through capitalising on our unique strengths and opportunities Ensuring service priorities are understood and met through communicating, monitoring and responding to key performance indicators and building a capable and engaged workforce Key Capabilities: Key Relationships: Display self-knowledge Establish the change imperative Stimulate innovation and create wins Build relationships and mobilise support Internal: EMT Sponsor Corporate Functional leaders General Managers/Operational Leadership Group Ashburton Leadership Group Canterbury Clinical Network Transition Programme Manager, Rural Health Services Public Health Nursing Service Think and act strategically Understand and communicate the vision Develop common purpose and direction Empower others to act External: All Health providers in Ashburton Ashburton SLA [once established] All health providers in other rural areas across the Canterbury region Rural Canterbury Primary Health Organisation Community Stakeholders [including the Ashburton District Council Health Committee] Union Officials Ashburton & Rural Health Briefing Paper Page 15

16 Rural Mental Services including CAF Rural. Community Dental Service Health and Disability Commissioner Advocacy Service Ministry of Health Consumers and their families Ashburton & Rural Health Briefing Paper Page 16

17 Appendix Two B: Draft Accountability Statement: Transition Programme Manager Rural Health Services Team: Position title: Reports to: Role Purpose and Accountability: Ashburton and/or Rural Leadership Teams Transition Programme Manager - Rural Health Services Ashburton Health Services Manager or EMT Sponsor Provide continuity of leadership for rural health services [other than Ashburton] throughout a transition period moving towards fit for purpose, customised and sustainable models of care in each area. As a member of the Ashburton and/or Rural leadership teams, this role has shared accountability for: Patient centric, whole of system, integrated care Patient quality and safety Enabling and supporting clinical leadership Staff health, safety and wellbeing Key Responsibilities: Key Capabilities: Provide leadership and management for Nurse Managers at Kaikoura, Waikari, Oxford, Darfield, Ellesmere Hospitals and Chatham Health Centre, the Transition Manager, Akaroa and Kaikoura Medical Centre staff Develop and implement local strategy, business and operational plans to meet the unique needs of each rural community. Develop and maintain appropriate monitoring and response systems to ensure business risks are effectively managed. Manage the transition at Kaikoura, into an Integrated Family Health Service Conduct a needs analysis and establish DHB management, for the Chatham Island Health Centre. Display self-knowledge Build relationships and mobilise support Understand and communicate the vision Develop clear direction and common purpose Empower others to act Stimulate innovation and create immediate wins Foster a positive culture Key Relationships: Internal: Canterbury Clinical Network Director of Nursing [Ashburton and Rural] Finance Manager, rural health services Planning and Funding Public Health Nursing Service Rural Mental Services including CAF Rural. Community Dental Service External: All Health providers in Kaikoura Kaikoura SLA model of care group Kaikoura TLA and health related groups All health providers in other rural areas [Hurunui, Oxford, Darfield, Ellesmere, Akaroa, Chatham Islands, Pegasus Primary Health Organisation Rural Canterbury Primary Health Organisation Hurunui TLA and Health related groups Ashburton & Rural Health Briefing Paper Page 17

18 Appendix Two C: Draft Accountability Statement: Finance Manager Rural Health Services Team: Position title: Reports to: Role Purpose and Accountability: Corporate Finance Finance Manager - Rural Health Services General Manager, Finance and Corporate Services [Operational line reporting to Manager, Ashburton Health Services] The Finance Manager is accountable for promoting sound financial management across Rural Health Services through the provision of financial analysis, modelling, forecasting and decision making support for budget holders and clinical leaders As a member of the Corporate Finance team, this role has shared accountability for: Enabling effective decision making Analysing, reporting and presenting financial information Financial compliance and quality Enabling and optimising one-bucket funding in the best interest of the patient and the system Key Responsibilities: Key Capabilities: Provide Finance team leadership and management Provide analysis and advice for business decision making processes, including monthly and quarterly financial reporting, contract negotiations and the preparation of funding applications and business cases. Support operational managers in budget management including preparation and management of the budget process, internal budget variation reporting and financial analysis and interpretation of financial results Prepare costing models, benchmarking models, financial forecasting, efficiency studies and other projects Support contract management through monitoring performance and designing and implementing corrective action to ensure that contracted volumes and services levels are delivered appropriately. Manage business risk effectively through proactive risk identification, monitoring, strategic advice and support Display self-knowledge Build relationships and mobilise support Understand and communicate the vision Develop clear direction and common purpose Empower others to act Key Relationships: Internal: Corporate Finance Team Ashburton Health Services Manager Programme Manager, Rural Health Services Ashburton Hospital Leadership Team and Budget holders Other rural services Nurse Managers. Transition Manager, Akaroa health Services External: Ministry of Health Other District Health Boards Suppliers/External contractors Ashburton & Rural Health Briefing Paper Page 18

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