Job Planning for Quality and Performance NHS Employers & British Medical Association 9 January 2014
Fair use of slides • These slides the property of the authors ( Dr Ian Wilson, Dr Rob Harwood, Dr Paul Flynn and Dr Jonathan Fielden) and are intended to support local job planning discussions. They should not be used for commercial or for any other purposes without the authors’ permission.
INTRODUCTION
The Politics • Unprecedented structural • Managers and doctors change & significant will need to work even financial pressure more closely together to meet these diverse • Demands for higher challenges. standards of care and • Effective job planning is improved outcomes. one key mechanism to • Pressure on Productivity deliver this shared • Pressure on Contracts responsibility and Costs
Working together with Employers • Reflects a shared understanding of the key principles which should characterise a collaborative approach to the job planning process. • Highlights the benefits of effective preparation for both managers & consultants, including agreeing objectives • Offers a basis which is more likely to be an effective and mutually beneficial means of meeting the challenges that consultants and managers face o delivering high quality patient care in the face of testing financial circumstances and complex organisational change. These principles translate across to Specialty Doctors – although differences in contracts
Refreshing the Basics - What is a Job Plan? • What work the consultant does for the NHS organisation (&/or university) A prospective description • the objectives to be achieved by the A professional relationship consultant & supported by the An annual process employer(s) • When & where that work is done • how much time to be available for A great opportunity work • To drive improvements • what this work (quantified) will deliver and quality of patient care for the employer(s), employee and patients • To take professional • what resources are necessary for the leadership and ownership work to be achieved of services • what flexibility there is • the working relationships outside their primary role
What is it for? • • Alignment the objectives of Core to the business of the – NHS, NHS – organisation (including HE • It’s not just a timetable Institution), – individuals – tools to drive measurable & • Allows clinicians, managers sustainable improvements and the wider NHS team to – Timetable is one tool plan and deliver innovative, safe, responsive, efficient and • The keys to success: high-quality care. – Preparation • Opportunities to develop – Planning as a team personally &professionally – drive quality improvement for – use of SMART objectives present and future needs of patients.
Who is it for? “We cannot meet the • Consultants demands for a high quality • Clinical Managers service unless consultants • Service and Trust and managers combine Managers forces with the wider NHS team to find new and • Patients innovative ways to work. • The public This requires effort, patience • Planners and compromise but the rewards will be significant for • The Profession all involved”
Job planning should not be in isolation • • Performance Clinicians & managers have joint responsibility to provide – Delivery & outcomes • the best possible care within Quality Improvement the resources available – Clinical Care – – Patient experience Distinction b/n management of care and management of resources is • Education & Training becoming increasingly narrow. – Delivery & Quality – Job Planning is a mechanism through – Fewer Trainees which this shared responsibility can be agreed, monitored and delivered • Revalidation – Spirit of collaboration & cooperation – Focus on professional development – Reflective of the professionalism of • more innovative approaches to being a doctor working lives • Clinical leadership • Consultant-based / present services • Team approaches • Focus on measurable outcomes that benefit patients
“LOCAL” CONTEXT
The Plan for the Day • Job Planning – The Basics • Flexibility and Professionalism within Job – Dr Rob Harwood Planning • Advanced Job Planning – – Dr Jonathan Fielden using Objectives to drive • quality Job planning scenarios – Dr Jonathan Fielden – Yourselves! • • Preparing as a team Difficult Situations – Dr Ian Wilson – Dr Paul Flynn • Interactive session – • Q&A objective setting and service level agreements – Drs Paul Flynn and Ian Wilson
Handling Concerns • We know you’ll have questions • Experience suggests best to hold points and questions to the open session and the Q&A – Unless it is simply a clarification • LOT to get through in a very short time… • Future support and follow-up will be vital – Next steps
Dr Rob Harwood Job Planning: From the basics to advanced
A Time-Sensitive professional Contract • Programmed Activities Programmed Activities: (PAs) Normally equivalent to 4hrs DCC Direct Clinical Care • Typically 7.5 DCC & 2.5 (“Fixed Sessions” plus ) SPA SPA Supporting Professional • Full time contract is 10 Activities (non-fixed minus) PAs ANHS Additional Responsibilities (e.g. CD, • Plan ahead in whole or PGO) half PAs EDs External Duties (College, BMA, etc.)
A Time-Sensitive professional Contract • It is a plan not a record… – Prospective description of all the NHS duties you will be contracted to do to fulfil your NHS role – how, when & where duties will be delivered – within the context of professionalism, not clocking in/out • Agreement of objectives – What you will actually be aiming to do • The timetable one component of a job plan – a resource for delivering objectives – Not the prime purpose – Facilitative not restrictive • Job planning should finish with a timetable not begin with it
Emergency Work First • Predictable – Programmed into timetable – If in premium time, 1PA=3PAs – Not the same as a scheduled PA dealing with emergency work. • Unpredictable – Planned ahead as an estimate – Based on previous experience and data – Averaged over a period • Therefore is, by definition, annualised! – If >2PA should have job plan review • Alter job plan to decrease work or plan for scheduled/predictable
Around the edges, but important! • Private Practice – Contract requires it to be declared and scheduled (typical) – BUT any spare time should first be offered to the NHS… the “11 th PA” • Fees – General rule is can’t be paid twice for same period of time • Unless agreed & minimal disruption to NHS work. • Other additional PAs (>10) by agreement • Changes require fair notice
Job Planning is part of an ongoing cycle
Preparation Clinical Manager Consultant Diary for suitable for reference period Consider Quality Indicators Job Planning Consider Trust Objectives • Needs to begin well in Reflect on previous objectives advance of meeting. Team Job Planning Meeting · Set Team objectives • Diary useful particularly · On-call & Emergency work · Extra PAs · External duties if changing patterns of · Consider annualisation care. Consider Individual Objectives • Should also reference national quality Share information indicators and local Individual Job Planning Meeting priorities. · Set objectives · Consider resources · On-call & Emergency work · Extra PAs · External duties · Consider annualisation
Arranging the meeting • At least an hour. • Review previous objectives • Private, with no • Consider new interruptions. objectives & support • Who? (SPA) – Consultant • Consider DCC – Clinical Manager – Emergency/On-call (if – General Manager not done with team) • Those present should – Remainder of DCC be trained to carry it • Additional PAs out without the multiple • Private commitments levels of sign-off.
The meeting – objectives first The job plan review Review progress meeting against objectives Agree prospective Agree new objectives work programme • Personalised service objectives Appropriate • Weekly /other schedules • Personal development • Location of work objectives Agreed Identified Sign off for pay progression
Obstacles • Opening with the timetable • Bringing in other issues – Other colleagues – Trainees – Surprise! • Collect, reflect and share • Difficulty getting agreement – Compromise e.g. alternate week sessions – ‘Parking’ to get more information/perspective – No shame in going to mediation.
Dr Jonathan Fielden ADVANCED JOB PLANNING: Using objectives to drive quality and value What the consultant contract is intended to do
Terms and conditions of service Job plan with objectives, Professional timetable and ethics and other supporting obligations resources Elements Personalised model contract – of the National law the statement of contract particulars
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