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Wales Audit Office Good Practice Exchange 19th November 2008

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Wales Audit Office Good Practice Exchange 19th November 2008

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    1. Wales Audit Office Good Practice Exchange 19th November 2008 Effective discharge planning and management, patient choice.

    2. Glasby’s Model for Effective Discharge Planning Jon Glasby identifies the three levels at which action needs to be taken by health and social care organisations in order to achieve effective discharge planning: The face to face interaction at the individual level i.e. the discharge process At organisational level re systems, policies, planning and commissioning services At the structural level by having the right political environment to facilitate the first two –policy, budgets etc. Passingn the Baton is aimed at achieving improvement at Level 1 and therefore will not be effective in isolationJon Glasby identifies the three levels at which action needs to be taken by health and social care organisations in order to achieve effective discharge planning: The face to face interaction at the individual level i.e. the discharge process At organisational level re systems, policies, planning and commissioning services At the structural level by having the right political environment to facilitate the first two –policy, budgets etc. Passingn the Baton is aimed at achieving improvement at Level 1 and therefore will not be effective in isolation

    3. Ronseal … ‘Passing the Baton’ is the title of a campaign to improve the experience of people on their journey through care. It’s aimed at frontline Health and Social Care staff to help improve the effectiveness of care processes and planning in practice. Does exactly what it says on the tinDoes exactly what it says on the tin

    4. The method … There are no silver bullets to remove the complexities inherent in our care system, so success will look like: “many simple things done consistently” Passing the Baton, doesn’t have any new magical solutions that will solve all of your problems. Passing the Baton, doesn’t have any new magical solutions that will solve all of your problems.

    5. The ethos … “Processes don’t drive behaviour, values drive behaviour” While developing the Guide it could have become a huge and unwieldy tome as the subject of discharge planning is so broad and complex it has the potential to touch on almost everything we do.While developing the Guide it could have become a huge and unwieldy tome as the subject of discharge planning is so broad and complex it has the potential to touch on almost everything we do.

    6. Barriers to change Key barriers to change identified as we’ve toured the country =Key barriers to change identified as we’ve toured the country =

    7. Human salvation lies in the hands of the creatively maladjusted. Martin Luther King, Jr., Strength to Love, 1963 PtB incites riot/encourages practitioners to think outside the box, be creative and design personalised solutions in response to thorough assessment of the individual and in partnership with them.PtB incites riot/encourages practitioners to think outside the box, be creative and design personalised solutions in response to thorough assessment of the individual and in partnership with them.

    8. The most successful examples of effective discharge we have seen involve a combination of committed practitioners willing to go the extra mile and a senior manager who is willing to cover their backs, provide permissions and support when they do it (talk through Cardiff & Vale mental health case example)The most successful examples of effective discharge we have seen involve a combination of committed practitioners willing to go the extra mile and a senior manager who is willing to cover their backs, provide permissions and support when they do it (talk through Cardiff & Vale mental health case example)

    9. Creating Social Movements PtB encourages practitioners to reconnect with their core personal and professional values, to stand up for them in practice and to be intolerant of colleagues who do not do likewise. I.e. we all have individual accountability to make the change. It wont happen overnight. We are talking about cultural change for the long term. As well as bottom up commitment it needs clear Exec sign up and enthusiasm. And it can’t be applied in isolation. As Mike will go on to describe we need action at the other two levels of Glasby’s model as well. Questions for the debate: Can you be totally confident that your teams do not adopt the ‘Guantanamo approach’? What messages can you send to ensure that your staff can feel able to be ‘creatively maladjusted’? Are you confident that you have the critical success factors of advocacy and authority in place? Does your organisation display the required visible commitment to the long haul? Are you going after inspiration with a club??PtB encourages practitioners to reconnect with their core personal and professional values, to stand up for them in practice and to be intolerant of colleagues who do not do likewise. I.e. we all have individual accountability to make the change. It wont happen overnight. We are talking about cultural change for the long term. As well as bottom up commitment it needs clear Exec sign up and enthusiasm. And it can’t be applied in isolation. As Mike will go on to describe we need action at the other two levels of Glasby’s model as well. Questions for the debate: Can you be totally confident that your teams do not adopt the ‘Guantanamo approach’? What messages can you send to ensure that your staff can feel able to be ‘creatively maladjusted’? Are you confident that you have the critical success factors of advocacy and authority in place? Does your organisation display the required visible commitment to the long haul? Are you going after inspiration with a club??

    11. Progress in some areas Achieved by Budget realignment and better planning Leadership Engagement Modelling More Social Workers Better team work

    12. However the climb gets harder Stretching resources- brittle cover DETOC or wider determinants of pressure Commissioning issues which are more insoluble/ have a lead in time. To remove local agreements we need to improve PDD and MDM’s first. There are some good examples of this but other areas have greater challenges.

    13. The Hill/2 We need to unpick tradition and culture now Resource challenges- short term or longer term ? Pooling existing budgets ? Being firm about Choice Moving from observers to fixers How open is the culture ?

    14. But there are green shoots Choice policy/ Expectation management CHC assessment Unit Senior Commitment Acceptance of Multi-agency approaches Examples of good working can be built upon Cardiff East Locality team PHSI

    15. What would help Need to ensure clarity/economy of working together Still a part of every ones job, no dedicated role We try to work across structures but still run into culture and structure as barriers Need to take the wider view at all levels re performance.

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