Section of a 17th Century map of Florida and the American east coast
17th Century map spotted on weekend visit to Hatfield House

Objectives and milestones

I spent quite a lot of time this week thinking and talking about objectives – clarifying and wearing smooth some goals we set for ourselves, share with our colleagues, and intend to deliver for NHS staff, patients and the public.

One set of these are our “tier 1” deliverables – descriptions of changes we intend to make that are significant enough to be reported in public. If our progress towards these is impeded, or if we change our minds, there’ll be governance to work through, and budgetary assumptions to reset. That’s as it should be when we’re spending public money. Never let anyone tell you that being agile means no accountability.

Crafting these outcomes and deliverables at the right level is a fine art. If they’re too specific, teams won’t maximise value by adapting as they learn through the process of delivery. If they’re too vague, multiple teams might interpret them in different ways, and we’ll never know whether we’re on the right track.

Beyond that, I also worked on high-level objectives for me and my team, which feed into my own manager’s performance objectives. It’s nearly 3 months since I started at NHSX, and having these objectives is essential for the next stage of my work with urgent and emergency care. Of the 3 objectives I have proposed:

  • The first encompasses stuff from those tier 1 milestones – 2021-22 delivery in support of system outcomes, including managing emergency department demand more effectively through NHS 111 and 999
  • The second is about how we create the competences required for user-centred digital transformation in the area we’re responsible for
  • The third, and currently least well-formed, hosts a set of questions that might build to a vision for a value-based, patient-centred learning healthcare system, enabled by digital.

There’s more work to do with these objectives and key results in the coming week, but I’ve already printed them out and stuck them on the wall behind my desk, so I can remind myself of them every working day. I also used them to ask myself some questions for the rest of this weeknote.

How am I focusing delivery to support system outcomes?

I observed the first hour of the live services board for digital in urgent and emergency care. It was great to hear about progress on these significant national services, and the difference they’re making right now to the urgent and emergency care sector. The 111 online team sets a good example as a live service team that is continuing on-going user research, picking up signals about how patients’ needs are changing through the pandemic, and why satisfaction with some parts of the service is not where it should be.

I had conversations about a couple of parts of the patient journey in emergency departments that are key to high quality care and effective flow through hospital. How can staff be enabled to signal when their patient is ready to proceed from the emergency department, and how can clinicians check for opportunites to avoid admitting patients for overnight hospital stay, when other kinds of care would be more appropriate? More digging on those to do in the coming week.

How am I growing the capability for user-centred digital transformation?

With help from colleagues, I spent a day interviewing candidates for the head of transformation strategy role in my team. In fairness to the candidates, I won’t say any more about that here until they’ve all heard the outcome.

How am I working towards a patient-centred, learning healthcare system?

In last week’s note, I shared a picture I had drawn to link together two learning loops – the patient’s and the system’s. I haven’t spent as long as I might have liked on this, but I did start to plot some products, services and activities onto the picture. This helped me clarify that digital’s role in service transformation might be to bridge the gaps between patient experience and service delivery, to enrich and accelerate learning in both domains.

Left-hand circular flow shows Patient learning loop: User need > Decide what to do > Get care > Experence drives behavour; Right-hand circular flow shows Service learning loop: Anticipate population needs > Decide what to offer > Give care > Data drives improvement; At the centre Get care and Give care meet at Point of care; underlaying both loops is a rainbow infinity symbol showing they are part of a single system. At the top of the picture spanning "Decide what to do" and "Decide what to offer" are 111 online and phone, NHS Pathways, and Directory of services. In the middle between "Get care" and "Give care" are Inbound booking, Data at point of care, and Onward referral. At the bottom between "Experience drives behaviour" and "Data drives improvement" are user research, outcome data, and service metrics. Top left near "Decide what to do" is Patient contact channels. Bottom right near "Anticipate population needs" is Data analytics and visualisation.

I’m always eager to hear your feedback and further lines of inquiry on any of the notes above.

Original source – Matt Edgar writes here

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