Midlands PHM Academy 21 st January 2020 NHS England and NHS - - PowerPoint PPT Presentation

Population Health Management

Midlands PHM Academy

21st January 2020

Population Health Management

Welcome

Karen Bradley

Starter for 10…

We have four questions to get you thinking about implications of PHM… 1) You can answer ‘Yes’, ‘No’ or ‘Not sure’ 2) Indicate your answer using the coloured cards: 3) Find someone with a dif iffer erent ent co colour loured ed card d to you…introduce yourself! 4) You will have 2 min minutes es to discuss the reason for your answers Yes No No Not Sur Sure

Qu Questi stion

• n 1:

1: P PHM sh HM shou

• uld

ld be be a at th t the ce centr ntre e of

• f al

all ou l our S r STP TP ap appr proache

• aches

Yes? No? Not sure?

Qu Ques estion tion 2: 2: W We sh e shou

• uld

ld be be lo look

• kin

ing g at t po popu pula lation tion su sub-gr grou

• ups

ps rathe rather r th than in indi divid vidual ual pathw pathways s or

• r se

service vices

Yes? No? Not sure?

5

Qu Ques estion tion 3: 3: Y You

• u can

an le lear arn mor n more abo e about ut th the needs ds of

• f a pop

popula lation tion su sub-gr grou

• up

p by ta talk lking ing to th

• them, tha

m, than fr from

• m lo

look

• king

ing at t th the data data

Yes? No? Not sure?

Qu Questi stion

• n 4:

4: R Resou sources ces sh shou

• uld

ld be be sk skewed ed fr from

• m dis

disadv advan anta taged ged to mor

• more

e adv dvanta ntaged ged gr grou

• ups

ps if if th that t le leads ds to

• be

better er overa rall ll average rage health/ lth/wellbe llbeing ing

Yes? No? Not sure?

7

Population Health Management

Programme Recap

Fraser Battye

Where have we come from? Where are we now? Where are we going?

A ‘Core Team’…

• Enthusiastic, energetic, appetite for

change

• Senior enough so lessons from projects

can inform STP’s overall PHM approach

• Multi-disciplinary, (e.g.) analysts,

clinicians, commissioners, local govt, voluntary sector, finance, etc.

• High level sponsor and project

management in place

In March 2019, we asked your STP for…

…to run a project:

• New - to run through from start to finish
• Focused - population group with scope

to improve outcomes

• Requiring a cross-sector approach - not

a simple ‘service improvement’

• In need of analysis - incomplete data,

sources need drawing together, etc.

• STP priorities and value in bringing
• rganisations together

Defining a population sub- group (PSG) Analysis and engagement to understand PSG Measuring what matters; measuring to learn Using research evidence to design changes Logic modelling and setting

• utcomes

Multi-disciplinary team working Stakeholder mapping and influencing Culture of stewardship Systems thinking

Introduction to PHM; the science of improvement Needs assessment; opportunity analysis Impact assessment; evaluation Population segmentation; risk prediction Actuarial modelling Problem structuring; communicating results

Core Team Analysts

Where have we come from? Where are we now? Where are we going?

Single sources of data; performance management

PHM: direction of travel

Systems of intelligence for population outcome improvement Individual organisational resources; competitive culture Collective, system resources; culture of stewardship HiPPOs and hunches Intelligence-driven decision making Focus on individual services, pathways, interventions… Needs of populations / population ‘segments’ Cost; bio-medical; doing to patients Value; wider determinants; doing with populations

From To

‘Technical’ ‘Relational’

Population segmentation Resource mapping Actuarial analysis Impactability analysis Risk stratification IG Digital infrastructure Logic modelling Outcome definition / measurement Librarian skills Evaluation Multi- disciplinary working Leading in systems Culture of stewardship Project working Influence, persuasion, story telling Analyst-decision maker relationships

Where the real value lies: move from analysis to action

Learning from the people we serve Valuing and prioritising

Where have we come from? Where are we now? Where are we going?

• 1. Reviewed and assessed core concepts and approaches in adopting PHM
• 2. Understood what is now required to:

a) complete your project; and, b) make PHM ‘business as usual’ in your STP/ICS

• 3. Share lessons and generate commitments for next steps
• 4. Meet someone from another STP team who could help you in future work

By the end of today, you will have:

Defined support needed from the Faculty between now – end March

Dates for diaries

Analysts’ Revolution 19th March End of programme ‘celebrate and share’ 5th March

Population Health Management

A Review of Approaches to PHM: What Have We Learned… and What Will We Use?

21 January 2020

• 1. Creating a Culture of Stewardship
• 2. Defining Population Subgroups
• 3. Learning about (and from) Population Subgroups
• 4. Using Logic Models: Impact and How to Achieve It
• 5. Measuring what Matters
• 6. Influencing Stakeholders

Approaches to Population Health Management

Is your STP/ICS ready to embrace PHM?

C=Dx x F> R V

✓How much has the PHM approach changed your mindset? ✓How useful will the PHM approach be for your project?

• 1. Individually rate PHM approach on a 1–10 scale (1= lowest)
• 2. Team discussion to arrive at a consensus rating on 1-10 scale
• 3. Plenary discussion across teams citing specific examples
• 4. Option for teams to revise their consensus ratings on 1-10 scale

Rating Approaches for Change in Mindset and Action

1.

• 1. Crea

eati ting ng a C a Cul ultur ure e of

• f St

Stewar ards dship hip

• 2. Defining Population Subgroups
• 3. Learning about (and from) Population Subgroups
• 4. Using Logic Models: Impact and How to Achieve It
• 5. Measuring what Matters
• 6. Influencing Stakeholders

Approaches to Population Health Management

Creating a Culture of Stewardship

POINT OF OPTIMALITY BENEFIT HARM

Resources

UNDERUSE OVERUSE

BENEFIT - HARM

Effect ct Size

Creating a Culture of Stewardship: Balancing Population Value and Personal Value

‘Technical’ ‘Relational’

Population segmentation Resource mapping Actuarial analysis Impactability analysis Risk stratification

IG

Digital infrastructure Logic modelling Outcome definition / measurement Librarian skills Evaluation Multi-disciplinary working Leading in systems

Project working

Influence, persuasion, story telling Analyst-decision maker relationships

Where the real value lies: move from analysis to action

Learning from the people we serve Valuing and prioritising

A Culture of Stewardship: Technical and Relational Skills

Creating a Culture of Stewardship

✓Balancing Population Value with Personal Value

Mindset Usefulness

✓Balancing Technical and Relational Skills

Mindset Usefulness

1.

• 1. Crea

eati ting ng a C a Cul ultur ure e of

• f St

Stewar ards dship hip 2.

• 2. Defi

fini ning ng Pop

• pul

ulation tion Sub ubgr groups

• ups
• 3. Learning about (and from) Population Subgroups
• 4. Using Logic Models: Impact and How to Achieve It
• 5. Measuring what Matters
• 6. Influencing Stakeholders

Approaches to Population Health Management

Defining Population Subgroups

Who are the popula pulatio tion: n: by sex, x, ag age, , life-sta stage ge, income

• me, locatio

ation? n?

Demographics

What at do they do: : how w much, h, when, en, wher ere, what t are the triggers? gers?

Behaviour

What at do they think: k: needs ds, feelin ings, gs, beliefs, s, values? ues?

Attitudes

Burden den of disea ease se: clinical l conditions ditions, wellness, ness, illness, ss, multi ti- morbi rbidi dity, risk k of advers erse e event, nt, curr rrent ent / futur ure e healthcar thcare e costs ts

Health status

Defining Population Subgroups Geographically

Defining Population Subgroups: A Six-Step Approach

• 1. General statement about the population of interest
• 2. Establishing inclusion/exclusion criteria for the population of interest
• 3. How does this population subgroup fit with other subgroups in the STP/ICS?
• 4. What are the ambiguities around inclusion and exclusion in the subgroup?
• 5. What is the size of the population subgroup within the geographical area?
• 6. What resources are available for the care of this population subgroup?

Defining a Population Subgroup

✓A Geographic Approach

Mindset Usefulness

✓A Six-Step Approach

Mindset Usefulness

1.

• 1. Crea

eati ting ng a C a Cul ultur ure e of

• f St

Stewar ards dship hip 2.

• 2. Defi

fini ning ng Pop

• pul

ulation tion Sub ubgr groups

• ups

3.

• 3. Lea

earning rning ab abou

• ut

t (an and d fr from

• m)

) Pop

• pul

ulati tion

• n Sub

ubgroups

• ups
• 4. Using Logic Models: Impact and How to Achieve It
• 5. Measuring what Matters
• 6. Influencing Stakeholders

Approaches to Population Health Management

Learning about and from Population Subgroups

• 1. Dynamic identification of people at

risk

• 2. Practice / Network based MDT led

proactive management

• 3. Development of people owned care

plan (or ‘my life/care plan’)

• 4. Care coordinator (or care lead) for

people who need more support in care coordinating their care

• 5. MDT to trust each other

(assessments to start with) – define rules of the ‘BEACH’

• 6. Continued support for healthy

independence using community groups and vol / third sector

Learning about Your Population Subgroup: Risk Stratification

• invo.
• .com
• m

‘I didn’t need this new hip. All I needed was a bannister so I could get down to see the postman!’ ‘You forgot to ask about the

• dog. It died. That’s why she

doesn’t get out or take care

• f herself as much.’

Learning about Your Population Subgroup: Engaging to Learn

✓Risk Stratification

Mindset Usefulness

✓Engaging to Learn from a Population Subgroup

Mindset Usefulness

Engaging to Learn from Your Population Subgroup

1.

• 1. Crea

eati ting ng a C a Cul ultur ure e of

• f St

Stewar ards dship hip 2.

• 2. Defi

fini ning ng Pop

• pul

ulation tion Sub ubgr groups

• ups
• 3. Learning about (and from) Population Subgroups

4.

• 4. Using

ng Log

• gic

ic Mod

• dels

els: : Imp mpact act an and Ho d How to A

• Ach

chieve e It

• 5. Measuring what Matters
• 6. Influencing Stakeholders

Approaches to Population Health Management

Using Logic Models

Inpu puts ts

Resources used

Act ctivi ivities ties

Things done (measured by outputs)

Outcomes comes

Effects of activities

Imp mpacts cts

Broader societal ‘goods’

Logic Models: Defining Intended Impact & How to Achieve It

• What specific difference do you want

to make for / with your population sub group?

• Outcomes are changes - in

knowledge / awareness / skills / access / behaviour / condition / status (etc)

• So language describing change is

important: reduced, increased, improved, better, worse (etc)

• Focus on outcomes that matter, not

measures you currently have

Logic Models: Theory of Change; Cause–> Effect Assumptions

“If we deliver training, then we will improve the care planning skills of care homes staff... If staff have better care planning skills, then they will be more able to cope in the event of a crisis... If staff are more able to cope with crisis, then there will be fewer unplanned hospital admissions.... If there are fewer unplanned admissions, then more people will die in a setting of their choice. They will have a better death; we will make better use of resources. ”

The theory connects activi ivity… …to outcomes comes… …to impacts pacts

Using Logic Models

✓Define Intended Impact & How to Achieve It

Mindset Usefulness

✓Theory of Change; Cause → Effect Assumptions

Mindset Usefulness

1.

• 1. Crea

eati ting ng a C a Cul ultur ure e of

• f St

Stewar ards dship hip 2.

• 2. Defi

fini ning ng Pop

• pul

ulation tion Sub ubgr groups

• ups
• 3. Learning about (and from) Population Subgroups
• 4. Using Logic Models: Impact and How to Achieve It

5.

• 5. Mea

easuring uring wha hat t Matters ers

• 6. Influencing Stakeholders

Measuring What Matters

Measuring What Matters

Measure to Learn Population Needs and Personal Wants

Measure to Serve all Stakeholder Interests

Measuring What Matters

✓To Learn Population Needs and Personal Wants

Mindset Usefulness

✓To Serve All Stakeholder Interests

Mindset Usefulness

1.

• 1. Crea

eati ting ng a C a Cul ultur ure e of

• f St

Stewar ards dship hip 2.

• 2. Defi

fini ning ng Pop

• pul

ulation tion Sub ubgr groups

• ups
• 3. Learning about (and from) Population Subgroups
• 4. Using Logic Models: Impact and How to Achieve It
• 5. Measuring what Matters

6.

• 6. Inf

nfluencing uencing St Stak akehold eholders ers

Approaches to Population Health Management

Influencing Stakeholders

Systems Thinking across All Stakeholders

Respectin pecting g Comple plexit xity y with th Simp mple le Ru Rules les

Effective Teamwork and Directional Leadership

Balanci lancing ng Technic chnical al and d Relati ational

• nal Compe

mpetenci encies es Direction ectional al Leader dership ship

Influencing Stakeholders

✓Systems thinking across all relevant stakeholders ✓Effective teamwork and Directional Leadership

Mindset Mindset Usefulness Usefulness

• 1. Creating a Culture of Stewardship
• 2. Defining Population Subgroups
• 3. Learning about (and from) Population Subgroups
• 4. Using Logic Models: Impact and How to Achieve It
• 5. Measuring what Matters
• 6. Influencing Stakeholders

Approaches to Population Health Management

Population Health Management

Break

Population Health Management

So what has really resonated with you?

Simon Bourne

We have three stations:

• If you have a gr

green een car ard go to stat tation ion 1

• What advice would you give to your previous self as you embarked on this PHM programme? (Write a letter to your

previous self – as you entered the room for session 1 in July)

• If you have a yel

ello low car ard d go to stat tation ion 2

• What advice would you give to a project team from another area about to embark on a PHM project? (Ketso kit)
• If you have a red

ed car ard d go to station tation 3

• If you were starting your project / the programme again, what additional support do you think you would need and

who do you need to provide it? e.g. STP leadership, analysts, other organisations who aren’t currently involved? (Conversation café)

When the claxon sounds move to the next station

Activity

Population Health Management

Lunch

Population Health Management

Mad Tea Party

Mad Tea Etiquette

• Stay curious, dig deep, have fun
• Don’t over think answers
• Finish each of the open sentences wi

with h a sh shor

• rt

t ph phrase se!

I think Population Health Management is important because….

One thing that has struck me today is…

When I get back to base I am going to tell my team about…

Population Health Management

Now What?

Population Health Management

Force Field Analysis

Erica Ison and Tim Wilson

Instructions

Step tep 1

• In relation to your Population Health Management (PHM) project at the present time,

working in pairs or trios, within your team, identify graphically using a force-field diagram:

• Driving forces for change
• Restraining forces for change

Note: driving forces and restraining forces are not mutually exclusive, a driving force can also be a restraining force. Maximum time allotted: 15 minutes

Progressing your project Driving forces Restraining forces

Force Field Analysis: Step 1

Instructions

Step Step 2

• Come together as a team and make a combined force-field diagram on a

flipchart sheet

• Using this combined diagram, discuss and then agree what your next

credible step should be to make progress on your PHM project

• Having identified your next step, explore the support you might need to

achieve it, and decide upon at least one 'request' for support from PHM Faculty Members between now and the end of March 2020 Maximum time allotted: 30 minutes

Our fir irst t cred edib ible le step p wil ill b l be to: ____ ________ ____________ ____________ ___________ _____ The suppo port t we need d is is: ____ ________ ____________ ____________ ___________ _____

Progressing your project Driving forces Restraining forces

Force Field Analysis: Step 2

Instructions

Step Step 3

• Present your force-field analysis to the other STP teams, highlighting the

main driving forces and the main restraining forces for change using your flipchart sheet

• Outline your what your next step will be as a team
• Describe the support you think you will need to achieve this step

Time for presentation: 2 minutes

Population Health Management

Break

Population Health Management

Getting strategic and spreading PHM

David Frith and Karen Bradley

Your objective

Time to get competitive!

Bl Blue Team m Mo Mode Your 5 year vision for PHM in your system Red Team m Mod

• de

How to ruin another system’s 5 year vision Pit Pitchin ching g and sc scor

• rin

ing Which is our most cunning system?

• Individually, spend 3 minutes reflecting on where you’d like PHM to have got to in your system in 5

years’ time:

• Rapidly share your vision/hopes in your group. Agree key points. Your facilitator will take notes. (15

mins)

Blue Team Mode

What t benefi fits ts is is PH PHM deli livering ring for

• r you
• ur cit

itizens zens and you

• ur system?

em? What does your system’s PHM infrastructure look like? What resou

• urces/pr

ces/process

• cesses

es are in in pla lace e and functio ctioni ning? ng? Who is

• is in

invol

• lved

d in in genera erati ting ng and usin ing system m in intelli lligence? gence? What cult ltur ure/beha e/behavio viours urs are they demon

• nstra

strati ting? ng?

• Facilitators move and swap groups.
• Each group is now a red team charged with planning attacks on one other system’s vision.
• Facilitators briefly summarise the vision they have brought from another group.

Im Imagin ine e you

• u a

are a st stakeho ehold lder er wit ithin in that t system

• r
• r co

could ld in influence/ ence/af affect ect it it from

• m ou
• utsi

side de. What t cou

• uld

ld you

• u d

do (

• (or
• r not do)

that t cou

• uld

ld scupper pper any aspect ct of

• f t

that t vis isio ion bein ing g reali lised? sed?

• Rapidly generate a range of troublesome (and feasible) behaviours, actions or decisions.
• Agree your most cunning idea.

Red Team Mode

Pitching for the Academy Award

• Facilitators pitch their red team’s most cunning plan (highlighting the aspect of the vision it is trying

to destroy). If a similar plan has already been pitched, pitch your next best.

• On Mentimeter, everybody scores each pitch as it is made

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Looking on the bright side

And the winner is…DERBYSHIRE STP!

Population Health Management

Summary and Close

Dates for your diary

Lea eaders ers sess essions ions

These e half day session ions s will introd

• duce

uce the skills ls and insights ts required to to make effect ctiv ive e use of analy lytic tics, s, and to to work effect ctiv ivel ely y with analy lysts, ts, within sys ystems. ems.

Birmingham - 13th Februar bruary y Leicester - 25th Febr brua uary Stafford - 12th March Further her deta tail ils s on all ll sessions ssions is available ailable on our micros

• site

e midl dlandsphmac ndsphmacade ademy.n .nhs. hs.uk

End End of

• f P

Progra

• gramme

mme Ce Celebrati ebrations

• ns

PHM Academy: End of Year Celebration 5th

th Ma

March ch PHM: The Analysts Revolution 19 19th

th Ma

March ch

Email: england.stgphm@nhs.net www.midlandsphmacademy.nhs.uk

Useful resources

Population Health Management

Safe journey home!