professional development programme for organ donation “driving improved organ donation within your...

Professional Development Programme for Organ Donation

“Driving improved organ donation within your hospital”

Making Change Happen

1

Dr Paul MurphyAdam KingDimple Cosgrove

26 May 2010


By the end of this session, participants will:

• Understand the importance of having a clearly defined vision for Organ Donation and start to articulate their own vision for Organ Donation within their hospital

• Appreciate the benefits of annual planning and reporting to leading Organ Donation within their hospitals

• Understand the skills, knowledge and process required to develop Annual Organ Donation Plans and Annual Reports

• Be provided with practical hints and tips on developing local Annual Organ Donation Plans and Annual Reports

• Understand the roles and responsibilities of the Clinical Leads, Donation Committee Chairs and Specialist Nurses for Organ Donation in the Business Planning Cycle

• Have an opportunity to put theory into practice and build a local plan for organ donation

Session objectives

2


The progression of your learning journey

On

line T

oo

l: Self-A

ssessment T

ool, Docum

ent Sharing, P

odcasts, Discussion F

orum, P

DP

Atlas,

Program

me P

rogress Tracker

National Kick-Off Event(inc Law & Donation after Cardiac Death Master Class)

Change Management & Leadership Fundamentals

Master Class 1 (Diagnosis of Brain Stem Death and Regional Peer Consulting Group Launch)

Master Class 2(Donor Management & Physiology and Emergency Medicine)

Making Change Happen(Development of action plan to implement changes in Trust)

Master Class 3(Consent / Authorisation)

Donor Simulation & Paediatrics(Additional Subject Areas)

Regional Peer Consulting Groups(Coaching & networking event)

National Review Event(Review of Programme and Ethics and Media Skills Master Class)

National Kick-Off Event(inc Law & Donation after Cardiac Death Master Class)

Change Management & Leadership Fundamentals

Regional Peer Consulting Group(Introduction and coaching in action learning sets)

Making Change Happen(Development of action plan to implement changes in Trust)

Regional Peer Consulting Groups(Coaching & networking event)

National Review Event(Review of Programme and Ethics and Media Skills Master Class)

Podcasts: Eye & Tissue D

onation, Epidemiology of D

onation & Transplantation, Audit &

Statistics and PD

A: interpretation & Action

Online Tool Self Assessm

ent Tool, Docum

ent Sharing, Podcasts, Discussion Forum

, Program

me Atlas, Program

me Progress Tracker

All Clinical Leads Non Clinical Champions

3


Agenda

1 Change Management and Leading Fundamentals Refresh 09:30-09:55

2 Developing your vision for Organ Donation 09:55-11.15

Break 11:15-11:30

3 The Annual Organ Donation Planning Cycle 11:30-11:50

4 Developing an Annual Organ Donation Plan 11:50-12:05

5 Developing an Annual Report 12:05-12:20

Lunch 12:20-13:00

6 Managing and Tracking Against Plan 13:00-13.20

7 Building a Local Plan (Part A) 13:20-14:30

Break 14:30-14:45

8 Building a Local Plan (Part B) 14:45-15.30

9 Summary and Close 15:30-15.45

4


During the Fundamentals of Leading Change session we:

• Identified what can help to make change successful and what are the common reasons for failure

• Identified the local barriers to promoting change within your hospitals

• Introduced the change frameworks which you can use to guide change Management for Organ Donation

• Discussed the importance of understanding who your stakeholders are to any change effort and tools for identifying and analysing your stakeholders

• Defined the three way leadership between Donation Committee Chair, Clinical Leads and Specialist Nurse for Organ Donation and your respective roles as Change Leaders

• Discussed techniques for tackling difficult conversations

• Started to plan actions to identify and implement the changes you can make within your own hospital

Fundamentals of Leading Change - Refresh

5


Understanding the bigger picture

6

PDP Strategic Big Wins

Developing a vision for Organ Donation

7


What success looks like for the PDP

• The PDP for Organ Donation will contribute to the Organ Donation Taskforce objective

to increase Organ donation rates by a minimum of 50% within 5 years – Making organ

donation “Usual”

• To achieve this vision the Programme will focus on 6 big win areas:

8


What does success look like under each of the 6 big wins?

• We would like you now to split into six groups, one group per strategic big

win

• For your strategic big win we would like you to describe the future state of

what a gold standard hospital would be doing under this objective i.e.

What would people in the hospital be doing around organ donation from a clinical

perspective?

What would the Organ Donation Committee be doing?

What behaviours would you see?

What outcomes might have been achieved / what success stories are there?

• Put your ideas on post-it notes and stick these on a flip chart

• Group discussions for 30 minutes and then 30 minutes feedback

9


What can happen without an effective strategic direction?

• Lack of general direction and lack of a clearly defined ‘future state’

• Failure to appreciate the longer-term interests and too much emphasis on

short-term success

• Actions are un-coordinated and without shared purpose or meaning

• Ineffective decision-making and poor prioritisation

What is needed is a compelling view of what the future of Organ

Donation looks like in your hospital

Why do you need a strategic direction for improving Organ Donation?

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Your strategic direction for Organ Donation must be developed in the context of the wider vision for Organ Donation and

the local visions of your individual hospitals

Ensuring alignment of your Organ Donation Strategic Direction

NHSBT will identify the common organ donation themes and support Donating Hospitals to shape their local strategic direction for organ donation in alignment with the Taskforce vision

Organ Donation Taskforce Objective

To increase organ donation rates by 50% within 5 years

Local Hospital Organ Donation

Strategic Direction


Strategic Direction


Strategic Direction


Strategic Direction


Strategic Direction

Overall Hospital Vision





Annual Plan Annual Plan Annual Plan Annual Plan Annual Plan

Local Organ Donation strategies will be based on local needs, the overall hospital vision and the ODTF objectives

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Ensuring your strategic direction for Organ Donation is effective

Build a believable image of how Organ Donation will be in the future in your hospital

Is it realistic?

Ensure that this image is inspiring, realistic and achievable so that people are motivated to act as the vision intends them to

Is it achievable?

Align the vision to the interests of key stakeholders, the wider organisation and those of the national agenda for Organ Donation

Is it meaningful to a wide audience?

Focus the vision on clear priorities and ensure that it is easily understood

Does it eliminate confusion and support decision making?

Create a vision that is easily communicated to the rest of the hospital

Is it concise and does it appeal to people’s emotions?

Avoid visions which are too prescriptive or constrain individual initiative

Is it flexible?

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Examples of Organ Donation Visions

Transplant Australia exists to enrich and celebrate life. Our vision is for Australia to lead the world in organ and tissue donation and transplantation - saving lives, improving quality of life and providing much needed care and support.

The vision of Donate Life America is to ensure that every person in the U.S. understands the need for organ and tissue donation and accepts donation as a fundamental human responsibility.

We wish to see organ donation become a usual rather than unusual event as part of end-of-life care across the NHSEach individual should be given the choice and opportunity to offer their organs for the purposes of transplantation after their death. This choice should not be denied by the assumptions of NHS staff or a lack of facilities and infrastructure

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• The process involves the combination of both creative and logical approaches

• Development of the vision may involve several iterations as you test your ‘hypotheses’ and validate with your colleagues and stakeholders

• The type of data which you can use to input into the development of your strategic direction include:

Review of the Organ Donation Taskforce Report and the Programme’s 6 Strategic Big Wins

Assessment of the national legal and policy frameworks for organ donation

Assessment of your hospital’s overall vision

Analysis of current Organ Donation practices within your hospital

Benchmarking against Organ Donation best practice within other hospitals

PDA data

How do you develop a strategic direction?

Draft strategic direction and collect data to test it

Refine the direction and validate with others

Communicate and embed the strategic direction

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Communicating your strategic direction to your colleagues and the wider hospital and receiving their buy-in is essential to the vision’s success

Ways of communicating your vision include:

• Written and verbal communication e.g. the Annual Organ Donation Report, the Annual Organ Donation Plan, training materials and other communications

• Encouraging discussion of the Organ Donation strategic direction within your hospitals and amongst colleagues

• Reinforcing key messages by linking it to the day-to-day activities of the hospital

You know your vision has been embedded when:

• Stakeholders are able to articulate the strategic direction and it’s impact in their own words

• The strategic direction is discussed outside of situations in which it is required

• Elements of the strategic direction become part of the organisational culture and ‘the way things are done around here’

Communicating your vision for Organ Donation?

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The Annual Organ Donation Planning Cycle

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What is the Annual Organ Donation Planning Cycle?

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The annual organ donation planning cycle provides a structure of analysis, planning and reporting around which you can make the right changes to improve organ donation

Purpose of planning cycle:

• Ensure content of plan reflects realistic ‘path’ from current state to objectives

• Ensure delivery of plan is on-track and responds to changes in circumstances

• Ensure oversight by Executive Board


What does the Organ Donation Planning Cycle look like?

Benchmarking Data

Mid Year Review-

ODC Meeting

Annual Organ Donation Plan

July

October

January

May

June

December

November September

March

February

April(Financial Year begins)

AugustAnnual Report

Key

Organ Donation Planning Cycle

Annual Report

Annual Organ

Donation Plan

Benchmarking data

Benchmarking data

Mid Year Review

Present to Executive

Board

CLOD, SNOD & DCC*

PDA

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How can you plan effectively in line with the Organ Donation plan?

1. Assess: Conduct analysis of internal and external environment

to identify issues and potential opportunities

2. Plan: Consider objectives to overcome issues / make the

most of opportunities and establish activities and

when these would happen to achieve objectives

3. Implement: Deliver & track against plan, as well as reporting

against progress

Planning is not a one off activity – it requires regular assessment of progress and

interventions. Remember 3 simple steps: Assess; Plan; and Implement

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Key Assessment Activities

Assess

Fishbone Analysis

Potential Donor Audit (PDA)

SWOT Analysis

Unit Profile Stakeholder AnalysisBenchmarking

To

wha

t ex

tent

is t

his

pers

on/

grou

p af

fect

ed b

y th

e C

hang

e?

High

High

Low

LowInfluence

Imp

act

20


Potential Donor Audit - Introduction

What is it?

The Potential Donor Audit (PDA) is an audit of all deaths occurring in Intensive Care

Units for patients under the age of 75. A recent initiative is extending the audit to

Emergency Medicine departments, however, this is still in progress.

Aims of the PDA?

•Determine the potential for solid organ donation

•Understand why solid organs were not retrieved where potential recognised

•Identify all patients for whom death was diagnosed following brain stem tests

•Raise the profile of solid organ donation

•Heighten awareness of donation issues with clinical staff

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Developing an Annual Organ Donation Plan and Report

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What is it?

• An Annual Organ Donation Plan is a formal statement of a set of ‘Organ

Donation goals’ for the hospital, the reasons why they are believed attainable,

and the planned interventions (or activities) for reaching those goals

What are the benefits?

• Clarity of vision

• Objectives and actions

• Describe the metrics

• Define the seriousness of the venture

What is an Annual Organ Donation Plan?

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What is it?

• An Annual Report is a comprehensive report on an Organ Donation team’s activities

throughout the previous year. It is intended to provide their stakeholders including NHSBT

with information regarding the team’s activities and performance against their goals.

What is the purpose?

• The Annual Report is intended to provide their stakeholders including NHSBT with

information regarding the team’s activities and performance against their goals in an easy

to digest format

• Development of the report helps the Organ Donation team to reflect on their performance

from the previous year and aid their future strategy development

• The Annual Report is a celebration and communication of past and recent successes

• Communicating the Annual Report within and outside of the local hospital will help to

share lessons and develop learning

What is the Annual Report for Organ Donation?

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Annual Organ Donation Plans are a decision making and communication tool and should be determined by the specific goals and stakeholders of the Organ Donation team. Typical high level structure includes:

What does an Annual Organ Donation Plan look like?

Content Description

1. IntroductionWhat are their main priorities for the year, what is the purpose of the Annual Organ Donation Plan?

2. BackgroundWho is in the team, what are the primary roles of the Organ Donation Team. What’s happening in the hospital that would impact Organ Donation activities?

3. Policy FrameworkWhat national and legal polices have changed over the last year, how will this affect the key targets for the following year?

4. Strategic DirectionWhat are the high level strategic plans for the Organ Donation Team and their hospital?

6. Action PlansDetail actions against the objectives and indicate timelines for completion as well as owners, risks and issues

7. Risks/ IssuesWhat are the likely key risks and challenges inhibiting delivery against the action plan and what mitigation strategies can be put into place to minimise the impact?

8. Performance Indicators and Monitoring Arrangements

How will the Organ Donation team measure success against each of the key targets for the following year?

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Annual reports consist of but are not limited to the following contents:

\

What does an Annual Report look like?

Content Description

Introduction Introduction to the report including messages from the Donation Committee Chair and Clinical Lead

Overview and Background Feedback from the Donation Committee and the Strategy and Vision for Organ Donation

Summary of the Year Summary of performance for the year based on objectives set in the Annual Organ Donation Plan

Performance Variances and Action Plans

Detailed review of variances against the action plans and set objectives

PDA Benchmarking Benchmarking of Donation rates across hospitals and regions

Local Initiatives Topics to include may include local activities to increase Organ Donation rated, promote awareness or responses to change in law or policy

Future Development Vision and desired actions for the following year – Where does the Organ Donation Team want to be in a year’s time?

Possible risks/pressures Highlight risks and issues identified through the year, what are the challenges, how are the Organ Donation Team going to overcome these?

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SMART Objectives

S M A R T

Specific Measureable Accurate Realistic Timely

Is there a description of a precise or specific behaviour / outcome which is linked to a rate, number, percentage or frequency?

Is there a reliable system in place to measure progress towards the achievement of the objective?

With a reasonable amount of effort and application can the objective be achieved?

Can the person with whom the objective is set make an impact on the situation?

Do they have the necessary knowledge, authority and skill and is it relevant to the organizational goals and aims?

Is there a finish and/or a start date clearly stated or defined?

The Annual Organ Donation Plan should be focussed upon SMART objectives

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Example SMART Objectives

Objectives for the next yearActions required to deliver

objective Measurable outcome/KPIsPerson responsible for leading action

To have 100% referral of all potential non-heart beating donors and brain stem dead donors – with 80% conversion rate by 2010

• Resident Specialist Nurse for Organ Donation to feedback PDA

• Utilise Clinical Lead and Donation Committee

• PDA reflects 100% referral • Specialist Nurse for Organ Donation lead

• Clinical Lead for Donation

To achieve an 80% conversion rate by 2010

• Resident Specialist Nurse for Organ Donation to feedback PDA

• Utilise Clinical Lead and Donation Committee

• PDA reflects 80% conversion • Specialist Nurse for Organ Donation lead

• Clinical Lead for Donation

The minimum notification criteria is used in 100% of all cases to ensure timely referral

• Communicate/ reaffirm minimum notification criteria to all relevant staff

• PDA reflects use of notification criteria in 100% of cases

• Clinical Lead

To scope the implementation of a new Organ Donation programme within the Emergency Medicine department within 6 months

• Understand the process within emergency medicine

• Agree roles and responsibilities for scoping exercise

• A comprehensive report that progresses an Organ Donation programme within Emergency Medicine to be made

• Specialist Nurse for Organ Donation lead•Clinical Lead for Donation

The Annual Organ Donation Plan should be focussed upon SMART objectives

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Managing and Tracking Against Plan

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Balanced scorecard and Key Performance Indicators (KPIs)

Purpose:

• The balanced scorecard is a strategic planning and management system that is used to:

Align business activities to the vision and strategy of the organisation

Improve internal and external communications Monitor organisation performance against strategic

goals• Key performance indicators are quantifiable measurements,

agreed to beforehand, that reflect the critical success factors of an organisation.

• KPIs help an organisation: Define and measure progress toward strategic and

operational goals

Benefits:

• Increase focus on strategy and results • Improve organisational performance by measuring

what matters • Align organisation strategy with the work people do

on a day-to-day basis • Focus on the drivers of future performance • Improve communication of the organisation’s vision

and strategy • Prioritise projects / initiatives

Adapted from Robert S. Kaplan and David P. Norton, “Using the Balanced Scorecard as a Strategic Management System,” Harvard Business Review (January-February 1996): 76.

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Organ Donation KPIs

Resources, learning and

growth

(What we need to enhance to

succeed)

Outcomes

(What we want to achieve)

Internal Processes

(What weneed to do well

to reach our goals)

Customers / Partners

(What we need to do for and with others)

SNODs achieve and maintain competencies

Right proportion time spent in

NHS organisations

Implement policies and best practice

Embedded SNODs

Increase submission data on time

Increase donor family

consent

Complaints and Clinical Governance

incidents

Increased approaches by trained

person

CLODs are in place

Increase referral rates

Increase DBD conversion

ratesIncrease BSD

testing

Chairs of Donation

Committees are in place

Improve adherence to

MNC Increase DCD conversion

rates

Increase DBD organ donors

Increase transplantable organs DCD

Effective partnership

working

Increase transplantable organs DBD

Increase DCD organ donors

Increase proportion solid

organ donors donating eye

tissue

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Roles and Responsibilities

Responsible Accountable Consulted Informed

Annual Organ Donation Plan

Specialist Nurse for Organ Donation, CLOD & Committee Chair

Donation Committee

• Donation Committee• Executive Board• EM / ICU

Departments

• Senior Nurses, other Clinicians & Healthcare Professionals

• NHSBT• Medical Director & Director of Nursing• Chief Executive• Governance Committee

Annual Report for Organ Donation

Specialist Nurse for Organ Donation, CLOD & Committee Chair

Donation Committee

• Donation Committee• Executive Board


• NHSBT• Medical Director & Director of Nursing• Chief Executive• Governance Committee

Hospital Policy

Specialist Nurse for Organ Donation & CLOD

Donation Committee

• Donation Committee• Portering/ Lab Staff


• Other hospital staff• Medical Director & Director of Nursing• Chief Executive• Governance Committee

Unit ProfileSpecialist Nurse for Organ Donation

Specialist Nurse for Organ Donation

• Clinical Lead• Other clinicians

• Unit clinicians

PDA

Specialist Nurse for Organ Donation & CLOD

NHSBT

• Other clinicians • Donation committee• Other clinicians• Chief Executive• Medical Director & Director of Nursing

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Suggested schedule for Donation Committee MeetingsCore Donation Committee Meetings Monthly Update Meetings

Frequency Quarterly (minimum) Monthly

Attendees* Clinical LeadDonation Committee ChairSpecialist Nurse for Organ DonationMedical Director

Clinical Lead or Senior Nurse for:ICUEmergency MedicineNeuro ICU (if appropriate)PICU (if appropriate)

Consultant surgeonConsultant Palliative Care or lead nurseEnd of Life Care Pathway LeadOperating theatre representative – Senior nursePractice Development NurseService Improvement

Clinical LeadSpecialist Nurse for Organ DonationDonation Committee Chair

Key Inputs • PDA and comparative data• Data collected from other sources (interviews, conversations, general observations etc)• Annual Organ Donation Plan

• Individual updates• Minutes from previous Donation

Committee Meetings

Suggested Agenda Items to include

Quarter 11.Review PDA and comparative data2.High level assessment of progress and achievements3.Draft key headlines for Annual Report and Annual Organ Donation Plan4.Agree contributions and timelines for content development

• Discuss key updates• Discuss progress against action plan• Review PDA data provided by

Specialist Nurse for Organ Donation• Discuss next steps and priorities• Discuss risks and issues• Discuss individual cases, outcomes

and implications for future Organ Donation activity

Quarter 21.Discuss feedback on Annual Report and Annual Organ Donation Plan from Executive Board2.Revise Annual Organ Donation Plan if necessary3.Review progress and identify remedial actions

Quarter 31.Review PDA and comparative data2.Conduct mini-assessment of progress and achievements3.Identify remedial actions4.Confirm requirement for a mid-year review and key areas of focus

Quarter 41.Discuss insights from mid-year review2.Identify remedial actions3.Agree preparatory activities for Annual Report (meetings, data collection etc.)4.Consider key priorities for following year

*Other potential representatives include: Ethics Committee; Chaplaincy (multi-faith); Patient groups/ Foundation Trust Council (where applicable); Local donor family; communications department ; A representative from dialysis or transplant services

33

Action Planning

34


Building a Local Action Plan

• We would now like you to work with your strategic big win team from this morning and consider the key actions you would need to carry out to achieve the vision set for your big win

• To do this you will need to consider:

SMART objectives against your vision

Supporting actions

Prioritisation of actions i.e. immediate, short, medium and long-term

• We would like you to use the SMART template below to support your thinking and jot all your actions on post-it notes

• We will then ask you to come and plot your activity along the T-map as we did during the case study activity

Objectives for the next year

Actions required to

deliver objective

Measureable outcomes /

KPIs

Person responsible for leading action

Completion date

Resources required

35


Transformation Map

Increased

referral acco

rdin

g to

m

inim

um

no

tification

criteria

Increased

referral acco

rdin

g to

m

inim

um

no

tification

criteria

Increased

diag

no

sis of

brain

stem d

eathIn

creased d

iagn

osis o

f b

rainstem

death

Increased consent / authorisation ratesIncreased consent / authorisation rates Increased rates of donation in Emergency Medicine

Increased rates of donation in Emergency Medicine

Quick Wins VisionMedium Term Long TermShort Term

Increased organ donation rates by 50% in 5 years

2010 - 2013

Increased

do

natio

n

after cardiac d

eathIn

creased d

on

ation

after card

iac death

Increased quality and quantity of organs from improved

donor management

Increased quality and quantity of organs from improved

donor management

36


Summary

37

• Make sure you have a realistic and strategic vision that will support you to hit and achieve targets for organ donation in your hospital

• Use the organ donation planning cycle to help you support your planning, reporting and meeting together as a team and organ donation committee

• Take time to complete annual organ donation planning and reporting documentation to support you lead Organ Donation within your hospital

• Understand how you can best share workload for making changes in your hospital between the Clinical Lead, Donation Committee Chair and Specialist Nurse for Organ Donation

• Focus on those activities which are really going to make a difference in your hospital around the six big wins for organ donation

• Remember that this programme is an evolution not revolution - change will take time!

What’s Next?

38


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