Setting up your System Control Centre (SCC) – tips to help you plan ahead
NHSE have mandated that from the 1st December, all ICSs must implement a ‘System Control Centre’ (SCC); a major ask for the NHS. This, however, will mark the start of your SCC journey, not the destination. We’ve put 24 tips together to help make your SCC a success beyond the 1st December deadline
NHSE have mandated that from the 1st December, all ICSs must implement a ‘System Control Centre’ (SCC); a major ask for the NHS. This, however, will mark the start of your SCC journey, not the destination.
We’ve put 24 tips together to help make your SCC a success beyond the 1st December deadline.
1. Clarify your Input and Output KPIs
Amazon has got some big things right when it comes to how they operate their management processes. One of these is a focus not only on measuring the outcomes that you want to achieve (Output KPIs) but also the KPIs that can improve and directly influence performance (Input KPIs). When establishing your SCC ensure you distinguish the measures that will move the needle from those that simply measure the outputs. See the book ‘Working Backwards: Insights, Stories, and Secrets from Inside Amazon – Bill Carr and Colin Bryar’ for more details.
2. Understand your data provenance
Where does your data actually come from? What level of trust should you put on it? Is it collected as a by-product of some other process? How often is it collected?
If the answer to any of these questions is not clear then, whilst your SCC will be collecting data on a ‘real-time’ basis from multiple sources and dashboards, you run the risk of analysing and making decisions without knowing the provenance of your data.
3. Establish an ambitious shared goal
Your SCC has a new war room with people, screens and headsets. But what is it really there for? Teams work best when they are focused on a specific shared objective. Consider establishing a Big Hairy Audacious Goal (BHAG). See the book ‘Beyond Entrepreneurship 2.0 – Jim Collins’ for more details.
As Jim Collins says on his website: ‘A BHAG is clear and compelling, needing little explanation; people get it right away. Think of the NASA moon mission of the 1960s’.
4. Establish a Reference Data Model
Every piece of IT software has a data repository. These data stores have their own data models and format. When data is extracted from these systems to send to your SCC a set of assumptions will have to be made about the data you are actually asking for, how it is coded and how it should be sent to your data lake. To prevent misinterpretation, create a reference SCC data model which makes it clear what data you want and how it relates to existing standards (SNOMED / NHS Data Dictionary / HL7 / OpenEHR etc…).
5. Identify your key outcomes
Your SCC has a four-part purpose: Improved situational awareness, holistic and real-time management of capacity, co-ordinated action and mutual aid, and improved clinical outcomes. But specifically, what outcomes are you focusing on delivering? Is it about ED performance? Is it about the avoidance of preventable harm? Picking a handful of crucially important targets will focus everyone’s minds and help drive a clear team focus when using your SCC.
6. Understand data quality
Your SCC is already operating. You’ve been running it for weeks and have charts and screens showing KPIs. But how good is the information you are presenting? Examine each data feed and create a score for data quality. Consider measuring submission completeness and accuracy as a minimum. For more details of quality measures see the ‘OECD Handbook on Constructing Composite Indicators’.
7. Predict failure demand
Many organisations strive to deliver quality client outcomes but spend up to 60% of their time dealing with failure. Reflect therefore on the opportunity you have to use your SCC to identify and tackle failure in the system. Is it patients who don’t attend appointments? Or, radiology images which get taken but don’t get reported? Once you’ve identified the failures you wish to tackle you can start to use data to take action.
8. Model the “what ifs” at a system level
From the vantage point of your ICS SCC, you have a unique view of how the system is performing. Today, identify scenarios that could help transform outcomes for citizens. Perhaps you can ask, “what if we used IoT to monitor people once discharged to reduce length of stay?” Or, “what if we allowed patients to self-refer for diagnostic tests?” Or again, “what if we automated multi-agency information preparation for meetings such as DASH?”
9. Identify key decision points
You have already implemented a clear focus on outcomes in your SCC – well done. However, these are achieved through actions taken as a result of decisions. Kick-off a project to analyse how these key decisions are taken, by whom and at what point in the process. We are clear that our adoption of the Decision Intelligence (‘DI’) methodology significantly enhances the ability to drive better decisions and thereby better outcomes.
10. Review escalation mechanisms
Your SCC has all the right processes and team roles in place to make effective decisions and interventions that balance risks in the moment. If this is operating effectively, which other ‘out of hours’ escalation mechanisms are no longer required? Illustratively, do you need your exec team on-call? What about gold-command teams?
11. Measure the effectiveness of your interventions
Your SCC itself needs its own metrics so that you can tell how well you’re doing. Hours staffed. Interventions made. But the key will be to use these metrics to drive continuous improvement. Consider implementing a structured quality improvement methodology using the PDCA cycle.
12. Consider devolving the SCC
Whilst an ICS level perspective on improving outcomes is important, and an ICS level SCC will provide a ground truth for decisions at ICS level, it may only be part of the answer. Consider adopting a granular SCC say at place level. It may be that the SCC is the appropriate level to monitor Output KPIs, whilst the Input KPIs are best driven by action locally. Might you need a ‘place control centre’ too?
13. Time to rebrand?
Whilst a ’Control Centre’ brand captures the benefits of real-time decision-making tools the language of this naming-convention is far from evoking ‘support’, ‘collaboration’ or ‘patient’. If you reflect on your purpose and mechanism, then perhaps you’re actually running a ‘System Co-ordination Centre (SCC)’ or, a ‘Patient Outcomes Optimisation Hub (POOH)’.
14. Bring your team on the journey
We all know that change management matters. It may have been necessary to ‘Just Flippin’ Do It’ in the early days of the SCC, but now you’ve been live for weeks, you should take stock with your teams. They will have great ideas and insight. Take time out with them and ask for ideas. Even better, consider an externally facilitated workshop for a couple of hours. You’ll be surprised what you find out.
15. Identify external levers
You’re only partially in control in your ‘control centre’. Many of the factors impacting the outcomes you’re seeking are beyond your immediate control. However, that doesn’t mean you can’t tackle them. The first step is to look at your ‘outcomes to decision’ model and then identify the external levers you might be able to influence and thereby prevent harm or increase benefits. Perhaps these are actions where charities could offer more targeted support? Perhaps it’s working with the local council to better understand planned roadworks and thereby amend your patient transport schedule?
16. Visualise to drive action, not understanding
Who doesn’t love a good visualisation of data? The purpose of any visualisation is not to just look good (though it helps if they aren’t ugly). Rather, anything you design should be there to drive insight and improve decisions. To that end, your visualisation should be specifically designed to make obvious the actions needed, by whom and why. Easier said than done but set this as your cornerstone for all information and you’ll see a noticeable improvement.
17. Build skills in using data to drive change
These days we are all digitally empowered citizens, aren’t we? We use Amazon / Tesco / BBC Weather / Teams / Outlook every day. But today, take a moment to reflect on the need to build skills in how to use data to effect change – this is not the same as how to use a digital system. Your teams need techniques in data analysis and change management. Without the correct interpretation of the data and engagement and communications, you will achieve less than you otherwise could.
18. Use FMEA to mitigate risks before they hit
Failure Modes and Effects Analysis (FMEA) is a technique from the Lean Six Sigma world which teams can use to understand how ‘defects’ occur and what can be done about minimising the probability and impact of failures in a system. It’s not straight forward, but FMEA can also help you identify the measurable signs of failure before failure occurs. Worth spending time therefore looking into this for your key risks.
19. Review progress and make tactical adaptations
Your SCC is already working well but there are a couple of things you could do better. Take time today and you will discover there are lots of opportunities to improve how your SCC is working. Is it time to reflect on ‘what’s worked well?’ And, ‘what could we be doing better?’
20. Distinguish between complex and complicated systems
In his excellent book, ‘Team of Teams’, General Stanley McCrystal shares a useful distinction about just how hard it is to predict the behaviour of systems. He defines ‘complicated’ as something akin to a car engine with many inter-related parts. The outputs however are predictable from the inputs. When pressing the brake, the car slows by a predictable amount. He also defines a ‘complex’ system as akin to pool table; there are a number of moving parts, but their inter-relatedness is far from predictable; a small variance in cue angle on a break makes a massive difference to the position of the balls.
In a predictive control centre, it may be helpful to try and identify which parts of your system are capable of prediction (complicated) and which are too complex for us to reliably predict (complex).
21. Focus on team working
Your team is full of amazing people. They have more talent than you know. Most people only deploy a small portion of their insight in meetings and with teams though because they are not provided with the mechanisms to share and contribute. There are many texts worth reading on this but why not try ‘More Time to Think’ – Nancy Klein. By amending the structure of your team meetings, you’ll be surprised what your team has to offer and how it can help your SCC to thrive.
22. Identify outliers
It’s always tempting to focus on the ‘80’ of the ‘80/20’, but when you’re in the business of marginal gains you really do have to focus on the ‘20’. In terms of an SCC this means you need to deploy the latest AI and Machine Learning techniques for outlier detection. There are established techniques for data science algorithms that identify data points not in a ‘normal’ pattern based on years of data. In your SCC, could this help identify outlying delays in a process based on comparable data from elsewhere? The data analysis won’t fix the issue, but it could help highlight the opportunity for you to fix it.
23. Invigorate your partner eco-system
Delivering a system-wide transformation is a team sport. You need partners to help deliver the outcomes on which you’re focussed. Today is the day to draw (yes on paper) your eco-system and reflect on how it is working and could be improved. Do you have the right organisations at the table? Do you have the in-house skills to drive insight from your data? Whatever the needs of your SCC, engaging with your partners is crucial.
24. Reflect on your successes and plan for 2023
Your SCC is working well. You’ve identified your purpose. You have an effective team and partner ecosystem. You’re in control of your risks and mitigations, and you understand how your outcomes are enabled by actions resulting from decisions. Your SCC is driving actions across the system and things are improving for citizens.
It is now time to plan ahead for 2023 – it will be here before you know it. What initiatives will you run to improve further, and when the improvement comes how will you share and celebrate your successes?
At Agilisys Data and Decisions, we can and want to help.
Our team works with health and social care organisations. We are already supporting 8 Trusts and 4 ICSs to improve performance and, ultimately, citizen outcomes. We are working with ICSs across the full spectrum of digital and data needs; from developing data strategies to designing shared intelligence functions, predicting outpatient non-attendance to examining system demand and supply across acute cancer service providers. Our singular goal is to help you make better decisions using your data.
What we bring is a combination of:
1. Proven sector expertise – people who have faced the same challenges you confront (with imperfect success, but valuable learnings); and,
2. The digital, data and technology acumen needed to fundamentally change ways of working so that outcomes are measurably improved
If you are grappling with the new SCC mandate and would like to find out how a flexible and highly experienced partner could support you, we would be happy to arrange a free 90 minute workshop to explore your current situation, where you want to get to and how to achieve it. Equally, if a simple chat would be helpful – we can do that too!
We look forward to hearing from you.