The Challenge

Unipart Consultancy’s customer was one of many NHS Trusts facing a daunting challenge to achieve stretching ED and RTT performance targets. This was made more difficult by their challenging financial position. Unipart was engaged by the Trust with a mandate to instigate cultural and operational changes that would raise performance levels, but also to equip the Trust to sustain this enhanced performance and be able to overcome future challenges.

The Solution

Over an 18-month period, we set out to transform their “way of working” from the Board through the operation to the front line. The significant cultural and operational changes yielded a critical uplift in performance, but more importantly, established a foundation of continuous improvement to sustain the benefits delivered and equip the Trust with the approach necessary to overcome future challenges.

The programme began with a detailed diagnostic review. This identified three workstreams designed to kick-start the changes required:

• Inpatient operational process redesign – in order to drive an improvement in patient flow, reducing patient length of stay and delayed transfers of care. This would match proactive discharge planning and live bed management internally, with improved communication and handover with third-party stakeholders externally
• Elective operational process redesign – with the aim of improving productivity and revenue within their existing resource allocation. This would involve improved booking processes and increased clinic/theatre utilisation
• Enhancing the management system – developing a  framework and communications infrastructure to cascade, prioritise and manage key projects across divisions in line with wider strategic goals and resolve the existing disconnect between senior management and operational employees. This would be supported by capability development in project management and process improvement methodology
• The training and coaching of internal practitioners who are equipped to engage, train and coach employees to deliver operational performance improvements, supported by a change programme methodology
• A systematic sustainability model that actively engages stakeholders at all levels to support and embrace the changes delivered and drive continuous improvement.

The Impact

To date, the key programme benefits delivered have been:

• Additional elective revenues of £2 million across outpatient and theatre improvements
• Additional 750 outpatient appointments and 180 elective theatre procedures per month across existing FTE
• Prior to RTT fines being abolished in 2016, reduced referral to treatment fines by £360,000 per annum within gastroenterology, driven by cutting average patient waiting times from 36 to 12 weeks
• Reduced the average waiting time within dermatology from 28 to 9 weeks
• Improved patient flow within emergency pathways to reduce average length of stay by over 2 days for  medical non-elective patients
• Contributed to improved emergency department four-hour performance from 75% to 92%.