The Challenge
A major NHS Trust wanted to realise its vision of ‘Best Care, Best People and Best Place’. The Trust sought to develop a sustainable approach to improving services and maximising value for money, driven by a philosophy that brings life to the Trust’s pledges to patients and employees.
Unpredictable demand, particularly during the peak winter months, has been a source of disruption for staff
as the focus of their attention is shifted away from providing the best patient care to the task of finding available beds. The knock-on effects have been felt right across the hospital, on staff morale, on key quality and performance targets and on the Trust’s financial position.
Unipart Consultancy was appointed to advise, coach and develop Trust staff at all levels, from the Executive Team to front-line colleagues, and support them in achieving their vision. The Trust and Unipart worked together in partnership to create and deliver the approach that would provide the required change to achieve it.
In the course of this, Unipart would help the Trust to address long waiting times in the Emergency Care Centre (ECC), which includes an Accident & Emergency Department (A&E) and a 56-bed Emergency Assessment Unit (EAU).
The Solution
Unipart engaged people across the Trust in identifying issues that were affecting patient flow and best practices. With this insight, the programme objectives were widened to manage patient flow and capacity through the entire care pathway. Our approach, involving employees from all specialities and all levels, would be to nurture openness, collaboration and ownership of the change. Key to this would be building the capability of employees so that they may be engaged in devising and implementing their own solutions.
Six areas for strategic improvement emerged, requiring the right people to be in the right place at the right time. New processes ensured accurate data, clarity of individual roles and responsibilities and communication of all decisions and outcomes, while improved information gathered from external support services meant demand trends and potential service issues could be identified and resolved. Additionally, a single point of access scheme was developed to ensure that patients not needing acute care were redirected to the most appropriate setting.
A control room for patient flow and capacity was established where daily meetings – supported by effective visual management – could provide a clear, real-time view of performance, capacity levels, and inform in-the-moment decision-making. Not only did this approach offer improved transparency and accuracy with regard to bed demand and capacity levels, but the introduction of creative problem-solving (CPS) techniques empowered bed management teams to rapidly identify and resolve arising issues.
This redesigned bed management approach, processes and accountabilities created a structured and blame-free environment where all attendees can make a proactive contribution, ultimately with the aim of maximising efficiency and improving the care delivered to patients, while contributing to the improvement in the Trust’s A&E performance.
The Impact
By the end of our implementation, the following results had been achieved:
- More than £2m increased contribution with a £430k reduction in winter expenditure
- 57% reduction in A&E treatment times
- A&E 4-hour wait target achieved despite activity 21% above plan
- 56% fewer patients exceeding 48 hours in EAU
- 22% decrease in the average length of stay in EAU for medical speciality patients
- 72% year-on-year cost reduction
- 23% reduction in operations cancelled due to bed availability
- 31% of GP admissions were avoided, enabling commissioners to re-invest more than £1m
- Senior nursing time spent managing flow and capacity was dramatically reduced, restoring focus on the quality of patient care, boosting their morale.