The trust’s CBU1 (Medicine Division) are currently managing one of the top performing Accident and Emergency Departments in the UK. The Trust, located in South West Yorkshire, is also forecasting to over-achieve on activity targets in most areas across the business unit. Meridian initially undertook a successful project with Gastroenterology Outpatients. Due to the success of the first project, Meridian was invited to work with all other Medical Outpatient specialities in relation to Outpatient Clinics.
As a More-Work project, Meridian undertook observations and data analysis in the Development phase of the programme in all Medical Outpatients clinics in scope; Respiratory, Care of the Elderly, Dermatology, Rheumatology, Clinical Haematology, Diabetes and Endocrinology and Cardiology. The studies showed that whilst majority of the specialties had the capacity to extend their clinic templates by increasing the number of patients seen within a safe amount of time, other specialities such as Care of Elderly and Diabetes evidenced low demand and had opportunity to generate savings by a reduction of underutilised clinics.
The project sold was a 24-week Improvement Programme.
The overall goals of the project were as follows:
- Increase patient attendees per clinic in 5 out of 7 specialities.
- Reduce underutilised clinics or where low demand was identified.
- Overall management control systems of deliverance of paid for capacity for each speciality.
Meridian worked with the CBU1 Medical Outpatient management team through a series of 1:1s, meetings and training workshops. During the sessions, a new management control system was designed and tailored to each speciality so that all Medical Outpatient consultant-led clinics in scope were running efficiently and effectively.
One of the main focal points was to ensure transparency over delivery of paid and planned capacity through the implementation of management controls. In effect, there was an identifiable plan in place so that variances were investigated, actioned and mitigated from future occurrence. Furthermore, the redesigning of clinic templates would ensure an increase in productivity from clinic utilisation, optimisation from paid time and therefore an increase in income.
The implementation of new processes gave CBU1 management greater control over their service. Ultimately allowing visibility on a day-to-day basis on their teams and individual performance. The installation of a daily, weekly, and monthly performance review has been embedded to allow a review of ‘planned’ v. ‘actual’ to identify and mitigate future variances.
The Trust decided to adjust the scheduled installation period due to consultant engagement across the specialties, causing a delay in results.
The main results of the programme are:
- An increase of New and Follow-up patient attendees per clinic in Consultant-led Medical Outpatient activity.
- New patient attendees per week increased during the project. Consultant-Led clinic attendees increased from the base of 221 to an average of 277 per week.
- Follow Up patient attendees per week increased during the project. ConsultantLed clinic attendees increased from the base of 474 to an average of 533 per week.
- An extra 38 patients per week are now seen as a direct result of the productivity increase in CBU1 Outpatients.
- Nurse-Led New patient attendees remained at 80 per week, this was delivered however with 9.4 fewer clinics on average each week.
- Nurse-Led Follow Up attendees reduced during the project by an average of 15 patients per week however the productivity increase mitigated further reductions due to reduced resource (number of clinics).
- 61.4 additional patients per week are now seen as a direct result of the productivity increase in CBU1 Outpatients.
- The overall improvement is valued at £428,856.