The Trust provides Inpatient and Outpatient Services as well as Community Services for approximately 270,000 people within their area.
The analysis was a three-week long study, where a total of 17 resource days were used where Meridian reviewed 65 Medical job Plans, 8 Diagnostic Interviews with Clinical Directors, analysed the WLI spend as well as an Additional Sessions spend analysis within the Division of Medicine.
The programme sold was a 24-week Improvement project.
The overall goals of the project were as follows.
- Job Plan and Template Review
- Junior and Middle Grade Doctor Analysis
- Spending Controls Developed, Agreed and Installed
Throughout the project, Meridian worked closely with the management team for each project area to ensure that the work being carried out was agreed and accepted by the staff on the ground.
To enable the staff from the trust to fully understand the Meridian project process, a series of management workshops were delivered in conjunction with the key milestones of the project.
Working closely with the Divisional Director and the respective Clinical Directors, an operating standard for ward staffing was developed within RCP guidelines to ensure that the levels of staff on the ward would not affect length of stay or discharges.
This standard was used in a weekly “Resource Review Meeting” whereby the ward rosters were analysed four weeks in advance to ensure that there were enough staff to cover the wards.
This meeting doubled up as a “Premium Spend Resource” meeting whereby all additional doctor requests were submitted for sign off by the Divisional Director. Should it be found that there was sufficient staffing where the additional doctor was requested for, this request was denied.
Through these actions there was annualised saving of £152,490 as well as other benefits such as visibility of issues 4-weeks in advance enabling risk avoidance. Locking down of the rotas ensuring there were sufficient staff in the right place at the right time and creation of 1 version of rotas as opposed to three different ones that were used by the various levels of management.
Using the RCP guidelines, a capacity model was developed to outline the Medical Staffing requirements for each of the Medical Wards. This was then compared to current capacity and presented to the Medical Director, Director of Finance and CEO.
When compared to current capacity there was an identified saving of £305,000 within Elderly Care. Once agreed a proposal was prepared and submitted to the Medical Leadership to change the allocations of Consultants, Middle Grade and Junior Grades across two acute wards.
This model is re-useable with the different variables able to be changed depending on the specialty and will allow the trust to right size their ward capacity and minimising the use of premium cost Medical Staff.
The analysis highlighted that there is an overreliance on additional sessions to deliver activity. Meridian developed a robust WLI process to separate out the required and unnecessary additional sessions. This review brought together key management positions such as the Chief Operating Officer, Medical Director and Care Group Managers to make informed operational decisions on whether or not an additional session should go ahead based upon a revised additional session criterion such as current utilisation of Outpatient clinics and RTT Position.
Through this process the WLIs reduced by 90% in February 2019 compared to February 2018 with an annualised saving of £74,859.
The processes introduced and implemented gave the management of the Medicine Division better control over the proactive governance of the booking teams, rostering and operational variances, As well as visibility on a daily basis of individual and team performance.
Daily, weekly, and monthly performance review meetings have been installed. Embedding the planned versus actual review philosophy within the organisation.
The main results of the programme are:
- Decrease WLI Spend by £74,859 (90%) that was transacted against their CIP programme.
- Decrease Annual Locum Spend by £152,490
- Realignment of Medical Staffing for Elderly Care leading to an annual saving of £305,000
- Total Annualised Savings £532,349
- Improved patient experience
- Reduced Capacity without affected RTT Performance
- Potential for more savings through clinic consolidation
- Re-useable capacity model to future proof Medical Staffing levels.
- Increased transparency between Medical Staffing, Medicine Division and Care Group Managers.