Meridian has engaged with the Trust on 2 previous occasions working within the Physical Health directorate. Following on from the success of these projects, Meridian were commissioned to undertake a further analysis across the entire organisation.
As part of this programme of work, Meridian was tasked with supporting the Trust to achieve a CIP saving of £1.18m across the remaining 3 Physical Health Directorates. These directorates included District Nursing, Therapy Services and other specialist Physical Health Teams including 4 rehabilitation inpatient wards.
Meridian conducted an analysis during the first few weeks of the project, and found the following;
- No overview of capacity or expectations of work targets within the teams.
- Different working practices within the different localities in respect of allocation, patient care and management.
- A lack of management control across the different services and between teams within the same service.
- Consequently, a lack of clear understanding regarding demands upon teams resulting in spare capacity and overspend of Bank and Agency.
Based upon the findings, Meridian began an improvement programme consisting of the following;
- Implementation of a new way of working based on agreed and clear expectations across all services.
- Installation of simple daily controls to allocate and record clinical activity.
- Methods of patient management, which calculate the complexity of staff workloads and highlight issues with patient pathways
- Improved communication and engagement between the different services to improve patient flow across the service.
Meridian embarked on a 28-week project with the Physical Health Services, across 3 Localities, 30 Community teams (246.1 WTE), and 4 inpatient wards (95 beds).
Within the Community based teams, Meridian supported the development of a range of management controls to improve the planning & allocation of work. These allowed easy monitoring of pathways in terms of frequency and intensity of contact & support and supported the achievement of agreed targets.
Management behavioural workshops were held with the different service supervisors and leaders to provide the necessary skills and coaching to help embed the new system. Subsequent technical installation sessions were also delivered to maximise understanding of the benefits of the new controls. This ensured that all developed controls were able to be fully utilised by services and deliver the maximum benefit.
Work allocation methods were developed within the Community teams to enable staff to plan home visits more effectively across the area. This freed up resource for delivery of other clinical activity thus taking patients off the waiting lists. It also helped to support other services and ensure time to check all patient records are up to date.
Meridian worked closely with the Trust’s General, Service and frontline managers for each of the three geographic areas. By identifying areas of best practice, they were able to pull together the most appropriate elements and create a unified way of working – a first for the Trust. This parity also allowed ease of comparison between the teams’ performance.
Within the Inpatient Services, working with Ward Managers and the Heads of Service, Meridian developed a suite of controls and processes focused on effective patient pathway planning and allocation of critical tasks. This was designed to ensure delivery of the most appropriate length of stay for each patient on the ward.
Front-line management practices were challenged to encourage escalation of issues where barriers to discharge existed. Key individuals were required to take ownership over delays and place expectations on external parties to ensure the Trust effectively managed its delayed discharges.
Meridian worked with front-line supervisors, the Bed Management Team and Community Team Managers to establish a clear escalation process. The outcome of this new process was a reduction in Length of Stay thus ensuring that patients are now treated in the most appropriate environment for their condition.
Following the successful installation of the requisite controls and the embedding of necessary management behaviours within the Physical Health Directorate, the results are as follows;
Against a CIP target of £1.19m there has been;
- Cashed saving of £247,640
- Identified saving of a further £1,95m, with £1.4m coming from Therapies and £550k from within the District Nursing teams.
- Productivity increase of 31% within the DN teams, from 6.2 to 8.1 contacts per WTE day
- Average of 21% increase in productivity across the Therapy services against the base
- Consistency in expectation and workload across the division, including follow up work in the 2 previously worked with areas.
- A reduction in the length of stay of 8%, from a base of 27.4 days in the acute wards, to 25.2 days
- A reduction of over 830 bed nights based on the reduction in length of stay, multiplied by the number of discharged patients
- An indicative productivity saving of £245k through the reduction in bed nights, based on the reduction in bed nights and the average bed cost
- Clear targets across each of the teams in terms of a percentage of worked time spent on Direct Clinical Contact. This ensures that all staff are working to the same expectations.
- Intended Discharge Dates for each patient, both in the community and across the inpatient wards. This ensures that all staff are clear on the plan for each patient, and how long they should be remaining within the service.
- A clear reporting process throughout all services, ensuring any issues are quickly identified and dealt with.
- An escalation process across the services, to provide a more cohesive working practice and prevention of delays across services.