Aberdeenshire Health and Social Care Partenrship is overseen by a joint board of Aberdeenshire Council and NHS Grampian known as an Integrated Joint Board and was launched on the 1st of April 2016. The annual budget is £250 million for the year 2016/2017. The partnership aims to create a single vision under one budget to deliver services for Adult Health and Social Care.
Since the integration, the joint board has been working to align service provision to allow for a more coordinated approach to the way health and social care is provided. Aberdeenshire is split into localities – North and South, and this programme focuses on one area within the South Locality specifically Kincardine & Mearns.
The Executive team invited Meridian to conduct an analysis to highlight and quantify where costs could be reduced through improving the way these services manage their own resources.
The analysis was a three day long study, where a total of 18 resource days was used. The current community service teams and inpatient ward including clinics and outpatients system showed a lack of control over activity, expectation, and performance. In the District Nursing team it was identified that there is a significant opportunity to improve face to face clinical contacts with service users by increasing the quantity of contacts per day per clinician.
The programme sold was a 10 week Improvement Programme Project.
The overall goals of the project were as follows.
- A Financial improvement of £184,922 annualised
- A productivity improvement of 10-20% expressed as face to face client contact per clinician
- A newly designed service specific to the needs of the patients and the Partnership
- Capacity and Demand modelling, rerources adjusted to match demand and maximum opportunity sought from available capacity
- Improvements extrapolated across the wider Partnership
The Kincardine & Mearns Improvement programme project ran for 10 weeks. The core objectives of the project were to implement consistency across the services, reduce bank, agency and overtime hours utilising substantive staff and to increase productivity based on face to face contacts per clinician per shift. With such a tight time scale, engaging with all levels of the Management team was key in delivering the improvement programme within the proposed timeframe.
Meridian worked with the management team within the Kincardine & Mearns area through a series of meetings and workshops. 7 workshops were delivered in total, 4 for the Service Managers and 3 for the Locality Managers and Clinical Leads. This allowed facilitating inputs from all levels of managers in developing the management controls required to meet the project objectives. During these various sessions a new management control system was designed to ensure effective running of the Arduthie Ward in Kincardine Community Hospital and the Community Teams including District Nursing, Care Management/Home Care, Local Authority Occupational Therapists and NHS Occupational Therapists and Physiotherapists.
The key focus was to implement management controls to increase productivity within the community teams, and in the hospital, to improve the patient experience and focus on getting the patient ready for discharge thus ensuring timely discharge and shorter lenths of stay.
1:1 sessions were given to all management staff to provide support with changing behaviours and new ways of working and basic excel training to manage the new controls implemented during the programme. All workshops were followed by 1:1 sessions with service managers, ensuring they received direct input from the Meridian team to help them apply the concepts discussed in workshops directly to their services.
Daily workload measures were implemented in all services which allowed managers to allocate work based on time to a target percentage daily. This gave the managers better control of planning optimal and fair levels of work for individual clinicians, improving productivity and identifying surplus resources on a daily/weekly basis.
All teams had daily/weekly schedule reviews installed to assit managers with the review process of work allocated. This allowed managers clearer visibility of activity within their services and ability to manage variances.
The processes introduced and implemented gave the management of Kincardine and Mearns Community teams and Arduthie Ward control over the proactive governance of their individual services, 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.