This Scottish NHS Health Board deliver a range of Mental Health and Learning Disability treatments through 12 community services and 5 inpatient wards. A vast amount of mental health treatments are provided for children, adults and older adults by almost 130 clinicians. The project involved a wide spectrum of healthcare professionals including support workers, nurses, psychologists, allied health professionals and consultants, all serving a population of 109,000.
Despite a number of concerted efforts from within the organisation to measure productivity, enhance service management and reduce financial pressures, circumstances did not change and the level of patient care and performance output remained unclear to management.
The Health Board invited Meridian in to conduct an analysis with the view that new systems, processes and behavioural coaching would help them answer the questions “how do we increase the productivity of our services?” and “how do we know how much resource is required to match the demand?”
Meridian spent 3 weeks across 28 sites to conduct an in-depth analysis of service line productivity which commenced on 24th August 2015.
In 78 resource days Meridian completed live studies with:
- 38 patients in 40 hours across 3 wards
- 67 members of inpatient staff for 5 full shifts
- 7 adult mental health clinicians
- 5 older adult practitioners
- 2 CAMHS workers
- 2 Rehab staff members –
- 3 Learning Disability service providers
In addition 12 months of historical data taken from the organisation’s own clinical system were analysed for the whole of the community services.
The analysis findings presented the following:
- An average of 2.9 community contacts per WTE day observed;
- With an average contact duration calculated of 51.8 minutes;
- An average of 1.8 community contacts per WTE day recorded on the clinical system;
- A direct contact time per intervention observed at 81minutes;
- Consultants spent an average of 49 minutes in direct clinical contact in the studies;
- The organisation of the whole presented under utilised clinicians demonstrating low levels of output.
- No method to measure performance, plan staff utilisation, allocate activity or review workloads;
- Lack of expectations set for staff and consequently no regular follow-up on workload allocation or proportion of time spent in direct clinical contact per day;
- Inconsistency in care plans leading to mass delay in discharges including service users in inpatient care units not having required treatment for days.
Meridian proposed the implementation of sustainable management systems and behavioural processes to provide the service with increased productivity, increased staff utilisation and on-going capacity management.
The project would involve working within all tiers of the organisation, in scheduled meetings, workshops and one-to-one sessions. The three areas of systems improvement recommended were the community services, mental health consultants and inpatient wards; to bring an average of 14% productivity improvement across all services worth a £2,172,878 financial benefit to the Health Board.
Throughout the duration of the 17-week project, Meridian worked with the teams to design standard approaches of planning, allocating and reporting activity within the structure of a Management Control System.
This involved developing and agreeing each, and every, element of the system to ensure that managers are able to have clarity over what work is being planned and what work is actually being provided within their team resource capacity.
There were a number of key system elements implemented and now owned by the service:
- A Workload Capacity Model, allowing service management to determine the resource requirement for each team to be able to provide care to their patients;
- An Operational Management Report providing the general manager with a full productivity review based on activity, resources and spend against target;
- A Care Planner for clinical staff to schedule work up to a reasonable expectation of service delivery, as measured by performance targets;
- A Bank Staff Monitoring System to provide a daily visual stimulus to operational management on any additional hours supplied to inpatient wards;
- Weekly allocation meetings, with operational coaching to team management, to review case load allocation of staff, evaluate on their performance and assign patients in to assessment and treatment slots frequently;
A series of workshops and 1:1 sessions took place with the operational management and managers and leaders of the services. Training and intensive coaching was provided to develop the managerial skill and competency, whilst ensuring full understanding of all the tools and processes installed to deliver the proposed analysis improvements.
Patient contact increased in just the 2nd week of the programme, and remained above the historical average delivered by the organisation over the last 12 months. This meant an 8% increase in treatment provided to patients, with the improvement maintained throughout the programme.
Meridian supported senior managers, responsible for signing off additional hours, developing the routine of reviewing the Bank Staff Monitor in the wards. This brought about a 33% reduction in the cost of bank staff and saved the Health Board £23,376 by the end of the project. By the end of one calendar year the Health Board expects to save £147,278 from reduction in bank hours in these areas.
For the first time the services are able to review team capacity and identify additional unutilised hours. This on-going weekly review has prevented recruitment into vacancy posts as the organisation have held back a number of vacant posts now deemed surplus to the required capacity. The value of the WTE vacancies totalled £1,072,263.
Overall the Health Board benefitted from a partnership with Meridian by being able to:
- Identify areas of low utilisation within the services and have the tools to realise improvements through taking corrective action;
- Increase the productivity of the substantive workforce and thus reduce the cost per contact to deliver a cumulative cost avoidance of £134,837;
- Sustainably maintain control of embedded management controls to look forward to an annualised savings total of £1,812,890.