The Client
This NHS Foundation Trust provide a wide range of health services to ca. 2.5 million people in the South East. The 7,200 staff provide community health, mental health and learning disability services.
In the Summary Strategic Plan 2014-19, the Trust identified 10 transformation programmes to ensure the quality and sustainability of the services provided. The report also highlights a savings requirement of £62.2m over the 5 years plan.
Specialist Nursing
The Trust provides a range of Specialist Nursing services to the region. The Specialist Services comprises of roughly 50 WTE staff in 8 Specialties.
Integrated Community Nursing
The Trust provides District Nursing services in the region. The service is divided into 4 geographical areas with a total of 180 WTE.
IAPT – Therapy for You
The Trust provides a Community Mental Health service with a total of 75 WTE. The service is divided into 4 geographical clusters.
In October 2014, the Executive team invited Meridian to carry out an analysis to evaluate the productivity of the service and identify opportunities for improvements and savings. The focus was on Specialist Nursing, Community Nursing and Community Mental Health services.
Following the Meridian philosophy, 50 resource days was spent on the ground with personnel to understand the views and collect data to base the evaluation on accurate records alongside the existing view of the Trust.
After 3 weeks Meridian presented their findings to the Executive Team:
- Opportunity to generate savings (£200k) in Specialist Nursing Service by increasing productivity by 15%; 2
- The need to ensure Safe Staffing Levels in Community Nursing Services to maintain the quality of the service provided (currently at 12 contacts per day and 50% patient-facing activity time);
- The need to increase productivity in the IAPT Service to meet the 15% Access target (a treatment population of c.14,500).
The Executive team agreed to start a project with Meridian for 13 weeks to implement the proposal.
Over the following 13 weeks, Meridian worked with all levels of management to implement System Controls to better manage each service and improve productivity. Moreover, Meridian carried out observations to validate the analysis findings as well as monitor progress of the project on weekly basis.
Meridian worked with each service (including the 8 Specialist Service Teams) to tailor a system to address the needs and requirements of each specific area.
Alongside regular 1:1 sessions with each of the 24 Team Leaders, Meridian arranged a weekly coaching workshop for each service. The workshops focused on developing the required control systems for each service as well as helping the team leaders to take ownership and develop the managerial aspect of their role.
With the weekly report installed, each service has a clear view of the performance of staff as well as the service as a whole. This took into account the average time spent per patient visit, total time spent on patient-facing activity and no. of contacts per day – targets were developed to ensure these performance levels could be measured and improved upon.
Specialist Nursing
The project team worked on identifying the productivity targets for each of the services. This took into consideration the nature of the each service and the requirements to meet the tasks. Meridian worked with each service to calculate the requirement of the service in terms of number of clinic hours and total worked hours.
Once this was established, we worked with the teams to utilise the required resources. Any extra resource was identified as savings or an opportunity to acquire further contracts.
Integrated Community Nursing
With the installed weekly report, the Team Leader can follow on the performance of their staff, individually and by band.
Meridian also worked with the teams to better manage their allocation system. This gives each team the ability to forecast variations in demand and workload, which helps them better plan and therefore maintain the quality of the service.
IAPT – Therapy for You
The team had no formal review process, the installed weekly report provided a much-needed overview of planned face-to-face patient 1:1s against actual. With the help of this tool, Cluster Leads now have a clear view on the performance of their team as well as the planned activities for the week ahead – increasing the booked slots availability up to 1,400 per week compared to the c.1,150 currently visible to managers.
Another fundamental change was the variation of “slot” allocations. The IAPT team used slots to measure allocations and duration of activities, however the actual time of a “slot” varied (between 56-74 mins) according to therapist by Band. This resulted in lost time and caused discrepancies in the amount of time available for GP sessions which, once identified, could be reduced through absorbing non-clinical time into DNAs.
Specialist Nursing
Over the course of the project, Meridian worked with each of the Specialist Teams to identify the appropriate level of staffing, taking in consideration service specific metrics, measures and requirements.
In parallel, Meridian installed System Controls to ensure the sustainability of the achieved productivity levels. This resulted in an identified saving of more than double (£431,000) the initial savings evaluation.
The Trust was able to realise up to 67% of the identified savings (£286,000) and also identified several opportunities to increase activity through additional contracts with the freed up resources.
Integrated Community Nursing
Meridian installed System Controls to help the Trust better manage the Service and maintain the level of productivity, quality and safe staffing levels. The installed reports highlighted several areas with potential for improvements:
- Demand for different Bands of nursing and the staffing levels required for each (through capacity planning);
- The need to re-evaluate the requirement for specific Bands and Unregistered Nurses;
- The need to re-evaluate the shift patterns and the staffing on the different shifts.
IAPT – Therapy for You
The installed System Controls and Weekly Management Reports now helps IAPT to better manage the service using higher utilisation levels of up to 17% of the activity (500 hours per week). The reports help the team leaders to have a birds-eye view as well as detailed view of large teams (with a span of control of 20-25 headcount) which was not previously possible. The report also implemented a control over the bank and agency hours which was not done before (c. up to 212 hours per week which can be reduced through increased activity controls).