This Healthcare NHS Foundation Trust provides mental health, intellectual disability and community healthcare services. It employs over 8,800 staff, including mental health nurses, psychiatrists, social workers and community nurses, whilst providing secure mental health services, seeing approximately 190,000 people every year.
Of focus to the project were the Community Services, which provide nursing, therapy and urgent care services within the county.
Meridian Productivity were invited to conduct an Analysis of the Services with the purpose of highlighting areas which if there was greater control, would improve the way the teams were managed, enabling the Services to run more efficiently whilst maintaining or improving the quality of care that is provided and provide greater value for money.
The analysis uncovered issues in the way of working that prevented optimum performance. This included a lack of reliable performance data that prevented clear line of sight over performance, clear targets and expectations that staff were working towards, robust planning standards that before the project, disguised workload and work content, a systematic and robust way of allocating work and an effective follow up process. In addition there was a need for greater understanding over the demand and capacity of the Service to enable informed workforce planning.
The programme was a 14 week Improvement Project.
The overall goals of the project were as follows:
- Agree direct face to face clinical patient contact time, specific to function, role and band that each member of staff should be working towards each day;
- Agree reasonable time values based on a robust, scientific method;
- Staff resource planning, based on a reasonable day’s work and treatment & task expectations;
- Equitable work assignment based on agreed capacity (by role/band) underpinned by management controls;
- An improvement in productivity within the Integrated Neighbourhood Teams and the Rapid Response Team, in reference to face to face contacts and the % of time spent with patients.
Meridian worked with the management team within the Trust’s Community Services through a series of workshops that were complemented with 1:1 coaching sessions and meetings. These were designed to increase control at the different points of execution, from the resource levels required to deliver the Services, to the targets that work was allocated to, to the duration of time it took to complete each activity, to the reporting structures in place to measure performance and take action on variances. During these various sessions a new management control system was designed to ensure effective running of the Services.
For the purposes of helping managers see the potential for improvement and drive action, a series of steps were followed including the development of a skills matrix that showed where each member of staff needs training and a comprehensive critique of the current Management Control System by the managers themselves. In partnership with Meridian, Team Leads and Heads of Services developed solutions to the problem areas that exist within the current way of working, enabling all changes made to be sustainable in the long term. In addition, managers participated in observations of the activities that staff members undertook with the associated amount of time to realise the improvements that were then made to the allocation process, whilst reviewing the impact of the various causes of lost time.
Members of the teams within the different tiers of management were provided with bespoke management coaching that led to a significant behaviour change towards monitoring performance, using objective planning methods, ensuring that work was allocated equitably, managing resource and tackling variances in a systematic and robust fashion.
For the purposes of having a clear expectation that each member of staff could realistically meet based on their band and role, targets were set and agreed that were translated seamlessly into daily and weekly reporting mechanisms. These provide visibility and transparency over how each team is performing, allowing managers to compare their performance against their peers and drive action. Through the installation of a variance reporting procedure, the various causes of lost time are recorded along with the total duration lost, enabling management to understand where focus needs to be for the purposes of increasing operational performance.
This also enabled the managers within scope to see the potential and understand how they can improve the performance of their teams by taking the right action.
The key focus was to implement management controls that underpin a substantial behaviour change designed to increase direct clinical contact with patients and maximise existing capacity.
Through a change towards quantifying the amount of work each member of staff has, and developing a set of scientific planning standards through observations and detailed analysis, accompanied by a robust work allocation method, each member of staff is given enough time to complete each activity and allocated the right amount of work, bespoke to their band and role.
The work completed over the course of the project, including the agreed targets, the type and duration of activities conducted, the skill level required to complete each activity and the annual leave, sickness and training uplift also enabled a robust capacity and demand model to be developed. This shows in a clear and transparent way what the required resource levels are by band, team and function.
The processes introduced and implemented gave the management of the Community Services better control over the proactive governance of activity as well as visibility on a daily and weekly basis of individual and team performance.
The main results of the programme were:
- A 19% increase in the number of contacts with patients;
- A financial savings opportunity of c£787,000, with a clear plan and start date in place to begin realising this;
- 51% decrease in the longest waiter, a 60% decrease in the average time waiting, and a 49% decrease in the total days waiting on the Therapy Waiting List through a bespoke and effective allocation system;
- Establishment of a scientifically based planning process;
- 30% reduction in the use of bank, agency and overtime (an additional annualised saving of £94,149);
The establishment of clear daily targets and expectations, bespoke to band and role;
A tailored Management Control System built in partnership with Team Leads and Heads of Service. This was to ensure relevant targets and expectations were translated seamlessly into controls and accompanied with the required behavioural changes to drive patient facing care, treatment and support.