Meridian worked with one of the largest providers of community health and care services in the NHS which serves a population of 882,000 people. It employs 2,250 full-time equivalent members of staff, 80% of whom are clinicians, doctors, dentists, nurses, and physiotherapists. The Trust provides community-based care, offering a wide range of NHS healthcare services, such as district nursing, health visiting and speech and language therapy.
In November 2015, Meridian Productivity Limited was invited to carry out a productivity analysis of the Children’s and Specialist Services. The main reason for engaging Meridian was to support the transformation of the services, many of which have worked in the same way for years and have never undergone any changes. When similar initiatives were carried out with those services in the past, the perception was that they weren’t successful because the managers were not involved in the process and therefore the changes were not followed, or were inappropriate, and certain decisions and ways of working were imposed on them with minimum support. It was crucial for the success of the project to ensure that the staff were engaged in every step of the programme and the work was done WITH them rather than to them.
The main challenge for the Trust was the lack of control over the ways working as well as the demand and capacity of the clinics and community teams. The booking systems and rules were inconsistent across the clinics and services, and they were not matched to the teams’ capacity. There was no clear expectation in terms of the amount of time the clinicians should be spending in clinics, domiciliary visits, travel, admin etc. Those times were not reported on so the managers had no overview of how long time was spent on delivery of different types of appointments or the productivity in the services, and told Meridian that they felt like they were working in the dark without any performance reporting system.
During the analysis, the Service Manager of the Specialist Services gave an example of a service in which the clinicians should be in the clinics 5 days/week, however from the clinic studies carried out by Meridian, the amount of time spent in appointments was less than 50% of the working week. This also showed that the managers had no visibility of, or control over what happens in the clinics.
Following the analysis, Meridian and the Trust embarked upon a 17-week transformation programme to improve management control and overall productivity within the Children’s and Adult Specialist Services. The objectives of the programme were to:
- Develop effective forecasting and improved control of the volume of activity, clinic times and home visits scheduling and utilisation and identify productivity improvement opportunities
- Support the Trust in realising its financial cost improvement targets for the Children’s Young People and Adult Specialist Services
- Increase productivity by setting SMART objectives for the proportion of time which should be spent in direct clinical care, agreeing reasonable activity norms, improving the management of the performance through having more visibility and transparency of the key indicators as well as a robust follow up mechanism
Working with the Management of all levels, Meridian assisted in designing and implementing a new management system to enable a robust and dynamic way of demonstrating the levels of direct clinical activity within the service to ensure there is the right level of resource and skill in the services to be able to meet the service demand, establish a productivity target expressed as a reasonable % expectations of time spent in direct clinical care per service and skill level, plan work using the agreed activity standards in order to 2 meet the direct clinical care expectation, measure the activity levels against a SMART expectation to be able to identify variances and act on them to improve productivity.
The main results of the programme are:
- Introduction of a SMART productivity indicator (% Direct Clinical Care) which allows for more effective workload planning, as well as a regular follow up system. The Managers have been equipped with the controls to support their teams in achieving the best performance and identifying negative variances in time to minimise their consequences.
- With Meridian’s assistance, the Information and Performance teams have designed a series of service reports which allow for a review of the current situation in the context of the selected points of control and identify the need for actions. Not only does it provide information over a period of twelve months which will allow for identifying trends and patterns in the performance and activity changes, but also gives a weekly summary of those indicators which is a key element of an effective management control system.
- Meridian has also worked with the Business Analyst in those services, which use a different patient record system to develop a service report. This was a major step forward as it finally brought these services in line with the mainstream reporting. – Apart from all of the above, the Trust will benefit from realising a planned cash improvement of £654,400 during the first full financial year after the completion of the project following a demand/capacity analysis carried out with Meridian’s assistance.
- Following an audit of the service after the completion of the programme, it was reported that the waiting times have reduced by up to 12 weeks in some services which led to fewer instances of waiting time breaches in the services.
- Due to changes made to the booking procedures, the DNAs in several services have reduced by more than 30%.