The Trust’s Integrated Community Teams provide both General Community (District Nursing) Services and Specialist Community Services for patients with acute health problems across Essex.
The Therapy for You (IAPT) Service provides Community 1:1 and Group-based interventions for clients with anxiety and depression across four regions (clusters) covering 180 GP surgeries.
The Trust has a CIP target to achieve in a range of services over the next 5 years. The Executive team invited Meridian to conduct an analysis with the view that better tools would help managers and supervisors monitor performance of their resource and increase productivity to achieve the Trust’s CIP target.
The Specialist Services comprises of roughly 50 WTE staff in 8 Specialties, along with an Integrated Community Service of 180 WTE, both headed by Service Managers.
Meridian was invited to conduct an analysis of the service and specifically asked to look at current productivity, capacity and demand of the service and current management systems.
Meridian expended 50 resource days on an analysis of the Specialist Integrated Teams and the IAPT service which commenced on Monday the 13th of October and finished on Wednesday the 29th of October 2014. The analysis identified the following;
- Community Teams working close to capacity, however there is a lack of management control, effective target setting and reporting;
- Lower utilisation within Specialist Services through a lack of standardised allocation/ clinic templates and standard way of working;
- Within IAPT, more accessible management information needed to support capacity planning and resource availability;
- No clear link between the demand and capacity of the service when assigning work;
- No evidence of a robust management control system.
Meridian proposed to install a number of tools and processes which improve the visibility resource planning, link the assignment of work to the capacity of the service and to install a robust management control system.
This proposal was accepted and the project commenced on Wednesday the 5 th November 2014.
The Trust’s improvement project lasted for 13 weeks and addressed all of the points from the analysis.
Engaging with the Service Director and Senior Management within Community teams and the IAPT service was key to delivering a successful project within the time scale. We completed 7 workshops and several 1:1 sessions to introduce the concepts and embed a management control system within the service.
Meridian quickly installed a reporting mechanism to capture the number of contacts and hours used across the services each week. This data had never been collected before and was essential in linking the demand and capacity of the service.
Working with the management team through the workshop sessions, all teams set and agreed a series of direct clinical care (DCC) targets and ‘planning norms’ which would be used to measure the performance of the team on a day-to-day basis. These controls enabled the teams to identify circa 400 hours per week (up to £431,000 of direct pay activity annualised), increasing face-to-face patient treatment time as a proportion of staff resource available.
Installation of the weekly management reports in conjunction with DCC% targets enabled the teams to quickly identify where hours were spent in other activities and monitor staff performance against the services’ total capacity.
In addition, a weekly planning review and followup meeting enabled the Community Teams’ management to keep track of their progress with the new process. Variances in the number of resource hours used based on the services’ demand for each week allows the teams to take action to meet their internal targets.
As a result of better planning, up to 22 new clinic slots (half-day AM/PM) per month were added to the roster of one service, a success for the programme after having failed to achieve this despite Commissioning pressures in the past.
Within IAPT, a new planning tool enabled the service to implement a common way of managing the hours allocated to each activity across each of the four clusters. Implementing a target of 80% for the number of slots by geography and Band allowed the teams to measure and take action against specific area teams where logistical challenges or ways of working in where preventing the service from meeting specific (Access and Recovery Rate) targets.
“Flexible” slots were removed from the services’ planning roster to free up to 20% of slots available for 1:1 and Group (patient-facing) activity time.
The IAPT service now has a robust way of monitoring how far in advance 1:1 and assessment slots are planned and take action to address any mismatched capacity to demand in the service. This enabled Team Leaders to target up to £398,461 annualised improvements on direct pay through several methods:
- Improving process for approval of bank/agency hours;
- Targeting 50% of DNA time as useful nonclinical activity/supervision time;
- Revising rotas to utilise 80% of WTE weekly activity as planned face-to-face session time.
A change in the way of working has introduced effective controls for bank and agency staffing hours to closely monitor where ‘un-booked’ slots are available.
By week 7 of the project, this identified up to 400 slots, un-booked and available for patient facing activity per week – effective management and utilisation of which would increase the target number of contacts from an average of 3 to 4 contacts per patient in total (across a treatment population of over 14,500 per annum).
This data can also be used by the executive to identify any excess capacity at the end of the year, which allows the service to either bid for more work. By enhancing the method of capturing data from existing clinical systems, and employing new metrics (such as average contact time and number of contacts per day), the process of monitoring and following-up on effective utilisation of resources improved.
This represented a significant change in the teams’ culture with a focus on establishing effective ways of meeting the target demand, without compromising clinical quality. This type of information had never been used in such a way before.
As a result, a productivity improvement of 17% (£286,000) was actually realised through the course of the programme, with teams having the understanding and tools to take appropriate action through forward planning.