The Trust operates a 350+ bed hospital serving over a quarter of a million people in the South West Yorkshire area. In the last year, the Trust delivered outpatient services to over 268,000 people. Meridian initially undertook a pair of successful projects within the Surgical & Medical Outpatients business unit. Due to the success of the first 2 projects, Meridian was invited to work with the Imaging department..
Meridian initially undertook observations and conducted data analysis across each modality. From the data, it was identified there was significant misalignment between the current booking protocols, and the capacity within the rooms each day due to COVID-19. This highlighted the opportunity to increase patient throughput without increasing expenditure. The observational studies showed that the majority of the Modalities had the capacity to extend their clinic templates and increase the number of patients seen within a safe amount of time, as well as having surplus resource in relation to the staffing needs to operate the department.
The project sold was a 15-week Improvement Programme.
The overall goals of the project were as follows:
- Increase patient attendees per room back to pre-COVID levels.
- Cost savings through closure of vacancies.
- Improved allocation of staff to ensure correct rostering by room.
- Identification & mitigation against variances causing lost capacity within the department.
Meridian worked with the CBU3 management team & Imaging Modality Leads through a series of 1:1s, meetings and training workshops. During the sessions, a new way of working was designed and tailored to each Modality so that all Modalities in scope were running efficiently and effectively.
One of the main focal points was to ensure capacity was able to return to pre-COVID levels as part of the NHS Recovery plan. This involved mapping out the whole department, and ensuring that available space was utilised for seating capacity. This ensured that patients were able to socially distance without the need to reduce the flow of patients into the department.
Staff rostering was an important element of the project, with routine issues with staffing not available to operate the rooms for the full period. Meridian worked with the department to both realign the opening hours of the rooms in line with service demand, and to roster staff 6 weeks out utilising a bespoke rostering mechanism, which provided the management teams with a clear view of their staffing rotas against the needs of the rooms. This allowed for pre-emptive action where either too many or too few staff were assigned. This has ultimately helped the service ensure they have the right people on shift each day at the right times.
A Weekly Operating/Variance report was developed and installed within the Imaging department. The purpose of this was to allow the service to capture and quantify the causes of lost time within the department, and through weekly review take corrective action to mitigate against and prevent recurrences of these variances where possible. In addition, through tracking of daily & weekly slot utilisation, the service was able to realign their booking rules to ensure that areas of low demand were better utilised by allocating work from the backlog, rather than leaving capacity unfilled.
A Capacity & Demand tool was created with the service, which allows managers to ensure that their planned operating hours are aligned with 2 the demands of the service. The model is flexible, in that it will be used either monthly or yearly to ensure that the opening hours are appropriate to the service needs. This automatically calculates the staff hours required to run the service. This will ensure that the staffing is set to meet the demands of the service both now and in the future.
The implementation of new processes gave CBU3 management greater control over their service. Ultimately allowing visibility on a dayto-day basis on their teams and individual performance. The installation of a daily, weekly, and monthly performance review has been embedded to allow a review of ‘planned’ v. ‘actual’ to identify and mitigate future variances.
The main results of the programme are:
- An increase in capacity back to full utilisation in line with the NHS Recovery plan Post COVID.
- A financial improvement to the value of £571k through increased throughput within the service.
- Cashed & Identified savings through vacancy closure worth £230k.
- An additional identified saving through realignment of resources.
- Increased oversight of all service KPI’s and improved ability to take action to resolve identified issues within the Imaging department
- A clear annualised plan in terms of capacity, and the ability to adjust the plan where demand fluctuates. This also allows for a flexible schedule with variable indicators built into the plan. • A self-perpetuating management control system which uses actual outputs to inform future planning.