Meridian has engaged with the trust on 2 previous occasions working within the physical health directorate. Following on from the success of these projects, Meridian were commissioned to undertake a further analysis across the entire organisation.
As part of the project, Meridian were tasked with looking at supporting the trust to achieve a CIP saving of £1.8m across the Specialist Services Directorate. This included Community CAMHS, IDD and Inpatients services.
Meridian conducted an analysis over the first few weeks of the project, and found the following:
- Significant waiting lists and delayed discharges across all the services.
- Low productivity across the community teams in terms of clinical activity and face to face contact.
- Barriers to discharge from the inpatients service causing extended length of stay, due to challenges between themselves and the community teams.
- A lack of clear definition of service provision, or management control across the different community services, and a lack of patient planning for discharge.
- Poor communication between teams regarding capacity and demand, resulting in a mismatch of workload
Based on the findings, Meridian began a programme consisting of the following:
- Implementing a new way of working which was based on clear expectations across all services
- Installing controls for clinical activity and patient management, calculating staff workloads and highlighting issues with patient pathways
- Increasing communication and engagement between the different services, to improve patient flow across the service.
Meridian embarked on a 26-week project with the trust, across 11 CAMHS teams (141.5 WTE), 6 IDD community services (78.58 WTE) and 6 inpatient wards.
Within the Community teams, Meridian supported the development of a range of pathways in terms of frequency and intensity of contact & support, including management controls to set targets and improve planning & allocation of work.
Management workshops were held across the different services to provide the behavioural context behind the new system and ensure the understanding of the controls was in place. This ensured that the controls that were then developed could be utilised by the services to get the maximum benefit from it.
Work allocation methods were developed within the Community teams to enable staff to plan home visits effectively across the area whilst freeing up resource for other clinical activity such as handovers, ward rounds and CPA reviews.
Meridian worked closely with the Trusts’ management for each locality, merging together the developed practices to create a unified way of working across the trust, allowing for ease of comparison between teams for the first time.
Review meetings across the Community and inpatients service were put in place, to ensure that the communication was sufficient to improve patient flow from the Community to Inpatients, and back to the Community. This helped reduce the delayed discharges from the Inpatients wards, and also across the Community teams.
Within the Inpatient Services, working with Matrons, Ward Managers and the Consultant body, Meridian developed a system of controls and processes focused on effective patient pathway planning and allocation of critical 2 tasks to ensure the most appropriate length of stay for each patient on the ward. Front-line management practices and behaviours were challenged with a view to taking ownership over expectations on external parties to ensure the Trust effectively managed its barriers to discharge.
Meridian worked with front-line management, and Community Team Management to establish a clear escalation process, minimising delays to discharge arising across the different services, with the outcome being a reduction in the Length of Stay, and ensuring patients were treated in the least restrictive environment.
Following the successful installation of the controls and behaviours within the SSD Directorate, the results were as follows:
- Productivity increased by 10%, from an average direct clinical contact time of 43% to 53%.
- An identified saving of £987k within the CAMHS community teams, £400k of which has been cashed through closure of vacancies, and the remaining opportunity to be used to take into account future increases in activity, and the target of being able to provide a service for 30% of the population, which is due by 2022 from commissioners.
- An identified saving of £286k within the IDD community services, which the trust is currently putting a plan together for in order to realise the opportunity.
- An overall expected cashed saving across SSD of £500,000 across all community teams.
- Clearly established targets across each of the community teams, ensuring all staff are working towards the same goal and a more equitable workload.
- A consistent approach to managing the Inpatients wards, which only opened in July 2018, and therefore have no reference point in terms of Length of Stay across the wards.
- Improved communication between the community services and Inpatients wards through morning board rounds and patient review on a daily basis.
- Patients having a clear intended discharge date from each service from Inpatients to community.
- A clear reporting process throughout all services, ensuring any issues are quickly identified and dealt with.
- An escalation process across the services, to provide a more cohesive working practice and prevention of delays across services.