This Trust is one of five trusts in Northern Ireland. It is responsible for the delivery of health and social care services to a population of 470,000. There are 9 Adult Community Mental Health Teams covering different areas across the Trust (c. 120 WTEs).
Meridian were commissioned to conduct a study across Community Mental Health Teams before the COVID-19 pandemic. The study was conducted over 3 weeks, and included 19 ‘Day in the Life of’ studies carried out directly with staff, analysis of diaries, current caseloads and activity data, as well as management interviews. The current CMHT Services Management Control System showed a lack of clear productivity indicators, defined expectations and planning mechanisms. The study also identified an ineffective work allocation process due to missing links between the caseload volumes, the complexity of the patients on the caseload, the workload and the available capacity.
The programme sold was an 18-week Improvement Project. The overall goals of the project were as follows.
- Increase operational grip over service delivery enabling increase in time spent in direct contact with patients;
- Install a full suite of management reports and reviews;
- Install new allocation processes enabling a move away from ‘caseload’ to ‘workload’.
- Develop a Demand and Capacity Model to show required resourcing across the service.
Meridian worked alongside the Head of Service, Locality Managers, and Team Leaders through a series of 1:1 meetings and CPD accredited training workshops. Through ongoing collaboration, a new way of working was designed to ensure effective running of the service.
As part of the new system, planning controls and performance reports and reviews were implemented.
A pivotal change in approach to planning and allocating work was achieved through developing and agreeing a Caseload Management Approach. Within the project timeframe, teams have undergone a caseloads cleansing process, which involved RAG-rating current cases and identifying planned frequency of contacts. The caseload analytics tool developed by Meridian brought to team leaders a visibility of the key productivity metrics against caseloads, allowing to determine staff capacity based on the actual work required in relation to cases rather than simply on the number of cases, as has been done historically.
A full suite of Management Reports and Review Meetings were installed providing operational and performance oversight to all layers of service management. Ongoing daily and weekly follow-up controls ensure sustainability of the new ways of working in maintaining increased productivity.
The implemented processes and controls enabled a fundamental shift in planning and allocating work across teams. The new ways of working gave the service better control and an enhanced ability to manage demand. A comprehensive reporting suite provided transparency of activity and evidence to support operational decision making on a daily and weekly basis.
The main results of the programme are:
- Staff increased overall time spent in direct care with service users from 24% to 36% of the working day by the end of the programme.
- Actual Pay Costs decreased by £26,135 during the programme with a projected annualised improvement of £104,540;
- Working with improved productivity, the service has been able to identify a surplus capacity of 16 WTEs across 9 teams through the demand and capacity model. This represent a cashable opportunity valued at £502,038.
- Actual cost avoidance savings of £112,877 achieved over the course of the programme with the projected annualised improvement of £391,308. Further identified annualised cost avoidance improvement valued at £638,790.
- A new caseload management approach enabled the service to understand the workload associated with each caseload and begin allocating according to new principles.
- As a result of the new controls and processes, a visible behavioural change amongst the management team and staff was achieved enabling the service to work more proactively rather than reactively.