Meridian worked with this client in 2013, which provides a major service for the region including both in Emergency Department and Radiology services. The Hospital provides services for approximately 25,000 patients per year with a bed capacity of 240.
In May 2013, the Client commissioned Meridian to carry out a productivity analysis of the Radiology and Emergency Department within the Hospital. Meridian were specifically asked to look at the capacity and demand of the service and the current management systems. Following the results, the Hospital embarked on a 12-week project to improve the management control system in Radiology and Emergency Department.
Meridian undertook a two week study in which a number of issues were identified in a number of areas which, if addressed, would substantially improve operational performance. The analysis was focused on the lack of a systemised approach to planning and assigning the workforce to the departments, based on patient demand. The analysis findings were as follows:
In the Emergency Department:
- There were inconsistent ways of working across the department;
- The resources were not aligned with patient demand;
- There was no process in ensuring that patients were seen efficiently and in a timely manner.
In the Radiology Department:
- The capacity of the Radiographers were not aligned with the daily demand within each of the modalities;
- There was no clear system in the assignment of scanning slots to meet the demand from the Emergency Department’s inpatients.
Meridian proposed the following implementation programme:
a) Design and implement controls and behaviours in both Radiology and Emergency Departments;
b) Development of reporting structure and report implementation;
c) Capacity planning process within Radiology (Radiographers and Radiologists);
d) Design, agree and implement new ways of working to improve patient flow/journey.
The proposals were accepted and the project commenced on the 7th of June 2013.
The overall goals of the project were as follows:
- Design and install management information system;
- Develop and install capacity planning and reporting tools;
- Redefine and agree booking templates;
- Determine and agree machine opening hours;
- Revise and agree staff rotas;
- Book patients into new templates.
The project put into place a management control system in both Radiology and Emergency Department. Meridian engaged with the clinicians and management in both the Emergency Department and Radiology through a series of workshops to develop and agree the following processes.
In Radiology, an activity list was and a flexibility matrix was created to enable the manager to calculate and quantify the resources required and lead to a capacity adjustment to meet and match patient demand. This identified £15,000 savings in radiographer time and increased CT scanner opening hours.
A reporting system has also been installed, providing information on the changing patient demand in each department and services provided by the hospital. This enabled senior management and clinicians to take action where necessary.
In the Emergency Department, there was a remodelling of the doctors and nurses allocations within the department, allowing for a change in the 2 ways of working. An hourly measurement of patient to doctor ratio was also created to maintain the appropriate staffing levels based on patient demand. This change in the process allowed for better patient experience and patient journey/flow from triage to treatment.
In addition review processes were installed. Firstly, the nurses and doctors on duty were required to review the status of the department, which focused on the number of patients waiting to be triaged or seen in the department. This not only provided an overview of the activity of the department but required the clinicians to act upon the variances that were identified.
In addition to this, a 3-hourly review process was put in place with both departments, where the doctor, the ED nurse in charge of the day, the radiologist manager and a member of the senior management review the status of both departments and ensure that there were no bottlenecks in both or any other supporting services affecting the patient flow.
- Increased patient throughput in CT by 20%;
- Reduced waiting times to eliminate breaches;
- Identified £15k in savings and enabled the service to provide 25% increase in the number of CT scanning slots by using the excess staff hours to accommodate demand for scanning in Radiology;
- Perpetuated change in the behaviour of senior management and senior clinicians in both departments, through a robust reporting process where management could assess the status of both departments and the supporting services.