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. Endoscopy services are being delivered at 4 locations throughout the Northern Trust, namely, Whiteabbey Hospital, Mid Ulster Hospital, Antrim Area Hospital, Causeway Hospital. Approximately 12,000 patients receive diagnostic or therapeutic endoscopy procedures annually.
Meridian were commissioned to conduct a study in Endoscopy before the COVID-19 pandemic. The study was conducted over 3 weeks, primarily focusing on the list utilisation across multiple sites and the constraints contributing to lost capacity at the point of booking. In the previous financial year, the Endoscopy Department under-delivered on their contracted activity, and waiting list initiatives were used to deal with follow up demand. The current system showed a lack of control over activity, expectation, and performance and therefore an opportunity presented itself to the Trust.
The programme sold was an 18-Week Endoscopy Improvement Project that began in June 2020, and while the focus remained on increasing session utilisation, the key priority was to regain as much elective capacity as possible. The overall goals of the project were as follows.
- Provide clear and actionable management information relating to job plan attainment, delivery and requirements;
- Develop a Capacity and Demand Model;
- Agree booking protocols and standards, with robust follow up processes;
- Establish an overall transparent way of working that clearly aligns demand with capacity.
Meridian worked alongside Service Managers, the Assistant Director for Surgical Related Specialties, and the Booking Co-Ordinator through a series of 1:1 meetings and CPD accredited training workshops. During these various sessions, a new way of working was designed and tailored to each area of the Endoscopy Department to ensure it was running efficiently and effectively.
The key focus was to implement management controls to effectively forecast and maximise capacity utilisation, which was a particularly challenging task considering the constraints brought about by new infection control regulations.
A new booking method that maximised list capacity with highly precise planning was implemented. The approach was based on agreeing composite procedure norms which have been developed at an individual procedure room level due to differences in the ventilation system leading to variations in downtime. The norms included pure operating time, set-up time, settledown, cleaning, and contact time.
Meridian installed weekly scheduling controls supporting the service to move to a more robust 6-4-2 session planning process. The management team now has all the required tools and processes to identify and mitigate lost capacity, both from the session and list utilisation perspective.
A full suite of Management Reports and Review Meetings were installed providing transparency of activity and evidence to ensure the Trust is on target and raise any issues that might cause larger variances. This operational oversight ensures sustainability of the new model to maintain increased productivity.
The processes introduced and implemented gave the Endoscopy Management Team better control over their service, as well as visibility of daily and weekly operational performance and future forecasting and capacity planning.
Due to COVID-19, Meridian worked alongside the Trust to regain capacity for scanning, whilst identifying potential further efficiencies.
The main results of the programme are:
- Implementation of a new session planning approach enabled the Trust to better utilise list availability and increase the average number of patients per list by 12% whilst maintaining the same level of staffing resource.
- Annualised improvement was valued at £90,169.
- Total amount of time lost due to late starts reduced by 30% during the lifetime of the project across all sites.
- A Demand and Capacity Model was created evidencing the increase in commissioned activity delivery from 35% to 53%.
- Behavioural change within the management team and staff enabling the Endoscopy Department to work proactively rather than reactively.