Leicestershire Partnership NHS Trust
The Leicestershire Partnership NHS Trust provides integrated mental health, learning disability, substance misuse and community health services to the Leicester, Leicestershire and Rutland areas. The Trust serve a population of approximately one million people and have a budget in excess of £250 million and employ over 5,500 staff.
Meridian worked with the Musculoskeletal (MSK) Service, comprised of the eight City and County Teams who work in an outpatient setting and help rehabilitate patients that have musculoskeletal problems relating to bones, joints and muscles.
A one and a half week study was conducted with the MSK Service, inclusive of the two booking teams, incorporating physiotherapists and administrative staff.
The study involved gaining an understanding of the physiotherapy capacity from a booking template perspective, quantifying both clinical and non clinical timetabled activity.
Following the study, it provided the opportunity to:
- Standardise and fix therapists’ clinic templates
- Improve the management of the admin booking staff
- Increase visibility of the referral waiting lists at all points in the patient flow
- Develop management control on capacity and demand across the teams, through the development of forecasting, capacity planning and reporting tools.
Meridian worked with the service over a 9 week period, working directly with the Business Manager, Team Manager, Team Leads and Admin Managers in workshops and one to one meetings.
These sessions provided an opportunity to agree and set the targets, ensure understanding of the tools developed and provide managerial staff with the ability to make changes going forward if and where necessary. It also allowed staff to monitor and review variances, resulting in a structured and transparent working process that increased the visibility and utilisation of therapists.
In line with the Fair Days Work initiative, KPI’s included:
- The percentage of Direct Client contact time for Qualified Staff = 85% and Team Leads = 55%
- 1:3 ratio of new to follow up template appointments
- 11 bookings/ hour for admin staff
In the booking teams, staff moved to three location clusters, which ensured staff had ownership over localities but also provided flexibility for the Admin Manager to utilise staff effectively to the demands made on the service. Furthermore, the project increased transparency over staff, the ability to review performance on a regular basis, decrease vacant slots and better manage the teams through clustered working, eliminating silo operations.
Through the change in processes it highlighted the conversion of telephone calls to bookings, demonstrating mornings and lunch times were peak periods. Furthermore, later shifts and Saturday working was also emphasised as possible changes to aid the service with the ability to improve patient contact and booking conversion.
The Service Capacity Summary developed helped initiate a reduction in potential lost clinical hours and has provided the Team Leads and Team Manager with the ability to control the team and service, whilst questioning practices that were ongoing and not as easily accessible. It highlighted ratio imbalances between new and follow up appointments and disproportionate non clinical activity, which where possible was converted to clinical activity. It also provided insight into, e.g. Teams Leads undertaking classes, which they shouldn’t be, staff retaining patients with a higher new to follow up ratio, longer staff supervision sessions than required, etc.
A Weekly Capacity and Demand Summary was also designed and generated on a CCG level, whereby historic and actual demand could be monitored in line with capacity of new and follow up appointments, direct clinical contact and variance between qualified and unqualified staff.
This project highlighted that in relation to the demands on the service at the time, a shortfall in clinical staffing was identified across the 3 CCGs that MSK primarily operated within and formed the basis of potentially increasing resources.