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 £180k across the Mental Health Service for Older Patients Directorate through an improvement in contacts per day in Community services (CMHT & IRIS/MHIR) and reduction in Length of Stay in Inpatient Wards.
Meridian conducted an analysis over the first few weeks of the project, and found the following:
- Low productivity across the community teams, averages ranging from 2.2 to 3.2 contacts per WTE day.
- Barriers to discharge from the inpatient service causing extended length of stay, caused by challenges between themselves and the community teams.
- Significant waiting lists and delayed discharges across all services
- A lack of clear definition of service provision and 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 to deliver the following;
- A new way of working based upon clear expectations across all services.
- Installation of controls for recording clinical activity, allocating patients and following up on daily contact activity.
- A methodology for patient management, calculating staff workloads and highlighting issues with patient pathways.
- Improved communication and engagement between services to improve patient flow.
Meridian embarked on a 20-week project with the MHSOP Services, across 14 Community Teams (82.56 WTE) and 5 Inpatient Wards (91 beds).
Within the Community Teams, Meridian supported the development of a range of management controls to improve planning, allocation and follow up of work. These allowed easy monitoring of pathways clearly defining the required frequency and type of contact to support the achievement of agreed targets per day.
Work allocation methods were developed within both sets of Community teams to enable staff to plan home visits effectively across the area. Improved planning thus freed up resource for other clinical activity including handovers, ward rounds and CPA reviews.
Management behavioural workshops were held with the different service supervisors and leaders to provide the necessary skills and coaching to help embed the new system. Subsequent technical installation sessions were also delivered to maximise understanding of the benefits of the new controls. This ensured that all developed controls were able to be fully utilised by services and deliver the maximum benefit.
Meridian worked closely with the Trust’s managers for each separate locality. By identifying areas of best practice, they were able to pull together the most appropriate elements and create a unified way of working – a first for the Trust. This parity also allowed ease of comparison between the teams’ performance.
Daily and weekly review meetings were installed across the Community and Inpatient services to improve communication and consequently patient flow between all community services, IRIS/MHIR, CMHTs and Inpatients. This helped reduce delayed 2 discharges from the Inpatient wards and also the transfer of patients from community teams back to the community.
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 tasks. This was designed to ensure delivery of the most appropriate length of stay for each patient on the ward.
Front-line management practices were challenged to encourage escalation of issues where barriers to discharge existed. Key individuals were required to take ownership over delays and place expectations on external parties to ensure the Trust effectively managed its delayed discharges.
Meridian worked with front-line supervisors, the Bed Management Team and Community Team Managers to establish a clear escalation process. The outcome of this new process was a reduction in Length of Stay thus ensuring that patients are now treated in the most appropriate environment for their mental state.
Following the successful installation of the controls and behaviours within the MHSOP Directorate, the results were as follows:
Within Community Teams;
- A cashed saving of £190k towards CIP (Appendix 1) with an additional £260k of additional savings identified. The cashed saving represents 100% of the £190k MHSOP CIP target, whilst including the identified saving means a 237% opportunity against the target for the CMHT’s
- Further identified saving of £142k from IRIS, which has been planned for the following year’s CIP.
- A reduction in bank, agency and overtime spend of £55k against the base.
- An 45% increase in productivity against the base from 2.2 contacts per WTE day to 3.2 for the CMHT’s, and a 31% increase for IRIS, from 3.2 contacts per WTE day to 4.2.
- Clearly established targets across each of the community teams, ensuring all staff are working towards the same goal and a more equitable workload.
Within Inpatient wards;
- A reduction in the length of stay of 11%, from a base of 72 days in the acute wards, to 63.9 days.
- A reduction of over 2300 bed nights based on the reduction in length of stay, multiplied by the number of discharged patients.
- An indicative productivity saving of £872k through the reduction in bed nights, based on the reduction in bed nights and the average bed cost.
- Patients having a clear intended discharge date from each service from Inpatients to CMHT.
- 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 delayed discharges from services.