The Outpatients Department service in the hospital was managed by a group of speciality-based Service Managers, presiding over 5 different sites. Each site was managed by a senior nurse who was responsible for staffing the clinics and maintaining the running of them. Overall management of the service was held by the Assistant Directors of Operations.
The system and processes in place showed a complete lack of control over activity, expectation and performance. Daily activity was logged in a recently installed computer system, which also held all of the clinic templates and patient records.
During a 3-week study, Meridian identified a number of areas in which opportunity could be found, to save money, improve efficiency and ensure that patients were receiving a high level of satisfaction upon visiting the departments. The Trust did not have any productivity or utilisation measures in place, clinics were being underused and additional expenditure was being provided to meet the demand by way of additional staffing and clinics. Meridian spent 50 resource days observing clinics in their entirety, monitoring patient journeys, staff performance, usage of available appointments and other ancillary tasks associated with the running of the departments.
During our observations we noted that the utilisation of these clinics, across all observed disciplines was 49% against a national expectation of 85%. There was a high proportion of missing medical records, and out of all observed patients only 15% were seen at their appointed time, with 37% of patients waiting longer than 30 minutes to be seen in clinic.
With clinics not being fully utilised, over 1.6 million was spent on running and staffing additional outpatient clinics on top of the established budget.
The overall goals of the project were as follows:
- Understand the booking process and modify to increase efficiency
- Review and change clinic templates to ensure best use of consultant time
- Introduce performance management tools for clinic review
- Install performance management meetings
- Identify and realize savings across the Surgery and Medicine Divisions
In addition, at the request of the Trust Management:
- Drive productivity in existing clinics to maximize revenue
- Bring forward patients to increase revenue before end of the financial year
The installation of the above was reinforced with a series of workshops and training sessions based on management techniques, behaviour changes and productivity concepts. The workshops were targeted at Service Managers, Divisional managers and also the Executive.
These had the effect of facilitating a change within the behaviour of the different tiers of management to enable greater commitment to effective planning, better utilisation of consultant time and also remedying performance issues being brought up through clinic monitoring.
- Clinic Template capacity increased to see more patients in existing time
- Daily Clinic Dashboards created to monitor the performance of each clinic
- Weekly performance review meetings installed to deal with any performance variances
- £78,670 generated in extra tariff payments before end of financial year
- New control element for additional clinics introduced – standards and justification to be met before sessions are sanctioned
- Performance improvement across specialities – Increased utilisation of consultant time
- Installation of weekly expenditure report charting current additional expenditure against historic expenditure
- Reduction in additional clinics
- Annualised additional clinic savings of approximately £1,254,555