This large NHS Foundation Trust delivers Mental Health Services in the Community & Inpatient settings to a large geographic area. The Executive Team invited Meridian Productivity to conduct an Analysis of the Community Services for Adult & Older Adult patients to identify if any potential opportunity was available.
The Trust asked Meridian to identify areas of improvement within its Community and Specialist Directorates as over the last two years, the Community Services have failed to meet their CIP Saving targets and have had a large overspend on Bank & Agency Staffing.
Meridian has had a long history working with this Foundation Trust & its Executive Team over many years in multiple Directorates and Departments. It was due to this successful relationship that Meridian were invited into the Trust for a fourth time.
Meridian invested 28 resource days on an analysis of 7 teams within the Specialist & Community Directorates to identify any areas for improvement.
This analysis phase included observing days out with members of staff documenting clinical and non-clinical activities, a caseload analysis and a historic productivity analysis of each individual staff member. Furthermore, this also allowed staff the chance to express their views towards how the service could be improved.
The analysis identified the following:
- No clear or enforced targets for frequency of client contact
- A lack of Management Control over the care provided for patients
- No visibility or assignment of the volume of work needed on a daily basis
- Lack of cohesion in the way of working across the 7 Community Teams
- No clear link between the demand and capacity of the service when assigning work leading to highly unequitable workloads and hugely differing productivity levels between staff members
- An average of 2 patient contacts per day across the 7 community teams equating to 20% on average spent with patients
Meridian proposed to install a robust and cohesive management system within the 7 Community Teams. The project was designed to increase the amount of time spent with clients whilst increasing the quality of service provided to all users and to make financial cost improvements for efficiency purposes where possible. This proposal was successful and an improvement project was initiated with the Trust.
The Trust’s improvement project lasted for 14 weeks. Meridian engaged with the CMHTs management team in delivering the program of change through a series of 8 workshops, close 1- 1 training and daily engagement meetings.
These sessions were aimed at ensuring the managers would have technical training on the use and implementation of control tools installed by Meridian Productivity. Furthermore, behavioural training was given to Team & Directorate Managers to support their understanding and confidence to manage effectively their people and areas. A new management control system was designed to ensure effective running of the CMHTs by forecasting, planning, assigning and following-up on all aspects of client care with input and support at all levels by management.
Through these workshops, the leadership teams agreed and set KPIs & targets for each service to ensure their service operated at high efficiency and quality.
Management Control tools were developed in conjunction with the client’s Information Department to ensure the tools were robust, as accurate as possible and could be easily perpetuated. These gave the Managers the opportunity to make accurate and evidence based decisions over resource, management & governance using the Trust’s own data and building on their existing systems.
The purposes of these management tools were to help ensure the equitable allocation of work, facilitate the performance monitoring and identification of variances to ensure that set targets are being met and each patient was receiving an optimal appropriate level of care.
A robust management control system was installed along with a significant change in the culture and management of the teams. Targets were made clear and transparent to all staff members and could be accurately measured using the Trust’s new reports. A strong weekly follow-up process was installed to assess team performance and act on any variances or issues that arose.
The CMHTs are now in a position to assess the current productivity by staff, band and speciality using factual information. Furthermore, demand management tools were installed to enable management to calculate the staffing resource needed for the future.
An overview of the care being provided to each patient using a bespoke “Patient Visit Report tool” to provide a transparent evaluation process of the volume of care each service user is receiving and identify any quality care elements needing acted upon. These included things such as the date of each patient’s latest MDT or their average DNA rate. This tool helped ensure that each patient was receiving an appropriate volume and quality of care that corresponds to their care plan.
A common systematic way of working was rolled out across all Community teams within the directorate using the format Meridian had installed during the project. The Trust used Meridian’s way of working and new Management Controls to ensure that the quality of care was standardised across the whole Trust in each Community Team including teams Meridian had not worked with.
An increase in patient face-to-face time of 125% from an average of 18% of a clinician’s day spent in contact with patients to an average over 40% by the end of the project.
The annualised identified financial gain from the project equated to £880,000 based on the modification of resource levels to meet targets & patient demand.
Following the success of this and previous projects, Meridian were once again invited to continue their relationship with the Trust.