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. Acute services are provided by two hospitals – Antrim Area and Causeway – and community based services across four additional localities.
The Radiology Department undertakes approximately 280,000 diagnostic examinations including MRI, CT, Nuclear Medicine, Fluoroscopy, Ultrasound, Plain Film, Dexa scanning and Breast Imaging. These take place in the Antrim Area Hospital, Ballymena Health and Care Centre; Causeway Hospital, Coleraine; Mid Ulster Hospital, Magherafelt and Whiteabbey Hospital.
The Radiology team consists of consultant radiologists, radiographers, radiographer assistants, administration, portering and domestic staff all of whom play an essential role in delivering a safe and effective service.
Meridian were already working with the Trust in Endoscopy and Community Mental Health when they were invited to conduct a study in Radiology. The study was conducted over one week, primarily focusing on the reporting performance of the Radiologists and the utilisation of the multiple imaging rooms. The current Radiology reporting system showed a lack of control over activity and expectation, leading to large variations in performance and high outsourcing/insourcing costs. The scanning template slots showed a readjustment was required to meet commissioned activity and over-resourcing per scanner.
The programme sold was an intensive 11 Week Radiology Improvement Project.
The overall goals of the project were as follows.
- Redefining booking templates using post-COVID guidance and requirements.
- Creating dynamic Target Operating Models to be flexible with incoming demand.
- Moving the Radiologists to a ‘Push’ Allocation system and reduce Waiting List initiatives and outsourcing spend.
- An overall transparent way of working that clearly aligns demand with capacity
Meridian worked alongside the Service Manager, Assistant Service Manager and Modality Managers 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 Radiology Department to ensure it was running efficiently and effectively.
The key focus was to implement management controls to effectively allocate the work to Radiologists using a performance target system. In Radiology, a flexibility matrix and Allocation Tool was created, using defined Reporting Norms to begin pushing the appropriate scans to the Radiologists to ensure the right reports were reported on in the right time by the right person.
Meridian installed Daily Reports within the Imaging Team and Session Summaries for the Reporting Team, which reports on the utilisation of the resources and available capacity. This process is reviewed on a weekly basis in the Weekly Schedule Review Meeting, 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 Radiology Management Team better control over their service, as well as visibility of daily individual and team 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.
Daily and weekly performance review meetings have been embedded to allow a review of ‘planned’ v ‘actual’ to identify and mitigate future variances. The main results of the programme are:
- A creation of dynamic Target Operating Models, to right-size scanning templates in order to recover service value and increase slots by up to 44%
- The Radiologists on a work allocation system can complete the same average level of activity within a shorter period of time, enabling a reduction in Outsourcing and Insourcing Sessions.
- Behavioural change within the management team and staff enabling the Radiology Department to work proactively rather than reactively.
- The planned improvement was valued at £814,177.
- As a result of the Improvement Programme, the Trust recovered a service value of £2,328,347 and further identified cost avoidance of £1,299,634.28.