Raising ED performance and elective productivity to reduce patient waiting times and length of stay

This NHS Acute Foundation Trust was one of many NHS Trusts facing a daunting  challenge to achieve stretching ED and RTT performance targets. This was made more difficult by their financial position, which didn’t allow them to invest in improvement initiatives to provide a platform to help meet this challenge.

The challenge

Unipart Expert Practices were engaged by the NHS Foundation Trust with a mandate to instigate cultural and operational changes that would raise performance levels, but also to equip the Trust to sustain this enhanced performance and be able to overcome future challenges.

How we helped

Unipart Expert Pracitces successfully engaged with the Trust over an 18 month period to transform the ways of working, from an executive level right the way through the operation. The significant cultural and operational changes yielded critical uplift in performance, but more importantly established a foundation of continuous improvement to sustain the benefits delivered and equip the Trust with the approach necessary to overcome future challenges.

The programme commenced with a detailed diagnostic review that highlighted three key high impact project workstreams.

  • Inpatient operational process redesign: delivering improved patient flow, reducing patient length of stay and delayed transfers of care through proactive discharge planning, live bed management, improved communications and handover with third party stakeholders
  • Elective operational process redesign: delivering improved productivity and revenue within existing capacity through improved booking processes, increased clinic/theatre utilisation and workload balancing between inpatient, day case & outpatient clinics
  • Management systems: developing a management framework and communications infrastructure to cascade, prioritise and manage key projects across divisions in line with wider strategic goals and resolve the disconnect between senior management and operational staff, supported by capability development in project management and process improvement methodology

To embed these workstreams, Unipart engaged with teams right across the organisation to drive a culture of systematic problem solving, building the skills and capability to take ownership of their operational areas as well as working with a team of dedicated change practitioners to develop the Trusts own internal capability to deliver change programmes. 

The results

To date the key programme benefits delivered have been:

  • Additional elective revenues of £2.8 million per annum
  • Additional 750 outpatient appointments per month and 180 elective theatre procedures per month with existing capacity
  • Referral to treatment fines reduced by £360,000 per annum within gastroenterology as a result of cutting average patient waiting times from 36 to 12 weeks
  • Improved patient flow within emergency pathways to reduce length of stay, saving 42,000 bed days per annum, equivalent to the capacity of more than three full wards
  • Improved emergency department 4 hour performance from 75% to 96%, from 120th to 6th best in the country

In addition, the following demonstrable and sustainable financial, service and quality benefits for patients and staff going forward have been delivered:

  • The training and coaching of 15 internal practitioners who are equipped to engage, train and coach staff to deliver operational performance improvements, supported by a change programme methodology
  • A Trust-wide policy deployment framework that provides line of sight and ownership across the organisation to drive and manage the delivery of both continuous improvement activity and wider strategic initiatives
  • A systematic sustainability model that actively engages stakeholders at all levels to support and embrace the changes delivered and drive continuous improvement.