Addressing the performance needs of healthcare organisations whilst recognising the financial, operational and political challenges within the NHS

For one recent client we have delivered:

  • An annualised saving of 42,000 bed days per year, equivalent to the capacity of 3 full wards
  • Improved ED performance from 75% to 96% of 4 hour target. Moving from 120th to 6th best performing Acute Trust in the UK
  • Reducing RTT fines by £360,000 a year in one specialty through a reduced average wait from 36 to 12 weeks
  • Delivering an additional £2.8 million elective revenue through increased productivity

We have the confidence to offer all of our solutions with 100% fees payable against delivery of agreed benefits.

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Inpatient pathways and the patient flow challenge

Developing a targeted end-to-end inpatient flow model to address the patient flow challenge and create a step-change in ED performance.

Key benefits

  • Improved ED performance and fine reduction – Improved 4 hour ED performance by up to 21 percentage points (75 – 96% adherence), reducing fines by over £200,000 per month
  • Eliminated 12 hr ED breaches and fines – We have reduced 12 hr ED breaches by up to 100% over a 6 month period
  • Reduced A&E Treatment times – Reduced A&E treatment times by 57%
  • Improved patient handover – Reduced ambulance turnaround time by 16%
  • Proactive discharges – Increased morning discharges by 13%
  • Reduced patient length of stay – Reduced average patient length of stay by up to 30% in key medical specialties
  • Increased bed availability – by reducing length of stay, we have created additional capacity equivalent to 42,000 bed days per year, or 3 full wards
  • Improved patient safety – Reduced the number of unnecessary bed moves including medical outliers by up to 31%
  • Improved patient experience - Increased patient satisfaction from 84% to 94%
  • Reduced impact on elective activity – 23% reduction in operations cancelled due to bed availability

The Challenge

In the 2015/16 financial year, total attendances in ED across the UK increased by 5% year on year. However, the number of patients waiting more than 4 hours from arrival to admission, transfer or discharge increased by 97%.

In the first 2 quarters of 2016/17, ED attendances were 7% higher than the same period in 2013/14, but breaches were a staggering 253% higher.

This is the equivalent of an additional 3,739 patients breaching per day in 2016/17 compared to 3 years earlier.

It is clear from these figures that NHS trust's have reached a critical tipping point. With an ageing population that continues to grow, demand is only going to increase. Couple this with a £1.85 billion deficit for NHS providers and commissioners in 2015/2016 and it becomes clear that a huge step change in performance is needed.

The only solution is to improve the flow of patients through the hospital.

A targeted and proven solution

The end-to-end inpatient flow model addresses this challenge through the following key interventions:

  • Proactive Discharge Planning – Implementing a discharge planning tool to:
    • Visualise and track the current discharge status of ward patients
    • Align and coordinate supporting discharge services to expedite safe discharge, ensuring patients leave the hospital on their PDD (planned discharge date)
  • Coordinated Bed Management – Implementing a systematic and comprehensive bed management approach to:
    • Improve communication and understanding of bed availability and status
    • Forecast likely demand to identify any potential capacity constraints
    • Coordinate admissions with discharges to maximise effective handover and utilisation of beds
    • Ensure the patient goes to the right bed, first time

These interventions are underpinned by the implementation of a problem solving methodology and an end to end management framework that visualises the process, promotes communication and collaboration across the end to end pathway and highlights bottlenecks in the process that are inhibiting performance. Through clear process and ownership, the operational teams are equipped with the tools and capability to effectively manage and overcome future problems, improving the flexibility, responsiveness and safety of the service.

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Elective care pathways and the RTT challenge

Developing an end-to-end elective pathway model to address the RTT challenge through effective utilisation and increased productivity.

Key benefits

  • Increased revenue from improved productivity of clinics and theatre sessions – Delivered a 25% increase in outpatient throughput and a 20% increase in theatre throughput to our clients, with additional revenues exceeding £3m per year
  • Improved theatre utilisation – Reduced late starts and early finishes by 20% and 27% respectively
  • Reduced costs by eliminating the need for waiting list initiatives – Cut waiting list initiative spend by up to 100%, saving our clients in excess of £500,000 per year
  • Reduced RTT waiting times and therefore fines – Delivered up to an 84% and 33 week reduction in average RTT waiting times, reducing annual fines by up to £360,000 in an individual specialty
  • Increased effectiveness of pre-operative clinics and surgical wards – Increased total specialty throughput by up to 10%
  • Reduced short and long term cancellations (Reduced last minute cancellations due to no beds available by up to 85%)
  • Improved effectiveness – Reduced inappropriate referrals by 20% and DNA’s by 50%
  • Improved patient experience – Increased patient satisfaction from 84% to 94%

The Challenge

In the 2015/16 financial year, the number of patients across the NHS waiting 18 weeks or longer from referral to treatment rose by 50% (201,424 in April 2015 to 302,908 in April 2016 - NHS England Statistical Work Areas).

From April 2016 to October 2016, this rose by a further 20% to 360,255 with almost 1 in 10 patients now waiting 18 weeks or longer for treatment.

Given that over 90% of NHS Acute Trusts experienced a financial deficit in 2015/16, it goes without saying that this trend is not sustainable. However, as the continuation of the trend suggests, the majority of Trusts are struggling to overcome this issue given the significant financial and operational constraints they are already experiencing.

The only solution is to improve the effective utilisation of existing resources.

A targeted and proven solution

The end-to-end elective pathway model addresses this challenge through the following key interventions:

  • Demand and capacity modelling – Implementing a demand and capacity management tool to:
    • Visualise and track demand trends and waiting times to align capacity to demand across specialties
    • Track patient waiting times within a specialty to effectively manage consultant resources within outpatients and theatres to maximise throughput
  • 6 week planning model – implementing a visual 6 week planning tool aligned to consultant rotas to:
    • Visualise clinic and theatre plans to easily identify under booked session.
    • Allow booking teams to manage and populate schedules 6 weeks in advance, preventing short term planning and firefighting
  • Bed capacity modelling – implementing a visual scheduling tool to:
    • Predict bed demand based on theatre activity mix, enabling booking staff to allocate
      procedures to align bed demand to available bed capacity
    • Enable advanced planning and sequencing of theatre sessions

These interventions are underpinned by the implementation of a problem solving methodology and an end to end management framework that visualises the process, promotes communication and collaboration across specialty services and highlights areas of underutilisation. This equips the operational teams with the tools and capability to effectively manage and overcome future problems, improving the flexibility, adaptability and responsiveness of the services.

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