Significant improvements in patient flow and capacity resulting in A&E treatment times reducing by 57%


The Challenge

A major NHS Trust wanted to realise its vision of ‘Best Care, Best People and Best Place’

The Trust sought to  develop a sustainable approach to improving services and maximising value for money, driven by a philosophy that brings life to the Trust’s pledges to patients and employees.

Unpredictable demand, particularly during the peak winter months, has been a source of disruption for staff
as the focus of their attention is shifted away from providing the best patient care to the task of finding available beds. The knock-on effects have been felt right across the hospital, on staff morale, on key quality and performance targets and on the Trust’s financial position.

Unipart Consultancy were appointed to advise, coach and develop Trust staff at all levels, from the Executive Team to front-line colleagues, and support them in achieving their vision. The Trust and Unipart worked together, in partnership, to create and deliver the approach that would provide the required change that would achieve it.

In the course of this, Unipart would help the Trust to address long waiting times in the Emergency Care Centre (ECC), which includes an Accident & Emergency Department (A&E) and a 56-bed Emergency Assessment Unit (EAU).

How we helped

Unipart engaged people across the Trust in identifying issues that were affecting patient flow and best practice. With this insight, the programme objectives were widened to managing patient flow and capacity  through the entire care pathway. Our approach,  involving employees from all specialties and all levels, would  be to nurture openness, collaboration and ownership of  the change. Key to this would be building the capability of employees so that they may be engaged in devising and  implementing their own solutions.

Six areas for strategic improvement emerged, requiring the right people to be in the right place at the right  time. New processes ensured accurate data, clarity of  individual roles and responsibilities and communication  of all decisions and outcomes, while improved  information gathered from external support services meant demand trends and potential service issues could  be identified and resolved. Additionally, a single point of  access scheme was developed to ensure that patients not needing acute care were redirected to the most  appropriate setting.

A control room for patient flow and capacity was  established where daily meetings – supported by  effective visual management – could provide a clear,  real-time view of performance, capacity levels, and  inform in-the-moment decision making. Not only did this approach offer improved transparency and accuracy  with regards to bed demand and capacity levels, but the introduction of creative problem solving (CPS)  techniques empowered bed management teams to  rapidly identify and resolve arising issues.

This redesigned bed management approach, processes  and accountabilities created a structured and blame-  free environment where all attendees can make a  proactive contribution, ultimately with the aim of maximising efficiency and improving the care delivered  to patients, while contributing to the improvement in  the Trust’s A&E performance.

Benefits

By the end of our implementation, the following  results had been achieved:

  • More than £2m increased contribution with a £430k reduction in winter expenditure
  • 57% reduction in A&E treatment times
  • A&E 4 hour wait target achieved despite activity  21% above plan
  • 56% fewer patients exceeding 48 hours in EAU
  • 22% decrease in average length of stay in EAU  for medical speciality patients
  • 72% year on year cost reduction
  • 23% reduction in operations cancelled due to bed availability
  • 31% of GP admissions were avoided enabling commissioners to re-invest more than £1m
  • Senior nursing time spent managing flow and capacity dramatically reduced, restoring focus on the quality of  patient care, boosting their morale.