Meeting the December 18-week referral to treatment target will be a challenge for many hospitals, especially those that missed the March milestone. Heather Lawrence, Kieran Brett and Michael Macdonnell explain how Chelsea and Westminster foundation trust hit the target nine months early
The project to deliver 18 weeks at Chelsea and Westminster started in November 2007 when performance was 42 per cent for admitted and 71 per cent for non-admitted patients. By March, the situation had been transformed to 90 per cent and 96 per cent respectively.
Here are our 10 steps to success:
Lead from the top. We put in a lot of effort early on to engage clinicians and managers. The board and executive teams generated a clear sense of urgency to raise the profile of the milestone among staff. Accountability at all levels was a key part of our success. To provide ongoing leadership, the board needed powerful information to make decisions. The monthly board report was restructured to provide clear, sharp messages about performance and risks. This was a key change and created a simple, clear tool for the board to make decisions.
Make sure you have enough capacity to deliver. Chelsea and Westminster brought in performance improvement skills from the 10 Partnership, a firm dedicated to public service improvement, to supplement the in-house team who were already grappling with complex and demanding day jobs.
Make 18 weeks about patient care in order to engage everybody in the hospital. The speed of treatment and quality of care really matter to patients. This is more motivating to clinicians and managers. Given the value that patients attach to this in an age of choice, making your hospital as attractive as possible to patients is paramount.
Break the problem down to understand your priority services. Adopting the 80/20 rule for 18 weeks is a very helpful way of reducing the scope and scale of the work, so find out which areas of the hospital to focus on to gain the most benefit.
Fix the basics. Focusing on some fundamentals such as high rates of completion for clinical outcome sheets, potential breaches, admission errors and booking were critical to success.
Get the numbers right and stay focused on them. After much hard work, the usefulness of data improved significantly at Chelsea and Westminster. The 10 Partnership was able to help here by drawing on best practice performance reporting from leading organisations and central government.
Work closely with clinicians to create the necessary additional activity. The 18-week target creates a spike in demand as the long tail of waits is eradicated and so-called "legacy" patients are treated. The clinical and managerial staff really went the extra mile once they knew the scale of what was required. Without this dedication, the milestone would have been missed. A critical part of engaging clinicians was to provide clear data about the scale of the challenge to help them plan additional capacity.
Hold regular "stocktakes". The 10 Partnership designed and participated in regular performance progress meetings with each of the directorates, including clinicians. These meetings were tough at times but essential in tracking performance and identifying what needed to be done to manage future risks, such as potential breach rates.
Be pragmatic. The journey to December will be tough for many hospitals. Too much emphasis on deep pathway redesign across the hospital will fail to deliver for December if it is not accompanied by a sharp and sustained focus on performance and risks.
Do not give up. The staff at Chelsea and Westminster have been amazing and have made heroic efforts to deliver 18 weeks. It is hard work and takes a grinding relentlessness to do it. Get the right focus, capacity, processes and engagement and you will succeed.