Three factors are key to rapid improvement in NHS productivity and efficiency: a focus on what is known to work; follow the lead set by the best; drive improvement through measurement.

Three factors are key to rapid improvement in NHS productivity and efficiency: a focus on what is known to work; follow the lead set by the best; drive improvement through measurement.

The NHS Institute for Innovation and Improvement's publication on productivity and efficiency, published earlier this month, highlights areas where the greatest potential exists for these principles to be put into practice.

One of these is wasted bed days. Admitting patients to beds a day or more before procedures for non-clinical reasons wastes bed space and increases costs. We all know that, but what does the NHS do?

Top-performing trusts admit over 80 per cent of elective surgical patients on the day whereas others manage less than 40 per cent. The range is even greater for individual procedures such as hip replacement where some trusts admit almost all patients on the day whereas others admit virtually no-one on the day.

A key driver in length of stay is the slowing of hospital activity at weekends. Top performers discharge patients when they are ready rather than when the system is ready.

They do this by simply making admission on the day of surgery the normal way, with aligned supporting processes such as pre-operative assessment, surgical admission units allowing patients to go directly to theatre and planned bed allocation systems. Admission before day of surgery is also monitored by specialty as part of the overall organisation performance 'dashboard'.

These organisations manage, by measurement and monitoring, the length of stay for different categories of patients and then take action where hospital processes rather than clinical need are driving discharge. Solutions include agreeing performance criteria for the whole system (including inreach, outreach and community-based services) with the aim of delivering a 'pull system' seven days a week.

Performance dashboard measures include weekend discharge rates compared to weekdays, length of stay and excess bed day cost by specialty.