The upcoming winter may prove a challenging one for many trusts but with help on how to devise some key strategies, you can make sure your trust isn’t left out in the cold, say Nigel Guest and Ruth Burns
A recent survey of senior leaders by the NHS Confederation concluded that, unless urgent action is taken to address winter pressures, patient safety could be endangered, waiting times increased and some NHS organisations pushed into financial failure.
The prime minister responded by announcing an additional £500m of funding to relieve accident and emergency pressures; however, it is recognised that more investment will be needed across the whole urgent care system.
Capita’s health advisory team has been supporting local health economies and providers in preparation for a challenging winter, delivering support through the three Ds – discovery, design and delivery.
‘Through detailed understanding of local issues and specific pathways, trusts can identify practical changes that reduce admissions and occupied bed days to improve flow and address any gaps’
This is a combined approach of robust analysis using proven activity, capacity and income (ACI) models and qualitative rapid review interviews, observations and analysis against best practice.
This provides foresight and understanding of the winter “capacity gap” and likely pinch points. Through detailed understanding of local issues and specific pathways, trusts can identify practical changes that reduce admissions and occupied bed days to improve flow and address any gaps.
With this information clinical teams and managers can design a model of care and a programme of delivery that will realise the required improvements. Examples have included:
- reduction in patient moves;
- improved site management and escalation processes;
- rationalisation of assessment areas and bed configurations
- improved patient flows through departments;
- implementation of discharge processes.
All of these lead to reduced lengths of stay and a reduction in variation depending on the day of admission.
‘One client recently identified a release of over 30 beds through the implementation of their 90 day actions alone’
Once the model of care design is completed, initiatives are prioritised into 30, 60, 90 day action plans and combined with a robust governance and accountability framework to drive the delivery of the desired results. One client recently identified a release of over 30 beds through the implementation of their 90 day actions alone.
However, the biggest challenge is dealing with the human factors in an environment that is constantly battling with urgent issues. In this context the 3Ds process brings focus and discipline to the improvement effort to achieve positive momentum and help frontline teams incorporate improvement into their day job.
With the leadership and organisation engaged on a clear plan, many organisations benefit from hands on support during the implementation phase.
The injection of capacity and capability helps to increase the pace of delivery through facilitated engagement, independent challenge, subject matter expertise and rigorous programme management. This helps deliver the benefits required to bring the plans to life and shift the key performance indicators.
Nigel Guest is a director in Capita’s health advisory business and Ruth Burns is a principal consultant specialising in unscheduled care and improving flow