A strategic transformation programme has helped a community provider reform and redesign its services and improve efficiency as a central part of its bid for foundation trust status. Jo Manley and Mark Eaton outline the programme.

The challenges facing community healthcare provision are significant, sitting as they do in a complex place between hospitals and other organisations or the patient’s own home. Many providers are dealing with the concurrent challenges of changing commissioning structures, managing complex relationships and the ongoing need to reform and redesign their internal operations to balance the books.

Given the complex environment in which they operate, the need to proactively transform the way they do things is key to operating successfully.

Hounslow and Richmond Community Healthcare in south west London is facing up to this challenge through its organisation-wide Working Smarter programme. The programme brings together all aspects of a strategic transformation programme – from internally focused improvement activities aimed at reducing running costs to complex multi-agency projects that are already improving patterns of treatment and the way in which care is delivered.

One of Hounslow and Richmond’s first internally focused projects was led by Shirley Shillito, a team administrator working in specialist services for children and adults. Ms Shillito undertook one of the first lean programmes organised under the Working Smarter banner and led by Hounslow and Richmond Community Healthcare’s service improvement partner Amnis. The aim was to tackle both the problems of achieving administrative turnaround times and reducing the costs of bank staff and overtime.

Cutting overtime

Lean tools Ms Shillito applied to the process included value stream mapping, visual management and a redesign of the working space of the teams involved. This rationalised the work done, changing the way in which teams worked, including providing cross-cover for each other during absences. The overall result was that all bank staff costs have been eliminated and over 90 per cent of all overtime costs have disappeared.

Kulvinder Jhita, the service manager with responsibility for phlebotomy services, participated in the second wave of projects. Her project had the main aim of tackling the reasons why teams in phlebotomy were losing capacity.

Following a structured improvement approach, Ms Jhita was able to change working patterns within her team, including changing the frequency of clinics and moving some to different settings to better match patient demand. Her activities, which also included the introduction of text messaging and improved provision of emergency sessions, has led to a 50 per cent reduction in did not attends and an increase in monthly capacity of more than 400 extra appointments without needing more resources.

Her work has also reduced the need for bank staff and has increased patients’ choice of  when and where their appointments take place.

Waiting times for adults have halved, from an average of four to two weeks, and those for children have decreased to two days. Such work has given patients and GPs access to phlebotomy services that are much more responsive to their needs, with Ms Jhita and her team responding to the changing demand patterns and needs of both groups.

Rapid access

Hounslow and Richmond has also used the Working Smarter programme to focus on projects across whole health economies. For example, Richmond locality manager and allied healthcare professionals lead Karen Page led a project to tackle the establishment of a single point of access and rapid response service, as well as an associated inreach service working inside two local acute trusts.

The aim of the single point of access has been to provide professionals with rapid access to community services, to reduce the need for patients to go to hospital. By providing a triage within 20 minutes of a call, the single point of access is able to rapidly assess whether support can be safely and effectively delivered in the community and, if required, the patient is referred directly to support provided by the rapid response service.

Analysis suggests that the team managed to avoid 115 admissions out of a total caseload of 218 referrals arising in the first few operating months of the service. The inreach service has had a major impact on cutting the number of days patients need to remain in an acute setting by working proactively to move them into a community setting or getting them home safely.

  • Click on the image attached right to see how the provider reduced the number of ‘no shows’

As an example of the effectiveness of these changes, on average there are now 15 patients per month who are receiving IV antibiotics at home rather than being required to remain in hospital. Ms Page’s work has also contributed to a reduction in excess bed days and a reduction in associated management cost both for Hounslow and Richmond Community Healthcare and its partner organisations.

The Working Smarter programme is integral to the organisation’s strategy to become a foundation trust in the next two years. The programme’s focus on maximising impact while minimising disruption and the successful coordination of improvement activities is seen as the way forward and creates a model of how improvement activities can be coordinated in difficult times in the community health sector.