Southampton University Hospitals Trust provides local hospital services to some 500,000 people living in Southampton and South Hampshire, and specialist services such as neurosciences, cardiac services and children’s intensive care to more than three million people in central southern England and the Channel Islands.
The trust is also a major centre for teaching and research in association with the University of Southampton and partners including the Medical Research Council and Wellcome Trust.
The Trust’s 7500 staff treat more than 115,000 inpatients and day patients every year, including 40,000 emergency admissions; they see 350,000 people at outpatient appointments, and deal with around 85,000 cases in the emergency department. Providing these services costs more than £800,000 every day, and therefore robust financial management is essential to the effective running of the trust.
The decisions that really determine a trust’s financial performance are taken by clinicians, be this the choice of treatment, drug or prosthesis; these decisions all make a difference to whether a hospital runs at a profit or a loss.
The challenge Southampton faces is how to ensure robust financial management while continuing to provide the highest levels of care. The trust’s goal is to operate as a business-like organisation, with efficiency, financial control and robust management, and as a result to drive up the quality of patient care.
To achieve this requires clinical and finance staff to work together, in order to meet the joint objectives of financial control and care quality optimisation. The challenge Southampton faced was that clinical and management engagement was there, but that they did not have the right tools in place for the job.
The trust had previously been producing static reports on a service line reporting model, in order to see how departments were performing, and to get an understanding of profitability. However, the limitation of the static reporting is that it did not give staff the ability to drill down further to interrogate data and get the specific information needed to help deliver real improvements, change, and increased profitability.
To address this, the trust has deployed Ardentia’s Patient Level Costing solution. The system is built on actual costs allocated down to patient level, and is fully interoperable with existing in-house information systems, enabling finance and management staff to make the most of existing trust data and the work already done to generate reference costs. In addition, the solution generates service line reports as well as patient-level costs, helping the trust to meet the requirements of Monitor.
By taking financial information down to the patient level, the solution creates a link between clinical managers and the finance department to enable evidence-based management, meeting the dual goals of robust financial control combined with care quality optimisation.
The solution has been rolled out to all 50 specialities within the trust, and the goal is to ensure all clinical, management and finance staff are using the system, in order to deliver care that is both effective and cost-effective.
Static reports give trends, top-level info and statistics, but they only show so much. Finance staff and clinical managers need to have the ability to drill down and analyse the specific costs incurred at a patient level, such as ward days and theatre time, and they need to do this for a number of reasons.
Firstly, they need to be able to evaluate the fixed costs incurred by departments and consultants for specific procedures, to get an accurate benchmark figure for the cost of care, and how this compares with the income received.
This data can then be used as a tool for ongoing improvement, serving as a benchmark from which to develop more accurate costings for the future, and also alerting the Trust to individual high costs and enable staff to investigate why they occurred.
According to Fiona Boyle, finance manager at Southampton University Hospitals Trust: “The ability for clinicians and managers to be able to drill down to the patient level is so important and so critical, because their performance, efficiency, profitability are all measured on the data we have.
“Staff need to have the reassurance that this data is accurate, and also, crucially, the ability to verify this. They need to be able to drill down to the patient level to see the specific costs incurred, and the treatment delivered, as well as the income received. Patient level costing gives us an altogether better understanding of the business of healthcare.”
The system is helping to deliver constant improvement within Southampton, and is being used to help identify where improvements can be made, to ensure best value and efficiency.
Importantly, it’s also about learning from departments and consultants who are performing particularly well, looking to make these examples of best practice, and sharing this information across the trust.
In this way, the patient level costing data generated is used by managers to evaluate the best clinical procedures to take, and the likely outcomes, in order to meet the dual objectives of financial control alongside the highest level of patient care.