Healthcare quality and efficiency support team: annual report 2013

Workforce

NHS Lanarkshire: Admin Improvement Programme

Background/Context

NHS Lanarkshire made a commitment to improve productivity and efficiency in acute admin services as one of the avenues to reduce costs without detriment to patient care. Health records were included to ensure costs were not being 'shunted' from one area to another.

The programme started in 2011-12, after scoping work. The intention from the outset was to reduce waste, so that cost savings were accompanied by improved processes and improved service levels.

In 2011-12 savings of £627,000 were achieved in year. In 2012-13 the target was to achieve in year savings of £500,000 and recurring savings of £1.25 million across the two year programme.

Problem

From a service perspective, there was a need to resolve typing queues. These varied significantly - in some areas there were backlogs of 10 weeks. Coding also needed to be brought under control. Backlogs of several months had accrued. Understanding typing queues and workloads was difficult. It was done through counting tapes awaiting dictation.

There were inconsistencies in staff deployment when resource was assessed in relation to patient flows through the three hospitals in Lanarkshire. There were also inconsistencies in the way staffing levels were understood, due to historic cross-charging arrangements and use of vacancies, non-recurrent money etc. as funding sources.

Aim

The primary service goal was to achieve 48 hour turnaround on typing. In reducing waste it was also planned to save £500,000 in 2012-13 and £1.25 million across the two year programme on a recurring basis.

Action Taken

The following actions were taken:

• financial controls and workforce monitoring every month
• process mapping of secretarial work to eliminate problems
• implementation of digital dictation
• development of performance measures from digital dictation
• development and implementation of a common process for managing the return of case records - using Trakcare and saving 10 WTE
• secretarial staffing re-aligned to match workloads across the three hospitals (small changes made, mostly as staff left the service)

Results

The following results have been achieved:

• costs savings of £1.25 million achieved on a recurring basis (assuming current staffing levels maintained)
• average typing turnaround is now four days (still work to do to achieve 48 hour turnaround)
• coding backlog eliminated and coding being achieved within six week target

Efficiency Savings and Productive Gains

£1.25 million achieved as an efficiency gain over two years. £500,000 in efficiency gains in 2012-13.

Some productivity benefits on top of this, coming from the removal of typing and coding backlogs but these are hard to quantify because part of the original problem was a lack of measurement.

Sustainability

Measures are in place to control core processes:

• typing
• coding
• case record management

Further work is being done to ensure new technology will be used consistently and efficiently e.g. WardView, scanned patient records, patient portal, order communications for radiology and laboratories.

Establishing consistent processes with these new technologies should underpin the efficiency gains made and lead to further improvements in the quality and reliability of service standards. There is much still to do.

Lessons Learned

The following lessons were learned:

• it is important to tie down basic measures at the outset (e.g. staff numbers). Managers have to be measuring like with like
• staff are often very aware of what needs to be improved but feel powerless to make changes
• effective use of measures from digital dictation does lead to significant productivity increases
• clinical staff have a large part to play in admin efficiency, based on the way they work
• paper case records are complex to manage as healthcare journeys are shortened and often take place over multiple locations

The State Hospital: Nursing Skill Mix Savings 2012-13

Background/Context

The State Hospital developed a new clinical model which set out the principles for delivery of services in the new hospital - the build programme for which was completed in September 2011. This helped to influence the skill mix which was required for nursing to fit in with the integration of multi-disciplinary team working.

Problem

Nursing is a high cost service and is the principal cost within the budget of The State Hospital. The historic skills mix included a higher proportion of trained nursing staff than was necessary.

The Psychological Therapies Service worked in parallel with the clinical teams before the opening of the new build, but then became fully integrated into the newly-created ward Hubs - these staff also being trained.

In addition, the services provided are located more closely together in the new build, allowing patients to be cared for in the centrally-located facilities for more time during the day.

Aim

To have a trained/untrained skills mix set at acceptable levels. With multi-disciplinary teams in the hospital following the new build, this also highlighted the lower demand for trained nursing staff.

Action Taken

Worked in partnership to recruit an increased number of untrained nurses (in line with the agreed Workforce Plan and Local Development Plan) - as trained staff left through natural wastage or planned retirals.

Results

From the resources saved, this allowed reinvestment in other areas for patient activity, in line with the KPIs included in the LDP.

Efficiency Savings and Productive Gains

The planned skills mix has allowed resources to be spent more effectively as well as contributing to recurring savings.

Savings of around £140,000 have been achieved, which have been reinvested in enabling more patient outings, increased music therapy sessions, and new art and drama therapy sessions. In addition, it has allowed for more activities in the purpose- built recreation centre.

New practices have adopted new ways of working in place of more costly historic practices.

Sustainability

Further skills mix savings are planned with the aim that - by the end of 2014-15 - the desired skills mix will be achieved.

Lessons Learned

Workforce planning and an integrated focus through the LDP enables the identification of the potential better use of resources.