Process: Maximising use of available capacity in the 3rd quarter of 2016/2017

The problem

Underutilised capacity within the community hospitals.

What we did

  • Jointly, with the teams, we developed a key set of measures to enable better understanding in terms of the ‘cause’ and the ‘effect’ of this underutilised capacity.
  • Through our approach using ‘The kitbag’ and our methodology, we supported the system understand, on a daily basis, the cause of the under-utilisation and to identify a number of actions – both operational and process, but also behavioural in nature, that needed to be undertaken to increase the utilisation.
  • We facilitated open conversations with the system leaders, supported by the transparent and trusted information from the key measures. This resulted in the system testing a number of service improvement actions (with our support) to ensure there was better planning of utilisation.
  • As part of standard work the daily review and action focus of the community bed utilisation became ‘daily and routine’ and we coached and trained the teams to facilitate the approach independently.

What we achieved:

  • The result of the approach taken was an increase in community bed utilisation. The effect of this was a reduction in the number of medically fit patients in the Acute Hospital.
  • Against a national picture of a 24% increase in DTOCs, a reduction of 10.8% based on Q2 and Q3 figures in 2016, compared to 2015 was achieved
  • This is a reduction of 9 patients per day that were in the wrong care setting, who now are receiving the right care, in the right place.
  • This has delivered an annual cost reduction of £903,375, (based on £275 per bed day, DoH 2014)

A reflection from a CCG lead was that the daily rigour and grip…

“has helped both confirm things we thought we knew but also bust myths that were becoming barriers to progress.  Using this tool for improvement rather than judgement has been one of the most important things we have implemented in the last four years.”

we now have the ability to be open and honest to the weaknesses in our system. The validity of the data has a strength allowing the system to operate effectively.  The impact has afforded a culture change from a historical position of frustration and dispute in searching for the real problem, to a constructive functioning system allowing real problem solving. The level of confidence within the system to understanding its needs has brought about a high degree of trust of trying new ways of working.”