The flow of patients through A&E depends on many other areas of the hospital. We worked with the Trust to develop focussed problem definitions, and then combined improvement methodologies and analytical techniques to devise and test solutions in the ‘live’ hospital environment.
Re-designing A&E processes: We worked with staff to build a detailed map of emergency pathways, using a lean value stream analysis approach. Through these sessions we developed and tested new models of care for the ‘Rapid Assessment and Treatment’ of walk-in patients, an adapted model of GP triage, and an innovative repurposing of A&E floor space.
Improving data-driven decision-making: We designed and developed reports through an iterative process, ensuring that they met user needs. Once tested and agreed, they were then automated and deployed into the Trust’s existing Business Intelligence platform.
Improving ward discharge performance: We worked with individual wards to share performance data and understand their challenges. We then used a combination of lean and change methodologies with front-line support and coaching, leading to streamlined clinical support processes.
Modelling the hospital: We simulated patient flow through the whole hospital. This allowed us to understand dependencies and dynamics between departments, and then to work to test the impact of changing demand and new models of care.
Over the course of the programme, BHRUT’s A&E target performance improved 81 places -from 111th in England to 30th. The wide-ranging nature of the engagement means that it also produced other benefits, including:
• Putting in place robust operational data and reports to guide decision-making.
• A systematic approach to recording outcomes supported the Trust’s achievement of a £1.2m incentive payment through better performance reporting.
• Assessment Units were redefined in line with NHS London standards.
• Significantly improved discharge and bed management processes, including a 76% improvement in discharges before 10am and 40% increase in discharges before midday
GE Healthcare Finnamore were shortlisted for this work in the 2015 HSJ Value in Healthcare Award in the Value and Improvement in Acute Service Redesign category.