Overview
The Capita Health Advisory team was engaged to help develop a viable transformation plan capable of returning the Trust to financial balance and meeting the assurance requirements of the foundation trust regulator, Monitor. Following completion of the Plan and acceptance by Monitor, the team worked with the Trust to establish and mobilise the subsequent Transformation Implementation Programme. We then supported the Trust to deliver a series of change projects aimed at delivering efficiency benefits worth £27.8 million over two years.
The hospital had experienced consistent demand-led growth over a number of years and operating costs had grown disproportionally leading the Trust to report a financial deficit of £6.2 million in 2010 / 11. Local commissioning intentions and changes to the national pricing framework had further increased the pressure to balance budgets whilst the Trust continued to maintain a responsive and flexible portfolio of clinical services.
In order to address these many pressures, the transformation plan and its implementation programme sought to;
- Return the Trust to financial balance and operating within its terms of authorisation
- Demonstrate effective stewardship of the resources; ensuring that services were affordable, efficient and sustainable
- Deliver clinical service performance targets in line with upper quartile peer group performance.
Our Approach
Working with the Trust’s transformation programme team, our approach and role was to work with the executive and medical leadership team, constructively challenging the status quo and providing clinical process change capability and implementation support.
Initially we focused on identifying the root causes of the operational issues experienced by the Hospital. Our team of clinical change experts engaged directly with medical and nursing teams delivering services to understand, challenge, and support the development of a clinically led operating model.
We undertook a series of reviews covering Unscheduled Care, Outpatients, Radiology, Pharmacy, Women’s and Children’s, Information Technology and Facilities Management. Our approach was based on an assessment and analysis of Trust data, which was then benchmarked against national best practice, peer performance, Royal College guidelines and our experience of other NHS organisations.
‘Project Briefs’ were developed which described the potential opportunities for service improvement and financial efficiencies. In this way a diversified and risk assessed profile of savings was built on a detailed knowledge of the hospital and its services.
In order to provide all stakeholders with a clear rationale and route-map for the change, a transformation plan was produced and robustly tested by the Trust Board and their external assurers. This formed the blueprint for the transformation programme.
The Capita Team then provided programme management support for the development of a robust governance framework to secure the clinical safety and practical delivery of the anticipated Plan benefits. Capita’s clinical subject matter experts built upon the relationships developed with clinical teams, by supporting major change initiatives such as reducing the hospital’s length of stay and in identifying opportunities to optimise medical staff rotas and ‘hospital at night’ working patterns.
Following the successful establishment and launch of the transformation programme, Capita was asked to support the planned changes and the delivery of the financial savings. We did this by fulfilling several key roles in the programme including programme management, running the Trust’s PMO and providing clinical change domain expertise.
What we delivered
- Working with the Trust’s project team, designed and implemented improvements in patient discharge and admission avoidance processes resulting in a 25% improvement in the Trust’s average length of stay. This contributed to improvements to the quality of patient care and a reduction in the bed base
- The provision of advice and recommendations to help optimise medical staffing rotas and a revised ‘hospital at night’ model, all designed to support medical staffing efficiencies and closer sub-speciality team working
- Delivered the programme management role for two clinical service improvement workstreams (11 projects in total) to support Trust project managers delivering planned efficiency savings of £5.7 million in 2011 / 12
- In support of the Trust’s Transformation Director, established the Programme Management Office (PMO) to provide the governance and co-ordination of 23 projects due to deliver £13.7 million of savings in 2011 / 12. This role included introducing standard operating procedures for all common PMO responsibilities such as risk management, change control and dependency management, and facilitating effective clinical risk assurance processes so the safety and standards of care where continually maintained
- Enhanced the internal capability of the Trust to manage large scale process change with a focus on executive relationship building and clinical engagement
Training and coaching for managers and teams in project management.
“Working with the Trust’s transformation programme, the Capita team worked tirelessly to support both the development of our transformation plan and the delivery of the transformation programme. I have found them to be trusted and reliable advisors, who bring with them a wealth of experience and practical skills. Their experience and advice around reducing length of stay has been particularly strong and they have engaged clinicians in a creative yet pragmatic manner helping to ensure buy in and the sustainability of the solutions delivered”.
Mark Millar – Interim Chief Executive
Back to case studies