Model Hospital challenge

About SSGHealth SSG is a specialist healthcare consultancy providing practical high payback solutions to NHS organisations in transition, transformation and turnaround. Our model hospital solutions were developed at the coalface of NHS change. Our specialists have many years experience working closely with management teams to deliver quality with economy. We are expert at facilitating changes to working practices. Our overriding objective as a practice is to work with hospitals and healthcare systems to deliver sustainable change that delivers real benefit for patients. SSG client partners and subject matter leads are acknowledged experts and trusted advisors to providers, health economies and regulators.

Model Hospital challenge At SSG, we like to talk in terms of the Model Hospital Challenge, the challenge encapsulated by Lord Carter s report Operational productivity and performance in English NHS acute hospitals (1) concerning unwarranted spend variation. The Model Hospital challenge sits at the heart of a wider effort to put each local health economy on a sustainable footing. Carter Productivity and Flow Challenge Free up resource to deliver patient care standards and cash savings Financial Challenge Breakdown = 10-15% Patient Pathway 95th centile Clinical staff cost per WAU ( ) Relative Spend 30% Median = 1,524 Clinical Non Clinical 5th centile Trusts in order of clinical staff cost per WAU STP Service Redesign Balancing Quality with Economy Income Enhancement The NHS is expected to deliver efficiencies of 2-3% per year, effectively setting a 10-15% real terms cost reduction target for achievement by April 2021. We have summarised the path to model hospital achievement overleaf, which starts with the Carter productivity savings. 1. Lord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. London; 2016.

Frontline productivity and flow improvement addressing unwarranted variation Hospitals are complex, management rigours can vary specialty to specialty. The source of spend variation, however, is well understood: WORKFORCE PLANNING AND FLEX ABSENCE REDUCTION Ensuring the right skill and resource is deployed to match patient demand ADMISSION AVOIDANCE Maximising staff availability Sickness Management Avoiding time devoted to patients better served elsewhere Education & Training REDUCED CANCELLATIONS REDUCED LOS & CAPACITY BOTTLENECKS Clinical staff cost per WAU ( ) Avoiding unnecessary waits 95th centile 30% Avoiding time lost to wholly cancelled sessions and individual DNAs Median = 1,524 5th centile Trusts in order of clinical staff cost per WAU SEAMLESS PATIENT ADMINISTRATION Eliminate labour intensive processes PERFORMANCE MANAGEMENT Addressing the tail and supporting change leaders LIST FILL OPTIMISATION Maximising every clinic, theatre and diagnostic session The financial bridge the 10-15% efficiency breakdown The efficiency challenge can be met by a combination of unwarranted variation elimination; tactical bottom up savings that we would describe as day to day grip ; and longer term strategic savings arising from service reconfiguration: ADDRESSING UNWARRANTED VARIATION Productivity gains capable of delivering patient care The Model Hospital: Addressing the Operational & Financial Challenges standards and cash savings Front line productivity and flow addressing unwarranted variation WORKFORCE PLANNING AND FLEX ABSENCE REDUCTION Ensuring the right skill and resource is deployed to match patient demand Sickness Management Streamlining functions to ensure that their primary focus is supporting safe operational delivery cost effectively COST IMPROVEMENT PROGRAMMES Creating a pipeline of CIP initiatives aligned to strategic requirements ADMISSION AVOIDANCE Maximising staff availability Avoiding time devoted to patients better served elsewhere Education & Training REDUCED CANCELLATIONS Clinical staff cost per WAU ( ) REDUCED LOS & CAPACITY BOTTLENECKS Avoiding unnecessary waits FIT FOR PURPOSE HQ & SUPPORT SERVICES 95th centile 30% Avoiding time lost to wholly cancelled sessions and individual DNAs Median = 1,524 5th centile Trusts in order of clinical staff cost per WAU SEAMLESS PATIENT ADMINISTRATION Eliminate labour intensive processes PERFORMANCE MANAGEMENT Addressing the tail and supporting change leaders LIST FILL OPTIMISATION Maximising every clinic, theatre and diagnostic session 2

NursePlan Optimised Staffing Minimal Agency Model Hospital solutions Lord Carter s report Operational productivity and performance in English NHS acute hospitals (1) highlighted that some hospitals were spending 1.5 times as much as others on nurses. Although erostering is widespread, Carter reports that roster management and design remains an issue. The National Quality Board ( NQB ) has refreshed its safe staffing guidance and stresses the need for workforce efficiency, including matching work patterns to patient need, and reduced dependency on agency staff. Capacity 1 2 How many hours are available for rosters? Are the contracted hours being rostered? Demand How do I best fit need within a sustainable staffing envelope? 4 3 Where and when do I deploy my nursing hours to meet patient flow requirements? Where does your organisation sit? SSG has developed a solution called NursePlan which aligns your available nursing and HCA workforce with patient flow and acuity needs across inpatient and outpatient settings. It is the only solution that facilitates a minimal dependence on agency, by robustly applying NQB and Shelford Group rostering principals to achieve patient focused and cost effective deployment An eroster tool will tell you how many hours are still left to roster, the most sophisticated will seek regular acuity inputs to support day to day staff redeployment, none will tell you how to best set rosters in the first instance to optimise patient flow using your sustainable core workforce. The NursePlan approach provides the evidence and focus to eliminate unnecessary spend on agency or other high cost temporary staffing. (1) Lord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. London; 2016.

NursePlan can be implemented in a short timeframe 1-6 By week 12 By week 18 Site visit: process review with key players (chosen areas)/ info requests clarified Share productive staff hours available to each patient group from a sustainable substantive and bank workforce, after deduction of validated planned (leave, training supervision) and unplanned (sickness, maternity/paternity) absence requirements - obtain sign off on numbers Share patient demand and acuity forecast needs by patient group - obtain sign off on numbers Facilitated allocation of productive hours to demand/acuity needs by patient group across areas/cost centres Validation and full costed WTE establishment set - including before and after payback Facilitated sessions with budget holders/area leads to make most of allocated care hours Post implementation review, repeat process for other areas as required It is far cheaper than a software installation, for NHS organisations with a high dependency on agency staffing we are happy to rollout NursePlan on a no payback no fee basis. For an online demonstration and client references please visit our website or otherwise contact: Rob Stafford, Client Partner E: rob.stafford@ssghealth.com M: 07703 537953 T: 0207 933 8699 www.ssghealth.com

BedPlan effective flow planning Model Hospital solutions The National Audit Office has suggested Trusts with average bed occupancy levels above 85% can expect to have regular bed shortages, periodic bed crises and increased infection rates. A recent briefing prepared by the Nuffield Trust, estimated if admission rates continue to increase, the growing and ageing population alone means that the NHS will need at least an additional 6.2 million bed days by 2022. This is equivalent to approximately 17,000 beds, which equates to about 22 hospitals with 800 beds each. Capacity Demand 1 2 The number of available beds through the year is clear Bed capacity is proactively managed to preserve flow and elective needs Bed usage by type is tracked versus plan 4 3 Bed demand/ patient flow needs are known Where does your organisation sit? SSG s BedPlan tool aligns your bed capacity with patient demand needs and it provides essential scenario testing to plan winter and/or service changes. It is an easy to implement tool that rapidly enhances a hospital s flow management capability once embedded Bed planning tools are typically either designed by health sector modellers to answer one off reconfiguration questions or designed in house by Trusts with insufficent rigour or sophistication to effectively identify and mitigate bed capacity alignment issues.

BedPlan can be implemented in a short timeframe across patient areas and sites Site visit, process review with key staff and information requests Process information offsite, revisit if necessary to secure solid data Workshop 1 - validate base case Adjust model to reflect workshop modifications Agree and develop scenarios Workshop 2 - validate scenarios Handover model and scenario report Complete super-user training 1-2 3-4 5-6 We tailor our approach according to individual Trust needs. At the most basic level we provide a blank copy of the tool and guidance to Trust informatics staff. In most cases, clients prefer a more hands on approach. We typically provide support to populate the model and operationally validate the outputs through a series of interactive sessions with clinicians and operational staff. BedPlan dashboard For an online demonstration and client references please visit our website or otherwise contact: James Shillito, Client Partner E: james.shillito@ssghealth.com M: 07900 822044 T: 0207 933 8699 www.ssghealth.com

DocPlan optimised medical staffing Model Hospital solutions Lord Carter s report Operational productivity and performance in English NHS acute hospitals (1) highlighted that some hospitals were spending 1.6 times as much as others on medics, with specialty by specialty variation greater still. Lord Carter found that some trusts do very little effective job planning, with only half of job plans up to date in the first instance. Approximately 50% of Trusts do attempt to align some job plans with sessional productivity measures on an annualised basis, no Trust surveyed aligned all job plans. This means none have truly established the correct medical workforce required to match patient demand. Capacity Demand 1 2 The number of contracted PA s is clear Sessional productivity is actively managed to meet patient demand Contracted PA s are tracked as delivered 4 3 Patient demand/flow PA needs are known Where does your organisation sit? SSG s DocPlan aligns your consultant and SAS medic workforce with patient demand needs and provides the essential dashboard to monitor sessional productivity doctor by doctor. It is the only solution that facilitates the week by week patient demand alignment to eliminate unnecessary spend on locum, agency or extra sessional payments Job planning tools identify how many PA s have been contracted, sophisticated ones link with medic rotas to report when PA s took place, none will highlight how many PA s are required to cost effectively deliver patient flow and Trust activity plans. (1) Lord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. London; 2016.

DocPlan can be implemented in a short timeframe specialty by specialty 1-6 By week 12 By week 18 Site visit, process review with staff and information requests Medics Dashboard build commenced Specialty job plan capacity confirmed Efficiency assumptions and activity plans agreed with specialties Medical workforce establishment needs agreed Medics Dashboard - can now track to plan Medics Dashboard embedded in performance management routines Post implementation review, repeat process for other specialties as required It utilises your in-house teams and reporting platforms. Medic planning and management capability is thus enhanced to both sustain benefit realisation and keep the cost down to a fraction of a software house installation project. For an online demonstration and client references please visit our website or otherwise contact: Rob Stafford, Client Partner E: rob.stafford@ssghealth.com M: 07703 537953 T: 0207 933 8699 www.ssghealth.com

ATOM optimised list fill Model Hospital solutions NHS theatre benchmarking 1 shows that procedures per theatre session vary enormously when comparing the same surgical specialty across hospitals. In our experience, this is true even if the hospitals compared are close peers. A major factor driving variation is list fill practice. Alturos Theatre Optimisation Method ( ATOM ) is an approach developed with leading NHS acute trusts, such as Sheffield Teaching Hospitals, that has consistently delivered 10%+ improvement in list fill whilst simultaneously reducing the frequency of list overruns. At its core is a sophisticated algorithm, that when applied to surgeon specific theatre data, guides theatre schedulers to uniformly optimise list fill, rather than take an educated guess or rely on past fill behaviour. A = half an hour B = consultant tells me C = 2 slots ATOM predicted an increase of around 10% utilisation, although some members of the team were sceptical this is what we got, now the whole organisation is using the method in their clinical service Efforts to improve Theatre efficiency, centred just on start times and turnaround speed between cases, will not increase revenue per list without simultaneously taking control of the list fill process. This process is often dissipated across central functions, devolved booking teams, and medical secretaries. Success requires staff coaching and the support of surgeons. We have facilitated many Trusts to make the jump to scientific, evidenced based, list fill. (1) NHS Benchmarking Network: Benchmarking Operating Theatres Report from 2014/15 work programme, May 2015.

ATOM can be implemented in a short timeframe specialty by specialty 1-2 3-4 5-6 Site visit, process review with staff and information requests Process information offsite, revisit if necessary to secure solid data Workshop 1 - initiate pilot fill Monitor and adjust for local nuances Workshop 2 - pilot review Complete super-user training We coach your staff to deploy the ATOM algorithm surgeon by surgeon. Implementation payback is very quick, major specialties have seen costs covered in a week. Our improvement experts have gone on to help Trusts reschedule their entire theatre timetable in order to free up capacity, which has delivered improved RTT performance without additional lists and for one Trust enabled it to cope with the unexpected loss of two theatres without the new build cost. Timetable before (blurred at client request for data protection purposes) Timetable after For an online demonstration and client references please visit our website or otherwise contact: Rob Stafford, Client Partner E: rob.stafford@ssghealth.com M: 07703 537953 T: 0207 933 8699 www.ssghealth.com

Hothousing accelerated delivery Model Hospital solutions Hospitals are experiencing severe flow pressure, demand and acuity is increasing, bed numbers across health economies have steadily reduced. Length of stay reduction provided the counterbalance for a while, but in recent years bed occupancy has increased. As beds become more scarce the flow of patients becomes interrupted, patients back. A lack of beds can be a cause of elective cancellations or costly short notice extra bed provision. NHS bed utilisation studies indicate that for around one half of emergency bed days, an alternative setting - including home with medical services, home or a nursing home - would be more appropriate for the patient. Trust senior management commonly tell us that about one third of inpatients are waiting for something and another third shouldn t be there. There is a well established link between mortality and long waits in A&E. Equally, in the mental health sector out of area placements represent poor care, not least a greater dislocation from a patient's support network. Yet health professionals have many of the solutions... if our phlebotomists took bloods early, if these were then rushed to the labs, we could have the results in time for ward rounds, instead of the next day. Mental health professionals tell us that they have a lot of potential control over discharges and admissions, they know that at the end of the week and weekends they will have greater pressure to admit as an emergency. So why do these situations persist? Too much fire fighting? Too few opportunities to come together across professional and organisational boundaries? Bring together the right people Stimulate them with insight and user friendly information to find creative solutions Use physical and digital collaboration methods to maximise participation across time constrained and physically separated healthcare professionals Supported by skilled facilitators and subject matter experts able to practically help collaboration succeed whilst preserving a clear focus on securing a high value outcome A rapid collaborative design process creates excitement, generates buy in, and will facilitate the step change that is increasing required to deliver high quality healthcare with constrained resources Expert design facilitation and data discipline is essential. Data must be gathered, analysed and interpreted to provide the hothouse group with real insights into the root cause of problems. The facilitator needs to be able to confidently introduce best practice when the situation demands to accelerate solution design. This entails having the right external expertise in the room.

Hothousing has distinct phases, a typical deployment looks like this: 1-2 3-4 5-8 Site visit, process review with staff and information requests Process information offsite, revisit if necessary to secure solid data Establish hothouse timetable and key dates Launch project hub Multidisciplinary teams working together on scope Hothouse session design complete Hothouse session with key players Immediately process solutions to preserve momentum Enter delivery phase, maintain engagement via project hub Hothousing is by its nature intense in order to steer time constrained participants rapidly towards solutions. In all cases the key output is an actionable and owned delivery plan, which will take your organisaton forwards. Establishing a project hub is a useful tool to increase participation and visibility, people more than buy in to what they create. Ideal Care Safety Reliability Patient Flow For client references and to arrange a demonstration please visit our website or otherwise contact: Rob Stafford, Client Partner E: rob.stafford@ssghealth.com M: 07703 537953 T: 0207 933 8699 www.ssghealth.com