Balancing act: supporting finance leaders to deliver on short- and long-term priorities 21
Case study two: Gloucestershire Hospitals – improving the flow foundations
Overview of scheme/programme
Gloucestershire Hospitals NHS Foundation Trust has made significant improvements in ward patient flow and the efficiency of staffing models within these wards. In 2022 the hospital was running at up to 105% occupancy, at times up to 200 people boarding and around 50 people waiting for admission in the emergency department (ED). The improvement in length of stay and efficiency throughout the ward base focused on three components: 1. A joint programme with system partners based on Working as one , which has improved the front door and complex discharge interfaces by trialling new ways of working including better board rounds and a new integrated flow hub and then embedding the changes to drive improved length of stay. 2. Engaging staff on the wards with the challenges in patient care and improving flow – including clinicians developing their clinical vision of flow model and building ward-to-board visibility of length of stay and next step blockers. 3. Increased grip on ED staffing plans, and ward rotas and staffing templates – engaging wards on their staffing requirements, holding them to account on their plans and using performance accountability frameworks to support this grip across both performance and cost. Emergency length of stay has reduced by 21% and emergency bed occupancy by 10%, with boarding now below 30 and ED queues halved.
Summary: what is the specific outcome/ improvement area that this scheme sought to tackle?
Acute to community.
Which of the ‘Darzi shifts’ does this relate to?
Gloucestershire Hospitals NHS Foundation Trust (GHFT), Gloucestershire Integrated Care Board, Gloucestershire Health & Care NHS Foundation Trust (GHC), Gloucestershire County Council.
Key organisations/system partners involved
GHFT
Lead organisation
A combination of system improvement programme with external partners (system funded) and internal business as usual improvement through existing operational teams. The actual changes made did not require significant funding, but the transformation capacity did. Working as one has had separate system governance which is now transitioning into business-as-usual system governance around UEC improvement. Clinical vision of flow elements were managed through GHFT internal transformation and performance governance, and the grip on staffing achieved through collaboration between business-as-usual finance support and divisions.
How was the programme funded?
Programme governance
Making the case and getting started
A system diagnostic in 2022 supported the case for improvement in the front door model and on emergency length of stay. This supported a wider push within GHFT around performance improvement targets and a desire to really engage staff in the challenges faced. The negative impacts on patient outcomes and experience, and the impact on system finances that were caused by delays and productivity challenges. System working – agreeing collaborative models in, for example, the integrated flow hub, needed senior leadership direction and intervention. Staff engagement – starting from a challenging point given the pressures in 2022, significant focus has gone into engaging and supporting staff through the changes. Clarity and ownership of the problem – Built internal visibility through the GHFT BI Team that supported the ward-to-board ownership of length of stay and the delays which could be tackled.
How did you make the case to take this scheme forward? What created the main impetus/momentum to take it forward? What challenges did you encounter in getting things off the ground and how did you overcome them?
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